EROSIVE GASTRITIS

A Grand Case Presentation

Presented to the Faculty of St. Luke’s College of Nursing

In Partial Fulfillment of the Requirements

In Related Learning Experience for the

Degree of Bachelor of Science in Nursing

Submitted by:

2NU02 Group 7

Capistrano, Mary Kyle O.

March 22, 2023

 TABLE OF CONTENTS

I. Demographic Profile Page 2

II. Definition of Case Page 2

III. General Signs and Symptoms Page 2

IV. Incidence Rate (Global/Local) Page 3

V. History of Present Illness Page 4

VI. History of Past Illness Page 4

VII. Physical Assessment Page 4

VIII. Pathophysiology Page 7

IX. Diagnostic Procedure Page 8

X. Drug Study Page 9

XI. Nursing Care Management Page 15

XII. Discharge Plan Page 18

XIII. Bibliography Page 19

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I. Demographic Data of Patient

Name: Ms. PFV

Address: Caloocan City
Age: 17 years old
Gender: Female
Civil Status: Single
Occupation: None
Nationality: Filipino
Religion: Catholic
Admitting Diagnosis: Erosive Gastritis with Mild Signs of Dehydration
Date and time of Admission: March 08, 2023 (7:00 PM)
II. Definition of Case

Erosive gastritis is the erosion of gastric mucous that is caused by damage to the
mucosal defenses. Inflamed lesions are found in the mucous lining of the stomach which
induces dyspepsia, nausea, and vomiting. It is typically acute, manifesting with bleeding, but
may be subacute or chronic with few or no symptoms, and is diagnosed by endoscopy.
Common causes of erosive gastritis include; nonsteroidal anti-inflammatory drugs (NSAIDs),
Alcohol, and Stress.
In severe gastritis, bleeding is managed with IV fluids and blood transfusion as
needed. Endoscopic hemostasis should be attempted, with surgery a fallback procedure if
bleeding cannot be controlled endoscopically. Angiography is unlikely to stop severe gastric
bleeding because of the many collateral vessels supplying the stomach. Acid-suppressing
therapy should be started if the patient is not already receiving it. For milder gastritis,
removing the offending agent and using medications to reduce gastric acidity to limit further
injury and promote healing may be all that is required.
III. General Signs and Symptoms

Erosive Gastritis is an inflammation of the stomach characterized by multiple lesions

in the mucous lining causing ulcer-like symptoms. These symptoms may include a burning

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and heavy feeling in the pit of the stomach, mild nausea, vomiting, loss of appetite, and
weakness. In severe cases, there can be bleeding of the stomach which may result in
anemia. Some people with this disorder, especially chronic aspirin users, may show no
apparent symptoms until the disease has advanced. An accurate diagnosis can be made by a
physician’s visual inspection of the stomach using a gastroscope.

IV. Incidence Rate (Global/Local)

H. pylori is a bacteria that can cause peptic ulcer disease and gastritis. It mostly
occurs in children. Only 20% of those infected have symptoms. Symptoms include dull or
burning stomach pain, unplanned weight loss, and bloody vomit. H-pylori-caused ulcers are
commonly treated with combinations of antibiotics and proton pump inhibitors. The overall
prevalence of H pylori infection in superficial gastritis was 28.7%, in erosive gastritis 57.7%,
in gastric erosion 63.3%, in gastric ulcer 80.8%, in early gastric cancer 52.4%. There was a
significant difference, except for the difference between early gastric cancer and erosive
gastritis. Female patients predominate (71%) with a male-to-female ratio of 1:2.3 and mean
age of 52+14 years (range 19-83 years). The majority (47%) of the patients were >40, with
age group 41-60 with the highest distribution.

V. History of Present Illness

Two years prior, patient PFV had epigastric pain with a pain scale score of 6/10,
vomiting about 10x per episode, 1/2 cup per episode, and previously ingested food. No
fever, loose stools, melena, or hematemesis. Noted with decreased appetite and activity.
Consult at Sta. Teresita Hospital and was assessed as having Acute Gastroenteritis with mild
signs of dehydration, given Esomeprazole 40mg/cap OD for 14 days, Aluminum hydroxide
(Maalox), and Metoclopramide 10 mg/tab OD and Cefroxime 500 mg/tab BID for 7 days and
ORS. Noted with relief of symptoms. During the interim, noted improvement of symptoms
until 3 months prior, now with persistent abdominal pain PS 7/10, epigastric burning
triggered by food intake and relieved with no food intake and vomiting episodes about 10x
per episode ½ cup per episode, previously ingested food. Consult online done with an Adult
Gastroenterologist from Chinese General Hospital and was given Esomeprazole 40 mg/cap

