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Modifiable Factor: Diet Stress Bile Reflux

Non-Modifiable Factor: Age (75 y/o) Gender (Female)

Irritation of gastric mucosa

Disruption of mucosal barrier

Gastric acid comes in contact with the gastric tissue

Gastric Irritation/Inflammation; epithelial damages

Melena low Hgb

GI Bleeding

Weakening of LES

Bile and bile acid may reflux into the stomach

Sour taste

Too much stomach acid in the esophagus

Esophagitis

Definition of the disease

Acute gastritis is often caused by dietary indiscretion- the process the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis or obstruction. Acute gastritis may also developin acute illnesses, especially when the patient has had major traumatic injuries; burns; severe infection; hepatic, renal, or respiratory failure; or major surgery. Gastritis may be the first sign of an acute systemic infection. Chronic gastritis and prolonged inflammation of the stomach may be caused either by benign or malignant ulcers of the stomach or by the bacteria Helicobacter pylori (H. pylori). Chronic gastritis is sometimes associated with autoimmune diseases such as pernicious anemia; dietary factors such as caffeine; the use of medications such as NSAIDs, biphosphonate (eg, alendronate (Fosamax), or risedronate (Actonel)); alcohol; smoking; or chronic reflux of pancreatic secretions and bile into the stomach.

Modifiable Risk Factors 1. Diet Gastritis is often caused by dietary indiscretion- the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganism 2. Overuse of Aspirin & NSAIDs Each year, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths. More people die each year from NSAIDs-related complications than from AIDS and cervical cancer in the United States. (American Gastroenterological Association. "Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage."ScienceDaily, 11 Jan. 2005. Web. 9 Nov. 2011)

3. Ingestion of strong acid/alkali A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate
4. Bile Reflux Together bile and acid reflux can have serious consequences, inflaming the lining of esophagus and potentially increasing the risk of esophageal cancer. Bile reflux also affects stomach, where it can cause further inflammation. 5. Radiation Therapy Chemical or reactive gastritis is caused by injury of the gastric mucosa by reflux of bile and pancreatic secretions into the stomach, but it can also be caused by exogenous substances, including NSAIDs, acetylsalicylic acid, chemotherapeutic agents

7. Infection Infectious gastritis is caused by the Helicobacter pylori bacterium also known as H. pylori. H. pylori attacks the stomach lining and causes ulcers and inflammation. The H. pylori bacterium is passed from person to person through contact with infected saliva or unsanitary conditions. Untreated water also may contain H. plylori. The bacterium passes through to the stomach where it can remain and grow.

11. Stress "Stress" gastritis most typically refers to physiologic gastritis, most commonly seen in intensive care units or post-surgical environments. Stress increases stomach acid and slow down the digestive process. Stress, worry, grief and prolonged tension or clinical depression in general can eventually lead to dizziness after eating.
12. Smoking Smoking increase stomach acid, delays stomach healing and is a leading risk factor for stomach cancer

13. Excessive Alcohol Intake Upper gastronintestinal diseases, particularly gastritis, ulcer, and cancer, have often and long been blamed on drinking alcohol. For acute gastritis, inflammation of the stomach lining, this is an accepted truth for those who drink large quantities quickly (binge drinking) of highstrength potables, spirits. Chronic gastritis may have an entirely different cause, as we shall see. Chronic alcohol abuse increases the risks of esophageal and, perhaps, stomach cancer.

Non-Modifiable Factors

1. Age Aging causes degeneration of the stomach lining. Elderly people get this as the stomach wall tends to become thin with aging. In the United States, H pylori infection affects approximately 20% of persons younger than 40 years and 50% of those older than 60 years. 2. Race An estimated 50% of the world population is infected with H pylori; therefore, chronic gastritis is extremely frequent. H pylori infection is highly prevalent in Asia and in developing countries, and multifocal atrophic gastritis and gastric adenocarcinomas are more prevalent in these areas 3. Gender No sexual predilection exists.

