BIT INTERNATIONAL COLLEGE COLLEGE OF NURSING

Gastric Mucosa Erosion

A case presentation Presented to the faculty of the BIT INTERNATIONAL COLLEGE - College of Nursing Presented by: JOHN MICHAEL PITOY GERALDINE LUCIP GREMARIE ARADO GRETCHEN ELIZABETH IMBAT JEFREY CALAPINE

INTRODUCTION Abdominal trauma is any event which causes serious injury to the abdomen. The trauma may be so significant that multiple abdominal organs may be damaged. Most abdominal traumas are categorized as being either a penetrating or blunt injury. In any event, this is a very serious situation and the person who has suffered the trauma should get medical attention as soon as possible. There are many ways a person may suffer an abdominal injury, with some of the most common ways being an accident or an assault.

EPIDEMIOLOGY The abdomen is the third most commonly injured region of the body and the trauma of the abdomen occurs in 20% of the civilian injuries requiring surgical intervention. In the urban trauma center approximately the 25% of the injury are represented by the stab wounds (in the USA trauma center 35% gunshot wounds) and 10% are the blunt abdominal trauma. In the rural area the percentage shows a 17% of stab wounds, 14% gunshot and the remaining lesions are due to the blunt trauma. A large part of the blunt abdominal trauma (some series report 60%) are caused by motor vehicle accident; in the last few years the use of the life-belt has leads to a prevention of such lesions.

RATIONALE

The Level III Student-Nurses of the BIT- International College, College of Nursing are conducting this case study directed for better understanding of the nature and pathophysiology and to apply theoretical knowledge in handling patients with Abdominal trauma secondary to perforated hollow viscus.

The study was achieved thru the exposure of Level-III Student-Nurses at Governor Celestino Gallares Memorial Hospital, Operating Room at City of Tagbilaran, Bohol.

I. ASSESSMENT

A. Data Base Patients Initials Age Sex Status Religion Address Admitting Doctor Admitting Diagnosis Admission Date Admission Time Hospital : L.C.B. : 51 years old : Male : Single : Roman-Catholic : Calayugan Norte, Loon, Bohol 6327 : Dr. Florence Cepedoza : Acute Abdominal Problem Secondary to Perforated Hollow Viscus : May 21, 2011 : 10:15 p.m. : Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines

B. Social History Patient L.B. describes himself as loving father of two, friendly and has circle of associates at his town. He loves to drink native wine with his neighbors and associates. He also mentioned of being active in the church activities and gatherings during Sundays.

C. Chief Complaints Abdominal pain

D. History of Present Illness Patient L.B. has been having on and off epigastric pain. Six (6) weeks prior to admission (PTA), Patient L.B. had resumed epigastric pain also with vomiting.

E. Family History HPN (+) UTI (+) F. Food Allergies Patient mentioned of no known allergies to any foods or drugs. DM (-) HPB(-)

G. Condition on Admission Blood Pressure Pulse Rate : 140/90 mmHg : 82 bpm

Respiratory Rate : 24 cpm Temperature : 37.3 C

H. Admitting/Current/Ruled-in Medical Diagnosis Acute Abdominal Problem Secondary to Perforated Hollow Viscus

II. LABORATORY AND DIAGNOSTIC RESULTS 05/22/11 COMPLETE BLOOD COUNT Name of lab./ Diagnostic exam WBC- White blood cell RBC- Red Blood Cell Hgb-Hemoglobin Patients Results 8.1 K/uL 2.85 L M/uL 8.5 L g/dL Normal values 4.0-11.0 4.50-6.50 13.0-18.0 Decreased in Red Blood Cell indicates bleeding, anemia. Decreased Hemoglobin indicates depleted blood oxygen-carrying capability. Decreased in indicates anemia. Hematocrit Significance

Hct- Hematocrit MCVMean Volume Corpuscular

26.3 L % 92 fL 29.6 Pg 32.2 g/dL 13.6 % 376 k/uL

40.0-54.0 76-96 26.0-32.0 30.0-35.0 11.5-14.5 150-400

MCH- Mean Corpuscular MCHC- Mean Corpuscular RDW Plt- Platelet Count

05/22/11 DIFERENTIAL COUNT Name of lab./ Diagnostic exam Neutrophil Lymphocyte Patients Results 79 H 11 L Normal values 40-75 20-45 Significance Increased level of neutrophil count indicates stress. Decreased level of lymphocyte count indicates infection especially H- pylori.

Monocyte Eosinophil Basophil

6 4 0 CHEMISTRY

0-10 0-6 0-1

Name of lab./ Diagnostic exam Sodium Potassium Creatinine

Patients Results 134.2 mmol/L 3.15 mmol/L 378.4 mmol/L

Normal values 135-155 3.6-5.5 53-97

Significance

Increased level of creatinine count indicates increased level in blood pressure, and or the body declines to function properly especially the kidneys.

III.