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OD for 2 weeks, SodiumA Alginate 500 mg 1 sachet TID, Mosapride 5 mg/tab ODHS for 1
week, and Ondansetron 8 mg/ tab Q12 PRN for nausea and vomiting. During the interim,
still with intermittent epigastric pain PS 6/10 and vomiting episodes 5x per episode ½ cup
per episode, previously ingested food, non bloody associated with weakness and decreased
appetite. No hematemesis, melena, fever. 2 months prior, now with persistent epigastric
pain persistent abdominal pain PS 8/10, epigastric burning triggered by food intake and
relieved with no food intake and vomiting episodes about -1x per episode ½ cup per
episode, previously ingested food. Consult again done online, advised to continue
medications and advised work up. 1 month prior, noticed erosive gastritis per endoscopy
and H pylori positive hence was given Rabeprazole 1 tab BID before breakfast and dinner for
2 weeks, Mosapride 5mg/tab 1 tab TID 30 mins before each meal for 2 weeks, Rebamipide
100 mg/tab 1 tab TID for 2 weeks, Amoxicillin 500 mg/tab BID for 14 days, Clarithromycin
500 mg BID for 14 days with no relief of symptoms.
Two weeks prior, still with abdominal pain and vomiting hence given Lansoprazole
and Domperidone and was admitted from 2/24-2/28 at Chinese General Hospital as a case
of Erosive Gastritis with moderate signs of dehydration. Advised to seek consult with
Gastroenterology to exclude peritoneal TB. After discharge patient was well until after 1 day
noted with vomiting episodes >10x episodes, yellowing, non-bloody about 1 tbsp per
episode. 2 days prior, the patient went to MCU and was advised to consult with another
institution. 1 day prior now with >10x episode of vomiting salivary, 1 tbsp per episode and
epigastric pain PS 8/10 hence consult at NCH. Advised admission however opted for HAMA
for now and will come back once with a negative COVID swab.
A few hours prior, the patient went back to our institution with COVID swab results,
still with vomiting >10x 1 tbsp per bout, bilious and epigastric pain PS 9/10.

VI. History of Past Illness

Patient PFV has no history of hospitalization caused by a different illness before. She
also has no history of any surgeries or operations. The patient has no history of jaundice,
anemia, other hematological condition, myocardial infarction, tuberculosis, hypertension,
heart disease, rheumatic fever, epilepsy/seizure/convulsion, asthma, COPD, diabetes, and
stroke.

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VII. Physical Assessment

Head-to-Toe Assessment
General Assessment
● The patient was conscious, coherent, and not in distress but weak looking.
Integumentary
● No lesions are present and clear scalp
● Anicteric sclera and pink conjunctiva and has slightly sunken eyeballs
● Lips appeared to be dry and pale. No oral mucosa
● No nasal discharge was noted
● Nails appear normal with CRT<2-3 seconds
Respiratory
● Symmetrical chest expansion
● No retractions noted
● Has clear breath sounds
● Slight coughing was noted
Cardiovascular
● Normal rate and regular rhythm
● No murmurs
● Heart rate at a normal level
Abdominal/Gastrointestinal
● The abdomen is flat and soft
● Normoactive bowel sounds were noted
● Tympanitic on all quadrants
● + tenderness at epigastric area
● Nasogastric tube inserted
Musculoskeletal
● Warm extremities
● The patient is able to stand and walk
● Full and equal pulses with CRT <2 seconds
● Spine and back straight and midline
Neurological

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● The patient is conscious and coherent
● No signs of neurologic deficits
● Signs of weakness, malaise, and drowsiness are noted after episodes
● No facial asymmetry was present

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VIII. Pathophysiology of Erosive Gastritis

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IX. Diagnostic Procedure

Complete Blood Count

● To assess for anemia, as one of the symptoms of erosive gastritis is bleeding of the
stomach
Endoscopy
● To examine the upper digestive system for lesions and swelling
Pregnancy Test
● Pregnancy can induce nausea and vomiting
Fecalysis
● To assess if there is blood in the stool
X-ray of the Upper Digestive System
● To assess if there are ulcers present
Breath test
● To determine whether you have the bacterium H pylori

