ICD 10.

0: K29 Condition/Disease: Gastritis Description: Dyspepsia: Continuous or recurrent upper abdominal pain or discomfort with or without associated symptom (nausea, bloating, regurgitation,etc) Gastritis: Inflammatory changes in the gastric mucosa Peptic ulcer disease: Chronic illness manifested by recurrent ulceration in the stomach and proximal duodenum. Epidemiology: Complications of gastritis include PUD (Peptic ulcer disease) and, rarely, extensive bleeding. PUD accounts for more than 50% of all causes of upper gastrointestinal bleeds in the United States. Approx 10% of US population older than 17 years have peptic ulcer at some time Frequency of PUD is decreasing in the developed world but increasing in developing countries The prevalence of dyspepsia is 25 to 30 percent in the US Male-to-female ratio of gastritis is approximately 1:1 Male-to-female ratio of PUD is approximately 2:1 The mortality rate is low. Sign and symptom: Symptom: Typically present with abdominal pain that has the following characteristics: o Epigastric to left upper quadrant o Frequently described as burning o May radiate to the back o Usually occurs 1-5 hours after meals o May be relieved by food, antacids (duodenal), or vomiting (gastric) o Typically follows a daily pattern specific to patient (episodic and chronic) Bloating, indigestion, eructation, flatulence, and heartburn Anorexia, nausea/vomiting Gastritis may present as bleeding, which is more likely in elderly patients. Sign: Epigastric tenderness is present and usually mild. Dehydration, tachycardia, and electrolyte disturbance (With vomiting) Bowel sounds are normal. Hematemesis melena, pallor, and sign of volume depletion (Hemorrhagic gastritis) Signs of peritonitis or GI bleeding may be manifest. Perform a rectal examination Alarm feature: - Age older than 45-50 years - Weight loss - Dysphagia

Long history of symptom Anemia Persistent anorexia Early satiety Persistent vomiting Gastrointestinal bleeding

Specific diagnostic: - Upper gastrointestinal barium contrast radiography - Endoscopy of upper gastrintestinal tract - H Pylori test (IgG serology, urea breath test, fecal antigent test, rapid urea test) Disposition: - Outpatient - Inpatient : o Acute hemorrhagic or erosive gastritis that present with upper GI tract bleeding, tachycardia and hypotension o Uncontrolled pain or vomiting o Coagulopathy from medication or liver disease Management and tretment: - Diet: Avoid iritating food - IVFD: o Fluid resuscitation on Acute hemorrhagic gastritis o Blood transfusion if low hematocrite - Diagnostic: o CBC, BUN, Creatinin serum, Electrolyte (If suspected GI Bleeding) o Amylase, Lipase for pancreatitis o Urinalysis, asses dehydration o ECG, in elderly patient `Medication: 1. Proton pump inhibitor (PPI), ex: Esomeprazole, 20-40 mg PO qd 2. H2-receptor antagonist (H2RA), ex: Ranitidine 150 mg PO bid or 300 mg PO qhs; not to exceed 300 mg/d, or 50 mg/dose IM/IV q6-8h 3. Antacids (2-4 tsp PO qid prn) or a GI cocktail (30ml antacid + 10-20ml viscous lidocaine) 4. Sucralfate: 1gr, PO, QID 5. In chronic gastritis (Treatment of H Pylori infection): Omeprezole 20mg or lansoprazole 30mg + Clarithromycine 500mg + Amoxycillin 1gr, all taken BID - Monitoring: Sign and symptom When to refer: (Gastroenterologist or Surgeon) - If there is alarm sign - When there is complication (Malignancy, Hemorrhage, Perforation, Obstruction) Recommendation: - Patients should be warned of known or potentially injurious drugs and agents (NSAIDs, Aspirin, Alcohol, Caffeine (eg, coffee, tea, colas))

Refference: Five minutes emergency, Tintinally, eMedicine (Philip Shayne, MD)