Patient Assessment
Patient’s Initials: E.T. F
Age: 38 Years
Sex at Birth: Male
Goals of Care:
- Manage the stomach pain.
- Stop the internal bleeding.
- Establish the pathological cause of the pain.
- Recommend management strategies.
Admitting Diagnosis: Gastritis
Current Diagnosis: Acute Gastritis
Cues Analysis
In this case study, these were the identified problems:
- Acute gastritis worsening. The cues under this were abdominal pain when hungry and CRP elevation, which links to the possibility of increased inflammation and bleeding from gastrointestinal tract complications.
- Prolonged use of NSAIDs for controlling constant headaches. The cue here is the daily aspirin, taken 20 minutes ago. Aspirin was linked to the potential of making gastritis worse and causing more discomfort and irritation complications.
- Stressful family issues and workplace environment. The cues include strict and tough sales targets and the son’s stomach cancer ailment. These cues are related to stress that can worsen general health by causing the recurrence of gastritis, which is a serious complication.
Acute Gastritis Worsening
Treating the current inflammation, preventing consequences such as bleeding; otherwise, the stomach wound will advance to peptic ulcers. According to Tibi et al. (2023), “Peptic ulcers are characterized by disruptions in the mucosal layer of the gastrointestinal tract lining, commonly referred to as open sores …” (p. 6). These sores within the stomach can lead to bleeding and inflammation, which are known to cause chronic gastritis. This implies that if bleeding and inflammation are left untreated, they can develop into chronic gastritis.
Failure to treat the condition can lead to a lethal condition, such as ulcers or stomach cancer. Miftahussurur et al. (2019) confirmed, “…H. pylori infection has been thought to alter several biological functions, including increasing oxidative stress, and genetic and epigenetic alterations lead to gastric cancer…” (p. 160). To avoid gastric cancer, it is better to cure gastritis and reduce inflammation. This point is prioritized the most because it involves internal organs, and if not treated in time, it can lead to serious health injuries. Hence, E.T. F should control his acute gastritis so as not to reach the atrophic gastritis stage, which is prone to stomach cancer.
Prolonged Use of NSAIDs for Controlling Constant Headaches
Addressing NSAID use to prevent further irritation of the stomach mucosa is key to managing gastritis symptoms. Lu et al. (2021) explain that “NSAIDs are classic drugs to protect gastric mucosa…” (p.5). It is paramount to remember that although NSAIDs can protect the stomach mucosa, autophagy can also negatively affect it. Based on recent research, NSAID-associated stomach damage was reduced by pharmacological or genetic suppression of autophagy (Lu et al., 2021). The development of effective techniques to preserve the gastric mucosa while avoiding deleterious effects requires knowledge of the chemical processes underlying NSAID-induced autophagy and gastric mucosal injury.
By preserving the structure and function of the stomach barrier, the gastric mucosa plays a significant role in preventing ulcers. The mucous layer, mucosal microcirculation, endogenous prostaglandins, mucous-bicarbonate-phospholipid barrier, epithelial cell renewal, and epidermal growth factor are among the defensive mechanisms that make up this system (Lu et al., 2021). The stomach mucosal barrier protects against harmful conditions in the stomach and reduces the destructive effects of stomach contents, such as ethanol, gastric acid, protein hydrolysates, and duodenal bile.
A disturbance in the equilibrium of the stomach barrier normally results in moderate ailments like gastritis and stomach ulcers, and in more serious situations, consequences including bleeding or perforation. An imbalance between defensive and aggressive forces leads to the breakdown of stomach mucosal integrity (Lu et al., 2021). This factor is ranked second because the headache can be controlled by avoiding stress, thus eliminating the chances of taking NSAIDs. Therefore, E.T. F should seek therapeutic services to minimize his stress-related headache and stop using NSAIDs; this will prevent acute gastritis from advancing to ulcers and cancer.
