Phlegmonous gastritis
Description
◉ Patient: man, 19, previously in good health
◉ Symptoms include: • Inability to tolerate PO intake, persistent vomiting, severe epigastric discomfort that goes away with vomiting, and weight loss of 15 pounds
◉ Initial Work-up:
• Multiple regimens of empirical treatment for H. pylori → increasing vomiting.
◉ Lab findings: •WBC 14.9 ×10³/uL (with left shift)
• Hypochloremia and mild hyponatremia◉
• Mild transaminase elevation, ALP 147 U/L; elevated lipase (428 U/L)
◉ Imaging: CT abdomen
◉Endoscopy:
•scalloped, erythematous, nodular, and friable stomach mucosa.
◉ Histology:
•Rare eosinophils, gland abscesses, and neutrophilic inflammation of the lamina propria; neither lymphoma nor cancer.
•Coagulase-negative Staphylococcus and Granulicatella adiacens are the cultures.
◉Diagnosis
• Phlegmonous Gastritis with duodenitis
◉Definition:
•An uncommon, potentially fatal bacterial infection of the stomach wall that affects the mucosa, submucosa, and muscularis.
◉Epidemiology:
•Very uncommon; mostly older males with immunosuppression or comorbidities.
◉Common organisms:
•include mixed flora, Streptococcus species, and Enterococcus species.
◉Risk factors
include H. pylori, ingestion of foreign objects, iatrogenic causes, gastric mucosal damage, and nearby diseases or cancer.
Protocol
◉Management
•Antibiotics:
•broad-spectrum intravenous therapy that addresses anaerobes, Gram-negative bacteria, Staphylococcus bacteria, and Streptococcus bacteria.
•This patient had a notable clinical response after using daptomycin and cefepime for 14 days.
•In the past, gastrectomy was thought to improve survival; however, recent research indicates that antibiotics alone may be adequate in some situations.
◉Supportive care:
•NPO at first, followed by a progressive return to the diet as tolerated.
IV fluids and electrolyte balance.
◉Monitoring
•To evaluate the resolution of stomach wall thickening, use serial imaging.
•After three months, repeat the endoscopy to see normal stomach mucosa.
•No surgery is necessary.
•Because the patient responded well to antibiotics, a gastrectomy was avoided.
Nursing Management
In supportive and transdisciplinary management, nurses are essential:
Monitoring oral intake tolerance (risk of vomiting/dehydration) was one of the challenges encountered.
administering antibiotics via IV while keeping an eye out for side effects.
addressing the discomfort of patients (pain, nausea, risk of malnutrition).
Early detection of decline (risk of perforation, sepsis, and peritonitis).
◉Nursing interventions:
•Close observation of I&O (urination, hydration).
◉Nutritional support:
•work with a dietitian, monitor for intolerances, and help with diet development.
•Infection surveillance:
•to avoid catheter-associated infections, keep an eye on vital signs, lab results (WBC, CRP), and IV line maintenance.
◉Education:
•emphasize taking medications as prescribed and keeping an eye on symptoms after being released.
◉Psychological support:
•young patient at risk for anxiety and sadness due to sickness and weight loss = frequent hospitalizations.
Notes
For more dettails visit https://pmc.ncbi.nlm.nih.gov/articles/PMC10163626/
