Gastritis & Peptic Ulcers for the Nurse Practitioner Licensing Exam
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Gastritis and Peptic Ulcers for Nurse Practitioner Licensing Exam
Definition
- Gastritis: Inflammation of the gastric mucosa that can be acute or chronic.
- Acute gastritis: Triggered by irritants such as NSAIDs, alcohol, or infections.
- Chronic gastritis: Long-term inflammation often caused by H. pylori infection or autoimmune processes.
- Peptic Ulcer Disease (PUD): Breaks in the gastric or duodenal mucosa due to an imbalance between gastric acid production and mucosal protection.
Etiology
Gastritis
- Infectious causes:
- Helicobacter pylori (H. pylori): The most common cause of chronic gastritis, increasing the risk of ulcers and gastric cancer.
- Non-infectious causes:
- NSAIDs: Inhibit prostaglandins, impairing the protective gastric mucosal barrier.
- Alcohol: Directly damages the gastric lining.
- Autoimmune gastritis: Leads to parietal cell destruction, causing vitamin B12 deficiency.
Peptic Ulcers
- H. pylori infection: Causes increased acid secretion and weakened mucosal defenses.
- NSAIDs: Impair mucosal defenses, promoting ulcer formation.
Clinical Features
Gastritis
- Acute gastritis:
- Epigastric pain, nausea, and vomiting.
- Hematemesis or melena in severe cases.
- Chronic gastritis:
- Dyspepsia and nonspecific upper GI discomfort.
- B12 deficiency with fatigue, pallor, and neurological symptoms.
Peptic Ulcers
- Duodenal ulcers:
- Pain 2-3 hours after eating, relieved by food.
- Gastric ulcers:
- Pain worsens with eating, leading to anorexia and weight loss.
Diagnosis
- H. pylori testing:
- Urea breath test or stool antigen test.
- Endoscopy with biopsy for refractory symptoms or alarm features.
- CBC: To check for anemia from chronic bleeding.
Treatment
- Discontinue NSAIDs and alcohol.
- H. pylori eradication: Triple therapy with PPI, clarithromycin, and amoxicillin (or metronidazole).
- PPIs: For ulcer healing and acid suppression.
- Vitamin B12 supplementation: For autoimmune gastritis.
Complications
- Gastritis: Progression to peptic ulcer disease, gastric cancer, or pernicious anemia.
- Peptic Ulcers: Hemorrhage, perforation, and gastric outlet obstruction.
Key Points
- Gastritis is inflammation of the gastric mucosa, often caused by H. pylori or NSAIDs.
- Peptic ulcers are mucosal defects in the stomach or duodenum.
- Duodenal ulcers improve with eating, while gastric ulcers worsen.
- Diagnosis includes H. pylori testing and endoscopy in severe cases.
- Treatment focuses on H. pylori eradication, acid suppression, and lifestyle changes.