Signs and Symptoms

Melena Melena is the passage of black, tarry stool. It is the most common presenting symptom of major gastrointestinal hemorrhage
Anemia Pernicious anemia is a chronic illness caused by impaired absorption of vitamin B-12 because of a lack of intrinsic factor (IF) in gastric secretions. It occurs as a relatively common adult form of anemia that is associated with gastric atrophy Heart Burn Heartburn is a common form of gastric hyperacidity, causing burning sensation in the esophagus, or below the sternum in the heart region. It is one of the most common symptoms of indigestion. The etiology of heartburn may be explained as the result of regurgitation of partial food contents from the stomach back into the esophagus, carrying excessive acidity (hydrochloric acid) secreted by the stomach. Due to its acidity, this irritates the esophagus and produces discomfort or pain with a burning sensation. Nausea and Vomiting Nausea is a vague, intensely unsettling sensation of sickness or queasiness that may or may not be followed by vomiting. the emesis, or vomitus may vary in color and content and may contain undigested food particles, blood, or bilious material mixed with gastric juices

Epigastric Pain Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs. Often, those who experience this type of pain feel it during or right after eating or if they lie down too soon after eating Body Weakness Weakness is a lack of physical or muscle strength and the feeling that extra effort is required to move your arms, legs, or other muscles. If muscle weakness is the result of pain, the person may be able to make muscles work, but it will hurt. Anorexia Anorexia is the symptom of loss of appetite whatever the cause may be Belching The accumulation of gas in the GI tract may result in belching (expulsion of gas from the stomach through the mouth). Patients often complain of bloating, distention, or feeling of full of gas with excessive flatulence as a symptom of food intolerance

Hiccupping Hiccups are caused by spasmodic involuntary contraction of the diaphragm that results in the uncontrolled breathing in of air. The peculiar noise of hiccups is produced by the beginning of an inspiration that is suddenly checked by the closure of the glottis. Hiccups usually stop after a few minutes, but may become serious if they persist for a long time.

Intolerance to Food Sensitivity to certain foods, or food intolerance, is the inability to properly digest or fully process certain foods. A common consequence is damage to stomach and intestine Dyspepsia Dyspepsia, is the most common symptom of patient with GI dysfunction. Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms. Typically, fatty foods cause the most discomfort because they remain in the stomach for digestion longer than proteins or carbohydrates Feeling of Abdominal Fullness The abdominal pain with fullness and pressure is the result of excessive gas and bloating in the digestive system.

Secretions of the Stomach The stomach functions primarily as a storage and mixing chamber for ingested food. As food enters the stomach, it is mixed with stomach secretions to become a semifluid mixture called chyme. Although some digestion and a small amount of absorption occur in the stomach, they are not its principal functions. Stomach secretions from the gastric glands include mucus, hydrochloric acid, pepsinogen, intrinsic factor, and gastrin. A thick layer of mucus lubricates and protects the epithelial cells of the stomach wall from the damaging effect of the acidic chyme and pepsin. Irritation of the stomach mucosa stimulates the secretion of a greater volume of mucus. Hydrochloric acid produces pH of about 2.0 in the stomach. Pepsinogen is converted by hydrochloric acid to the active enzyme pepsin. Pepsin breaks covalent bonds of proteins to form smaller peptide chains. Pepsin exhibits optimum enzymatic activity at a pH of about 2.0. The low pH also kills microorganisms. Intrinsic factor binds with vitamin B12 and makes it more readily absorbed in the small intestine. Vitamin B12 is important in deoxyribonucleic acid (DNA) synthesis and is important to red blood cell production. Gastrin is a hormone that helps regulate stomach secretions.

Regulation of Stomach Secretions Approximately 2L of gastric secretions (gastric juice) is produced each day. Both nervous and hormonal mechanisms regulate gastric secretions. The neural mechanisms involve central nervous system (CNS) reflexes integrated within the medulla oblongata. Higher brain centers can influence these reflexes. Local reflexes are integrated within the enteric plexus in the wall of the digestive tract and do not involve the CNS. Hormones produced by the stomach and intestine help regulate stomach secretions. Regulation of stomach secretions can be divided into three phases: the cephalic, gastric, and intestinal phases.

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