ANATOMY AND PHYSIOLOGY:

An organ with an abnormal opening often is referred to as a perforated viscus. Viscus technically means a hollow organ found inside the body. The term viscus is a singular form, often used in referring to only one organ involved. Its plural term, viscera, generally is used to denote the involvement of many organs. Hollow organs often have several layers of cells in their walls in order to hold materials inside. A hollow viscus perforation can occur in many instances. Blunt abdominal trauma such as those that often happen in road accidents can lead to the perforation of the spleen and other organs. Penetrating abdominal trauma often can reach important organs like the intestines and stomach as seen in those caused by gunshots and stab wounds. Infections sometimes can lead to viscus perforation such as those that occur in a ruptured appendix, ruptured gallbladder, and as a complication of typhoid fever. Perforated viscus symptoms generally range from moderate to severe manifestations. They mostly include fever, low blood pressure, fast heart rate, abdominal pain, nausea, vomiting, and abdominal distention. Patients mostly are in severe pain with their abdomen feeling rigid or board-like when touched. When prompt treatment for a perforated viscus is not given, patients often develop complications that can be life-threatening. Open surgery generally is the standard management for a perforated viscus. Exploratory laparotomy was performed and it revealed a gastric mucosa erosion thus, surgeon decided to do vagotomy.

IV-A PATHOPHYSIOLOGY The most common cause of this form of gastric mucosa erosion is the use of NSAIDs. Other causes may be alcoholism or stress from surgery or critical illness. The role of NSAIDs in development of gastritis and peptic ulcers depends on the dose level. Although even low doses of aspirin or other non-steroidal anti-inflammatory drugs may cause some gastric upset, low doses generally will not lead to gastritis. However, as many as 1030% of patients on higher and more frequent doses of NSAIDs, such as those with chronic arthritis, may develop gastric ulcers. Patients with H. pylori already present in the stomach who are treated with NSAIDs are much more susceptible to ulcers and other gastrointestinal effects of these pain killers. Patients with erosive gastritis may also show no symptoms. When symptoms do occur, they may include anorexia nervosa, gastric pain, nausea, and vomiting. Gastric Erosion is a minor ulceration of the gastric mucosa. A localized inflammation or minor ulceration of the stomach lining. Gastric erosion is a slight break (or "ulceration") in the innermost layer (called "mucosa") of the stomach's lining. If an ulceration extends deeper than this layer, it is called a gastric ulcer. Gastrosplenic fistula resulting from erosion of a primary splenic lymphoma is a rare cause of massive upper gastrointestinal hemorrhage associated with benign peptic ulcer disease, gastric Crohn's disease, gastric adenocarcinoma, and primary gastric and splenic lymphomas. It is concluded from these results that IL-1 acts mainly in the central nervous system to inhibit the occurrence of stress-induced gastric erosion and that the IL-1 beta-induced inhibition of gastric erosion is mediated by prostaglandin in a manner that is independent of brain CRF. See also duodenal ulcer , which is a break in the normal tissue lining the duodenum (the first part of the small bowel).

The common Causes of Gastric Erosion :

Drugs like aspirin and steroid. cortisone drugs (steroids) used to treat asthma, Addison's disease or other conditions; Benign gastric ulcers are caused by an imbalance between the secretion of acid and an enzyme called pepsin and the defenses of the stomach mucosal lining. This leads to inflammation and may be precipitated by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs) such as ibruprofen.

Symptoms of Gastric Erosion

Stomach bleeding Blood in stools or black, tarry stools Anemia Weight loss Fatigue Black stool Nasea Abdominal indigestion Blood in stools or black, tarry stools

Treatment of Gastric Erosion

Multiple regimens are effective and usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics. Surgical intervention may be recommended for people who do not respond to medical therapy or to endoscopic therapy for bleeding. However, combined treatment with estrogen and lithium, significantly decreased the severity of gastric erosions in intact but not in ovariectomized rats and this was associated with a significant increase in the endogenous histamine content of the gastric mucosa. Avoiding smoking Avoiding tea, coffee , and soft drinks containing caffeine

ILLUSTRATION

Illustration of the abdomen

IV-B PATHOPHYSIOLOGY: Gastric mucosal erosion- is a minor ulceration of the gastric mucosa, brought by an abdominal trauma or problems, and or hollow viscus.

CAUSE H. pylori Alcoholism

SYMPTOMS

DIAGNOSIS Laboratory studies of blood test for anemia X-rays of the upper digestive tract

Stomach bleeding Blood in stools or black, tarry stools Anemia Weight loss Fatigue Black stool Nausea Abdominal indigestion Blood in stools or black, tarry stools

TREATMENT Multiple regimens are effective and usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics. Surgical intervention may be recommended for people who do not respond to medical therapy or to endoscopic therapy for bleeding.

COMPLICATIONS Bleeding Anemia

PREVENTION Avoiding smoking Avoiding tea, coffee , and soft drinks containing caffeine

Avoiding smoking Avoiding tea, coffee , and soft drinks containing caffeine