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 X. Drug Study

Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 40mg Suppresses Indication: Side Effects Monitor signs and symptoms of
Omeprazole 1x a day stomach acid To treat conditions where Headache gastroesophageal reflux
(morning) secretions by there is too much acid in the Nausea disease and peptic ulcer
Brand Name: specific inhibition stomach Vomiting disease
Prilosec of the H+/K+ Example: Diarrhea
ATPase system Gastric Ulcer Stomach Pain Monitor for C. difficile
Functional Class: found at the Duodenal Ulcer Constipation associated diarrhea and
Proton Pump Inhibitor secretory surface Erosive Gastritis FLatulence hypomagnesia when taking
of gastric parietal GERD long term
Chemical Class: cells. Parietal
Benzimidazole enzyme systems Caution when co-administered
are regarded as the with CYP2CIa substrates
acid pump within
the gastric mucosa, Adverse
it inhibits the final Effects
step of acid Contraindication Yellow skin
production. Patients with a history of Joint pain
hypersensitivity to the drug Persistent
Diarrhea

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 Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 10mg A dopamine D2 Indication: Side Effects Monitor BP during IV

Metoclopramide 1x a day antagonist but also Used to treat symptoms of Chills administrations
(30 mins acts as an agonist slow stomach emptying Clay-colored
Brand Name: before meal) on serotonin 5-HT4 (gastroparesis) in patients stools Do not use alcohol, sleep
Metozolv ODT receptors and with diabetes Difficulty remedies, sedatives or
Reglan causes weak Breathing sedation could occur
inhibition of 5HT2 Fainting
Functional Class: receptors Report involuntary movement
Prokinetic Agent

Chemical Class
Benzamides Contraindication Adverse
Patients with Effects
hypersensitivity to the drug Irregular/fast
heart beat
Patients with the ff: Severe headache
Gastrointestinal bleeding tiredness
Obstruction
Perforation

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 Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 1g It dissociates in the Indication: Side Effects Give during empty stomach
Sucralfate 4x a day acid environment Used to treat: Dry skin
of the stomach to Duodenal Ulcers Noisy breathing Monitor pain, use antacids for
its anionic form, Epithelial wounds Cough pain
Brand Name: which binds to the Chemotherapy-induced Pink sputum
Carafate ulcer base. mucositis Measure, record regular weight
Radiation proctitis to monitor edema
Burn wounds
Functional Class:
Protectants

Contraindication Adverse
Chemical Class Patients with Effects
Organometallic hypersensitivity to the drug Blue
Compounds lips/fingernails
Patients with the ff: Feeling full
End-stage renal disease Increased thirst
Uncontrolled Diabetes
Hyperglycemia

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 Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 500mg Prevents bacteria Indication: Side Effects Advise about the likelihood of
Clarithromycin from growing by Used to treat certain Nausea GI reactions
interfering with bacterial infections: Vomiting
their protein Pneumonia Diarrhea Assist with GI reactions
Brand Name: synthesis. It binds Bronchitis Insomnia
Klaricid with sub-unit 5OS Infections of the ear, sinuses, Instruct to report severe or
Xetihin XL of the bacterial skin, and throat prolonged GI problems
ribosome and
inhibits translation
Functional Class: of peptides
Macrolide Antibiotics
Contraindication Adverse
Patients with; jaundice, and Effects
Chemical Class a history of liver disease Bloating
Macrolide Headaches
Patients with Indigestion
hypersensitivity to the drug Abdominal Pain

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 Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 4mg Used to prevent Indication: Side Effects Assess motor function of the
Ondansetron nausea and Used to prevent nausea and Headache patient
vomiting caused by vomiting caused by cancer Constipation
chemotherapy, therapy Weakness Monitor improvements in GI
Brand Name: radiation therapy, Chills symptoms
Zofran ODT and surgery. It Drowsiness
blocks the action
of serotonin
Functional Class:
Serotonin 5-HT3
receptor antagonist

Contraindication Adverse
Chemical Class Patients with Effects
5HT3 Antagonist hypersensitivity to the drug Blurred vision
Rash/hives
The use of apomorphine Itching
with ondansetron can cause Hoarsness
hypotension Chest pain

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 Drug Dosage Mechanism Indication & Side Effects & Nursing Responsibility
of Action Contraindications Adverse
Reactions

Generic Name: 500 mg Diffuses into the Indication: Side Effects Take note for the history of
Metronidazole organism, inhibits For the treatment of acute Diarrhea CNS/ hepatic disease
protein synthesis intestinal amebiasis (amebic Painful Urination
by interacting with dysentery) and amebic liver Insomnia Administer with food and take
Brand Name: DNA, and causes a abscess full course therapy drug
Flagyl loss of helical DNA
structure and
strand breakage
Functional Class:
Nitroimidazole
Antibiotics
Contraindication Adverse
Patients with Effects
Chemical Class hypersensitivity to the drug Depression
Imidazole Blisters on
mouth
Swollen gums
Trouble
swallowing