Stressful Home and Workplace Environment
To permanently reduce the symptoms of gastritis, stress management is crucial. Techniques for reducing stress can improve overall well-being and help avert future exacerbations. The patient was stressed about his son’s cancer and sales targets at work. For better comprehension, the hypothalamus releases corticotropin-releasing hormone (CRH) in response to stress, thus stimulating the pituitary gland to produce adrenocorticotropic hormone (Kageyama et al., 2021). This process ultimately results in the adrenal glands secreting cortisol. Oroian et al. (2021) conclude that “Cortisol does cause a boost in commensal pathogens like HP, bacteria known to amplify local and systemic inflammation and gastritis” (p. 8). This element is prioritized last because it is something that a patient can control by adopting therapeutic services.
Failure to control HP bacteria can lead to significant gut complications. The erosive impact of refluxed material on the esophageal mucosa and the esophagus’s anti-reflux defense mechanisms are often in balance. The balance is upset when either of the two has a diminished defensive mechanism or a greater harmful impact, which can result in Gastroesophageal reflux disease (GERD). Therefore, any bacteria that can interfere with the lower sphincter muscle can lead to GERD.
According to Jie et al. (2019), “Helicobacter Pylori infection might reduce the contractility of the lower esophageal sphincter (LES) by increasing 5-hydroxytryptamine (5-HT) production…” (p. 751). Normally, the LES closes to prevent backflow of food, which can burn the throat and cause throat cancer. Some researchers found that among 138 throat cancer patients, 12% had severe acid reflux (Mahmoud et al., 2021). Therefore, E.T. F, if not treated based on his chest burning (acid reflux) symptoms, he may develop throat cancer.
References
Jie, W., Qinghong, X., & Zhitao, C. (2019). Association of Helicobacter pylori infection with gastroesophageal reflux disease. Journal of International Medical Research, 47(2), 748-753.
Kageyama, K., Iwasaki, Y., & Daimon, M. (2021). Hypothalamic regulation of corticotropin-releasing factor under stress and stress resilience. International Journal of Molecular Sciences, 22(22), 1-13.
Lu, S. Y., Guo, S., Chai, S. B., Yang, J. Q., Yue, Y., Li, H., Sun, P. M., Zhang, T., Sun, H. W., Zhou, J. L., Yang, J. W., Yang, H. M., Li, Z. P., & Cui, Y. (2021). Autophagy in gastric mucosa: The dual role and potential therapeutic target. BioMed Research International, 2021, 1-6.
Mahmoud, H., Kamel, A., Hamed, A., Shehata, M., Askoura, A., Omran, A., Mahmoud, B., & Abulelela, S. (2021). H. pylori and pepsin as a putative risk factors in laryngeal cancer patients. Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 22(22), 1-9.
Miftahussurur, M., Waskito, L. A., Syam, A. F., Nusi, I. A., Wibawa, I. D. N., Rezkitha, Y. A. A., Siregar, G., Yulizal, O. K., Akil, F., Uwan, W. B., Simanjuntak, D., Waleleng, J. B., Saudale, A. M. J., Yusuf, F., Maulahela, H., Richardo, M., Rahman, A., Namara, Y. S., Sudarmo, E., Adi, P., Maimunah, U., Setiawan, P., Fauzia, K., Doohan, D., Uchida. T., Lusida, M., & Yamaoka, Y. (2019). Analysis of risks of gastric cancer by gastric mucosa among Indonesian ethnic groups. PloS One, 14(5), 1-19.
Oroian, B. A., Ciobica, A., Timofte, D., Stefanescu, C., & Serban, I. L. (2021). New metabolic, digestive, and oxidative stress-related manifestations associated with posttraumatic stress disorder. Oxidative Medicine and Cellular Longevity, 2021, 1-14.
Tibi, S., Ahmed, S., Nizam, Y., Aldoghmi, M., Moosa, A., Bourenane, K., Yakub, M., & Mohsin, H. (2023). Implications of Ramadan fasting in the setting of gastrointestinal disorders. Cureus, 15(3), 1-18.