Sharp gastritis - for the first time the arisen inflammatory process proceeding with primary damage of a mucous membrane of a stomach (sometimes - deeper layers of a gastric wall). Sharp gastritis is shown by an eructation, nausea, vomiting, a meteorizm, a diarrhea, sharp pains, feeling of burning and weight in subspoon area. The diagnosis of sharp gastritis is established on the basis of data of the anamnesis (food, epidemiological, allergic), results of a chemical and bacteriological research a calla and emetic masses, roentgenoscopy of a stomach, gastroscopy. Depending on a form and weight of sharp gastritis treatment can include washing of a stomach, observance of a diet, antibiotic treatment, an oral regidratation, intravenous infusional therapy. At flegmonozny gastritis surgical tactics is shown.
Gastritises are the most widespread pathology in gastroenterology. According to statistical data, every second adult of the planet suffers from various forms of gastritis. At sharp gastritis inflammatory changes most often affect a superficial epithelium and the ferruterous device of a stomach. Less often inflammatory process extends to all depth mucous and even a muscular layer of a gastric wall. Craftiness of sharp gastritis consists it is in danger of development of erosion mucous, gastrointestinal bleeding, cicatricial changes in a stomach, is purulent - septic complications, chronic gastritis.
Reasons of sharp gastritis
On the etiologichesky mechanism of emergence allocate sharp endogenous and exogenous gastritises.
Development of sharp endogenous gastritis is connected with the infection which is present at an organism. Most often the helicoid bacterium of Helicobacter pylori which comes to light at 80% of patients with sharp gastritis acts as the etiologichesky agent. Emit to Helikobakteriya various toxins and enzymes (urease, etc.) under the influence of which in a mucous membrane of a stomach inflammatory reactions develop. The Helikobakterny infection also promotes development of stomach ulcer of a stomach.
More rare as causative agents of endogenous sharp gastritises streptococci, proteas, staphylococcus, colibacillus, a cytomegalovirus, causative agents of fungal infections (candidiasis, histoplasmosis, etc.), etc. act. Morphological and functional prerequisites for development of sharp gastritis arise at flu, scarlet fever, measles, diphtheria, viral hepatitis, pneumonia. In rare instances secondary sharp gastritis develops at disseminirovanny tuberculosis, secondary syphilis.
As Etiologichesky factors of sharp exogenous gastritis, first of all, food agents – thermal, mechanical, chemical act. The irritation mucous too hot, spicy or rough food of a stomach can cause development of sharp gastritis. On mucous a stomach tobacco smoking, alcohol, the use of strong coffee has the adverse damaging effect.
Among the exogenous reasons of sharp gastritis the food poisonings caused by the use of the food infected with salmonellas, shigellas, iyersiniya, klebsiyella also quite often act. Besides, the irritation and damage mucous a stomach can be caused by long reception of some pharmacological medicines – salycylates, glucocorticoids, bromides, medicines of iron, sulfanylamides, antibiotics. Sharp gastritis can develop against the background of radiation therapy concerning stomach cancer (beam gastritis), deliberate or casual hit in a stomach of chemicals (acetic, nitric, salt, sulfuric, acids; corrosive sublimate, liquid ammonia, the caustic soda, ethylene glycol, methyl alcohol; compounds of iodine, arsenic, acetone, phosphorus, etc.). At high concentration or a significant amount of the used toxic agents there can be a burn or perforation of a wall of a stomach and gullet.
Sharp allergic gastritis develops at individual intolerance of a certain foodstuff and usually is followed by other allergic manifestations - urticaria, angioneurotic hypostasis, an attack of bronchial asthma, etc.
Classification of sharp gastritises
At sharp gastritis in a mucous membrane of a stomach various changes depending on which the disease proceeds in a catarrhal (simple), fibrinozny, necrotic (korrozivny) or flegmonozny (purulent) form can develop.
At sharp catarrhal gastritis during gastroscopy the thickening, polnokrovy, puffiness of a mucous membrane of a stomach, the maintenance of a large amount of slime, sometimes – melkotochechny superficial hemorrhages comes to light. In case of existence of the numerous merging erosion speak about sharp erosive gastritis. Dystrophy and a slushchivaniye of a superficial epithelium, a serous ekssudation, existence of diffusion infiltration, an intaktnost of deep layers mucous and glands of a stomach is characteristic of a microscopic picture.
Patomorfologichesky changes at sharp fibrinozny gastritis consist in necrotic changes mucous, formation of fibrinozno-purulent exudate and a fibrous film on the surface of a stomach. Depending on depth of an inflammation distinguish krupozny (superficial) gastritis and difteritichesky (deep) gastritis.
Sharp necrotic gastritis develops owing to hit in a stomach of aggressive substances (chemical agents). At poisoning with acids the coagulative necrosis is formed; at poisoning with salts - a kollikvatsionny necrosis. At the same time not only the mucous layer of a stomach, but also all thickness of a gastric wall with formation of erosion and perforative ulcers can be damaged.
At sharp flegmonozny gastritis all layers of a wall of a stomach – mucous, submucous, muscular, serous are involved in an inflammation. Purulent gastritis often arises at ulcers, the breaking-up tumors, stomach injuries. Macroscopic changes are characterized by a stomach wall thickening at the expense of mucous and submucous layers, massive fibrinozny imposings. Against the background of sharp flegmonozny gastritis can develop perigastrit also peritonitis.
