Special Operations Forces Medical Handbook

4-81

GI: Acute Gastritis

COL (Ret) Peter McNally, MC, USA

Introduction: Inammation of the stomach lining or acute gastritis, is common. The causes of gastritis are
numerous, but it is most commonly caused by consumption of alcohol, aspirin, non-steroidal anti-inammatory
drugs (NSAIDs) or by acute infections.

Subjective: Symptoms
Dyspepsia (epigastric discomfort or burning), nausea, vomiting, postprandial fullness/bloating and occasional
GI bleeding; history of excess alcohol consumption or ingestion of aspirin, NSAIDs, corrosives or poorly
prepared or preserved food.

Objective: Signs
Using Basic Tools: Inspection: Nausea, vomiting and epigastric pain; appear pale and dehydrated; no fever.
Palpation: Abdomen is usually soft but may have some mild to moderate tenderness in the epigastric region.
Using Advanced Tools: Lab: CBC for evidence of infection or anemia; and urinalysis (elevated bilirubin).

Assessment:
Differential Diagnosis
GI bleeding - hematemesis or melena should suggest alternative diagnosis such as bleeding peptic ulcer,
Mallory-Weiss tear (esophageal tear caused by retching), etc.
Peritoneal signs (guarding, rebound, absent bowel sounds) - suggest intra-abdominal sepsis.
Icterus (jaundiced sclera) - suggest Gilbert syndrome (a benign disorder of bilirubin excretion) or
hepatobiliary disease.
Signicant weight loss - suggest possible malignancy.

Plan:
Treatment
Primary: Discontinue gastric irritants such as alcohol and/or medications (aspirin/NSAIDs). Rehydrate with
oral or IV uids. Give short course (4 weeks) of H2-blocker (e.g., Pepcid 40 mg q hs) to promote healing
of gastritis.
Complications: If acute gastritis is associated with bleeding (hematemesis or melena), manage in the same
manner as a bleeding ulcer. See section on Peptic Ulcer Disease.

1. IV uid resuscitation, two large bore IVs (> 18 gauge)


2. IV H-2 blocker (e.g., Pepcid 20 mg q 12 h)


3. Anti-emetic of choice (e.g., Compazine 5-10 mg IM q 3-4 hours, max 40mg/day)


4. Orthostatic vital signs, persistent systolic BP < 90 mmHg or tachycardia above 100 beats per minute after
   IV uids should prompt medical evacuation.

Patient Education
Diet: Take clear liquids initially, then progress to bland diet and then back to regular diet.
Medications: Antiemetics may be needed. Use short course of over-the-counter antacids or acid-blocking
medications.
Prevention and Hygiene: Consume only properly prepared and preserved food, clean water.
No Improvement/Deterioration: Return for additional evaluation if fail to improve within 24 hours or signs
of abdominal pain, fever, icterus.

Follow-up Actions
Return evaluation: Repeat exams if worsening symptoms of pain, fever, signs of GI bleeding.
Evacuation/Consultation Criteria: Evacuation is not usually necessary unless GI bleeding develops..