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BIT INTERNATIONAL COLLEGECOLLEGE OF NURSING

Gastric Mucosa Erosion

A case presentation

Presented to the faculty of the BITINTERNATIONAL COLLEGE - College of Nursing

Presented by:JOHN MICHAEL PITOYGERALDINE LUCIP

GREMARIE ARADOGRETCHEN ELIZABETH IMBATJEFREY CALAPINE


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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.
http://www.wisegeek.com/what-is-a-trauma.htmhttp://www.wisegeek.com/what-is-the-abdomen.htmhttp://www.wisegeek.com/what-are-abdominal-organs.htmhttp://www.wisegeek.com/what-are-abdominal-organs.htmhttp://www.wisegeek.com/what-is-the-abdomen.htmhttp://www.wisegeek.com/what-is-a-trauma.htm


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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.


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I. ASSESSMENT

A. Data BasePatients Initials : L.C.B.

Age : 51 years old

Sex : Male

Status : Single

Religion : Roman-Catholic

Address : Calayugan Norte, Loon, Bohol 6327

Admitting Doctor : Dr. Florence Cepedoza

Admitting Diagnosis : Acute Abdominal Problem Secondary to Perforated Hollow Viscus

Admission Date : May 21, 2011

Admission Time : 10:15 p.m.

Hospital : 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.


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C. Chief ComplaintsAbdominal pain

D. History of Present IllnessPatient 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 HistoryHPN (+) DM (-)UTI (+) HPB(-)

F. Food AllergiesPatient mentioned of no known allergies to any foods or drugs.

G. Condition on AdmissionBlood Pressure : 140/90 mmHg

Pulse Rate : 82 bpm

Respiratory Rate : 24 cpm

Temperature : 37.3 C

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


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II. LABORATORY AND DIAGNOSTIC RESULTS05/22/11

COMPLETE BLOOD COUNT

Name of lab./ Diagnostic

exam

Patients Results Normal values Significance

WBC- White blood cell 8.1 K/uL 4.0-11.0

RBC- Red Blood Cell 2.85 L M/uL 4.50-6.50 Decreased in Red Blood Cell

indicates bleeding, anemia.

Hgb-Hemoglobin 8.5 L g/dL 13.0-18.0 Decreased Hemoglobin

indicates depleted blood

oxygen-carrying capability.

Hct- Hematocrit 26.3 L % 40.0-54.0 Decreased in Hematocrit

indicates anemia.

MCV- Mean Corpuscular

Volume

92 fL 76-96

MCH- Mean Corpuscular 29.6 Pg 26.0-32.0

MCHC- Mean Corpuscular 32.2 g/dL 30.0-35.0

RDW 13.6 % 11.5-14.5

Plt- Platelet Count 376 k/uL 150-400


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05/22/11

DIFERENTIAL COUNT


exam


Neutrophil 79 H 40-75 Increased level of neutrophil

count indicates stress.

Lymphocyte 11 L 20-45 Decreased level of lymphocyte

count indicates infection

especially H- pylori.

Monocyte 6 0-10

Eosinophil 4 0-6

Basophil 0 0-1

CHEMISTRY


exam


Sodium 134.2 mmol/L 135-155

Potassium 3.15 mmol/L 3.6-5.5

Creatinine 378.4 mmol/L 53-97 Increased level of creatinine

count indicates increased level

in blood pressure, and or the

body declines to function

properly especially the

kidneys.


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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 bygunshots 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.
http://www.wisegeek.com/what-is-a-viscus.htmhttp://www.wisegeek.com/what-is-the-viscera.htmhttp://www.wisegeek.com/what-is-a-trauma.htmhttp://www.wisegeek.com/what-is-a-ruptured-aneurysm.htmhttp://www.wisegeek.com/what-causes-vomiting.htmhttp://www.wisegeek.com/what-causes-vomiting.htmhttp://www.wisegeek.com/what-is-a-ruptured-aneurysm.htmhttp://www.wisegeek.com/what-is-a-trauma.htmhttp://www.wisegeek.com/what-is-the-viscera.htmhttp://www.wisegeek.com/what-is-a-viscus.htm


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IV-A PATHOPHYSIOLOGY

The most common cause of this form of gastric mucosa erosion is the use of NSAIDs. Other causes may be alcoholism orstress 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 dosesgenerally will not lead to gastritis. However, as many as 1030% of patients on higher and more frequent doses of NSAIDs, suchas those with chronic arthritis, may develop gastric ulcers. Patients with H. pylorialready present in the stomach who are treatedwith 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 stomachlining. Gastric erosion is a slight break (or "ulceration") in the innermost layer (called "mucosa") of the stomach's lining. If anulceration extends deeper than this layer, it is called a gastric ulcer. Gastrosplenic fistula resulting from erosion of a primarysplenic 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 resultsthat IL-1 acts mainly in the central nervous system to inhibit the occurrence ofstress-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 alsoduodenal 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 thedefenses of the stomach mucosal lining. This leads to inflammation and may be precipitated by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs)

such as ibruprofen.
http://www.healthline.com/adamcontent/alcoholismhttp://www.healthline.com/goldcontent/aspirinhttp://www.healthline.com/galecontent/nonsteroidal-anti-inflammatory-drugs-2http://www.healthline.com/adamcontent/anorexia-nervosahttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.healthline.com/adamcontent/anorexia-nervosahttp://www.healthline.com/galecontent/nonsteroidal-anti-inflammatory-drugs-2http://www.healthline.com/goldcontent/aspirinhttp://www.healthline.com/adamcontent/alcoholism


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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) ornizatidine (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 therapyfor bleeding.

However, combined treatment with estrogen and lithium, significantly decreased the severity of gastric erosions in intactbut not in ovariectomized rats and this was associated with a significant increase in the endogenous histamine content ofthe gastric mucosa.

Avoiding smoking Avoiding tea, coffee , and soft drinks containing caffeine
http://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htm


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ILLUSTRATION

Illustration of the abdomen


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IV-B PATHOPHYSIOLOGY:

Gastric mucosal erosion-is a

minor ulceration of the gastric

mucosa, brought by an abdominal

trauma or problems, and orhollow viscus.

CAUSE

H. pyloriAlcoholism

SYMPTOMS

Stomach bleeding Blood in stools or

black, tarry stoolsAnemia Weight loss Fatigue Black stool NauseaAbdominal indigestion Blood in stools or

black, tarry stools

TREATMENT

Multiple regimens are effective and usually include either an H2receptor antagonist such as famotidine (Pepcid) or nizatidine(Axid) or a proton pump inhibitor such as omeprazole (Prilosec) oresomeprazole (Nexium) to suppress acid, combined with twoantibiotics.

Surgical intervention may be recommended for people who do notrespond to medical therapy or to endoscopic therapy for bleeding.

DIAGNOSIS

Laboratory studies of blood testfor anemia X-rays of the upper digestive

tract

COMPLICATIONS

BleedingAnemia

PREVENTION

Avoiding smoking Avoiding tea, coffee , and soft drinks containing caffeine
http://www.healthline.com/adamcontent/alcoholismhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.health-disease.org/digestive-disorders/gastric-erosion.htmhttp://www.healthline.com/adamcontent/alcoholism


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Avoiding smokingAvoiding tea, coffee , and soft drinks containing caffeine

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