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XI. Nursing Care Management
Assessment Nursing Diagnosis Planning Interventions/Rationale Evaluation
Assessed the patient’s Goal Partially Met
Subjective: Nausea related to Noxius Short-Term Goal severity of GI condition (Patient was relieved of
● Patient verbalized Taste nausea and have less
that she is After 4 hours of nursing Documented and noted episodes)
nauseous interventions the patient the conditions that
will be free of nausea triggered nausea and
Objective: vomiting
● Patient was
vomiting Long-Term Goal Eliminated offending
● Vomited ½ cup After 24 hours of nursing odors from the room as it
per episode intervention chronic can trigger nausea
● Saliva-like fluid nausea will be managed
with bilious Documented the patient's
secretions After 1 week of nursing pattern of nausea and
● Patient’s lips were interventions patient will vomiting episodes
dry and pale maintain/ regain the
● The patient's weight as appropriate Provided the patient with
weight decreased oral routine care as
from 42kg to 41kg needed

Encourage the patient to

take ice chips

Administer antiemetics
(ondansetron) as ordered
by the physician

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16
Assessment Nursing Diagnosis Planning Interventions/Rationale Evaluation
Nutrition deficiency Documented the patient's Goal not Met
Subjective: related to fluid restriction Short-Term Goal height and weight and (Patient
The patient verbalized and inability to feed orally After 8 hours of nursing computed her BMI nutritional
that whenever she eats or intervention the patient needs is still not
drinks she immediately will be less fatigued and Assessed the severity of maintained due
vomits it. weak-looking the nutritional risk of the to inability to
patient feed and drink
orally)
Objective: Long-Term Goal Assessed the patients
The patient looked After 24 hours of nursing eating pattern before and
fatigued and weak intervention the patient compared it from now
will have more energy
Patients weight is below Provided good oral
average for her age (41kg) After 1 week of nursing hygiene and dentition
interventions the patient
The patient looked pale will regain/maintain the Monitor appropriate IV
and had dry lips appropriate weight fluids

The patient has slightly After 2 weeks of nursing Refer to a dietician for the
sunken eyeballs intervention the patient appropriate diet
will have the appetite to
eat

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XII. Discharge Planning

Medications
● Remind the family and the patient for ant take home medications prescribed by the
doctor
● Remind and teach them of the proper doses and how to take the medication
● If there are any antibiotics prescribed make sure they finish the ordered amount and
do not stop in the middle.
Environment
● The patient should be placed in a stress-free environment as much as possible, as
stress is one of the causes of the disease
● Keep the patient in a clean and protected environment so that bacteria and virus
infections can not easily attack her
Health Teachings
● Educate the patient to not smoke and drink as this may trigger the recurrence of the
disease
● Tell the patient and the guardian to limit the use NSAID medications as they may
increase the stomachs acidity

Diet
● Educate the patient and her guardian on the proper diet that is appropriate for her
condition so that she could regain her weight loss
● Eat foods that are easy to digest so that the stomach wouldn't have such a hard time
digesting as she comes back from this illness
Social
● Encourage to surround the patient with her friends and family that understand her
situation in order to boost her mental and emotional health

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XII. Bibliography

Vakil, N. (2023, March 15). Erosive gastritis - gastrointestinal disorders. MSD Manual
Professional Edition. Retrieved March 21, 2023, from
https://www.msdmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-
ulcer-disease/erosive-gastritis

Vakil, N. (2023, March 15). Erosive gastritis - gastrointestinal disorders. MSD Manual
Professional Edition. Retrieved March 21, 2023, from
https://www.msdmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-
ulcer-disease/erosive-gastritis

National Organization for Rare Disorders (2023, January 12) Gastritis, chronic, erosive
- symptoms, causes, treatment: Nord from
https://rarediseases.org/rare-diseases/gastritis-chronic-erosive/

World journal of gastroenterology (2005, February 14) Helicobacter pylori infection,

glandular atrophy, and intestinal metaplasia in superficial gastritis, gastric erosion, erosive
gastritis, gastric ulcer and early gastric cancer from
https://pubmed.ncbi.nlm.nih.gov/15682469/

Cleveland Clinic (2020, September 8) Gastritis from

https://my.clevelandclinic.org/health/diseases/10349-gastritis

Watari J, Chen N, Amenta PS, Fukui H, Oshima T, Tomita T, Miwa H, Lim KJ, Das KM.
Helicobacter pylori-associated chronic gastritis, clinical syndromes, precancerous lesions,
and pathogenesis of gastric cancer development. World J Gastroenterol. 2014 May
14;20(18):5461-73. [PMC free article] [PubMed]

Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch Intern

Med. 1996 May 27;156(10):1097-100. [PubMed]

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