Depending on the area involved in inflammatory process distinguish focal (local) and diffusion (widespread) sharp gastritis. Focal forms of sharp gastritis according to the struck department of a stomach, in turn, are subdivided on fundalny, antralny, piloroantralny, piloroduodenalny.
Symptoms of sharp gastritis
Displays of sharp gastritis usually develop 6-12 hours later after action of an etiologichesky factor. At the same time dispepsichesky frustration are most expressed: appetite loss, discomfort and weight in epigastriya, moderate pains, unpleasant smack in a mouth, an eructation, nausea, vomiting the eaten food with impurity of slime and bile. At food infections the frequent liquid chair, a meteorizm, temperature increase of a body is noted. Repeated vomiting and a diarrhea at a sharp gastroenteritis can cause organism dehydration that is shown by weakness, dizziness, a headache.
At sharp allergic gastritis, except symptoms of dyspepsia, dermatitis symptoms – rash, an eritem, a skin itch join, Quincke, etc. swelled. At sharp erosive gastritis vomiting with blood or a melena, confirming gastric bleeding can be observed. High fever, a fever, vomiting with pus impurity, severe skhvatkoobrazny pains in the top departments of a stomach is characteristic of sharp flegmonozny gastritis.
Serious condition develops at the sharp korrozivny gastritis caused by the use of the concentrated chemicals. At patients the repeated, not giving relief vomiting is noted; emetic masses contains slime, blood, scraps mucous digestive ways. On lips and in a mouth at the patient signs of a chemical burn are defined; at hit of poisons in a throat there is a laryngospasm and asphyxia. The general state is aggravated with the shock phenomena: hypotonia, tachycardia, pallor of skin, superficial breath.
Diagnosis of sharp gastritis
At clarification of circumstances of a disease pay attention to the food, medicinal anamnesis, the accompanying pathology. The objective status at sharp gastritis is characterized by pallor and dryness of integuments, morbidity of epigastralny area at a palpation. At survey of a mouth language is laid over by a grayish raid, the unpleasant smell from a mouth is defined.
In hard cases at sharp gastritis the oliguriya is noted; at a research of the general analysis of urine the albuminuriya, urata comes to light. Changes in peripheral blood include moderate neytrofilny , increase in quantity of erythrocytes and hemoglobin; at bleeding – anemia. For identification of symptoms of latent bleeding the kcal on the hidden blood is investigated.
The developed biochemical blood test at sharp gastritis allows to reveal violations in work of a liver, biliarny system, a pancreas, kidneys. For assessment of a functional condition of a GIT the koprogramma research, for identification of activators – bacteriological crops a calla is conducted. For the purpose of detection of a helikobakterny infection the respiratory test on a helikobakter, definition of H. Pylori in blood and Calais by the IFA method, PTsR-diagnostics is carried out.
In certain cases at sharp gastritis gastroscopy by means of which hyperaemia, puffiness mucous, existence of erosion, intra mucous hemorrhages, sometimes – symptoms of gastric bleeding is defined is shown. At not clear etiology of sharp gastritis the endoscopic biopsy of fabric, mucous with a morphological research, is carried out.
The stomach X-ray analysis at sharp gastritis reveals a rough skladchatost and nodosity of a mucous membrane, an erosion, increase in gastric fields. At flegmonozny gastritis the survey X-ray analysis and MSKT of abdominal organs is shown.
Treatment of sharp gastritis
The basic principles of treatment of sharp gastritis are elimination of causes of illness and prevention of complications. At sharp gastritis in the first 12-24 hours starvation is shown, then the sparing diet is appointed. At food or chemical poisonings washing of a stomach is made. The refusal of reception of the medicines irritating a stomach, smoking and alcohol is necessary.
From medicines at sharp gastritis blockers of N of the 2-gistaminny receptors possessing antisekretorny action (ranitidine, , ), inhibitors of a proton pomp ( and its analogs), antatsidny means (aluminum phosphate, aluminum hydroxide, magnesium a carbonate, magnesium oxide), gastroprotektor (bismuth medicines) are appointed. At sharp gastritises of a specific etiology the corresponding treatment (antikhelikobakterny, antifungal, antitubercular therapy) is carried out.
At sharp gastritis are applied to removal of a pain syndrome atropine, , a papaverine; at vomiting purpose of prokinetik – a metoklopramid, a domperidon is shown. At the expressed dehydration infusional therapy is carried out by salt solutions.
Treatment of sharp flegmonozny gastritis is carried out by a surgical way: in this case the gastrotomiya, drainage of the purulent center is shown; in certain cases – a resection of a stomach or a gastrektomiya.
Forecast and prevention of sharp gastritis
Sharp catarrhal gastritis at timely and correct therapy usually comes to the end with recovery in 3-4 days. Predictively the course of sharp korrozivny gastritis is adverse: the patient can die from shock, a perforation of a stomach and peritonitis. Gullet striktura, cicatricial deformation of a stomach can be an outcome of chemical burns of a GIT that can demand performance of plasticity of a gullet, imposing of a gastrostoma, etc. interventions.
Also serious forecast is noted at sharp flegmonozny gastritis at which development of perforation of a stomach, purulent peritonitis, an empiyema of a pleura, a mediastinit, abscess of a liver, poddiafragmalny abscess, sepsis is not excluded.
Prevention of sharp gastritises demands an exception of the alimentary reasons, refusal of alcohol intake and tobacco smoking, careful use of medicines, adequate treatment of endogenous infections.