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Gastroenterology Subdivision Case Report

CHRONIC GASTRITIS
Department of Child Health, Medical School Hasanuddin University dr. Wahidin Sudirohusodo General Hospital, Makassar
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INTRODUCTION
Gastritis dyspepsia which inflammation signs and hipersalivation in the stomach. Acute gastritis suddenly and lasts briefly. Chronic gastritis longer lasting or recurrent.
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Symptoms of gastritis include: Stomach pain Indigestion Burping Hiccuping Loss of appetite Nausea and vomiting Bloody or black vomit Dark black, tarry stools
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CASE REPORT
A, a girl, 13 years old, admitted to the dr. Wahidin Sudirohusodo General Hospital, on 2 nd July 2006 with vomiting.
HISTORY TAKING A girl consulted to gastroenterologi subdivision by respirology subdivision because of : -Vomiting 1 day ago, > 5 x/day, no projectile. - Her appetite - She complain in stomach pain
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- Fever 1 day ago, no continue - Cough with mucous, but no dyspneu. - Bowel movement and micturation were normal. - There was history of stomach pain about 1 year.
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PHYSICAL EXAMINATION

- Physical examination : a moderately ill. - BT : 38,8 C

- Pain of the suprapubic and epigastric

LABORATORY EXAMINATION

- Routine Blood : WBC 12.900/mm - Blood Electrolyte : Natrium 135 (136-145) mmol/l Kalium 2,8 ( 3,5 - 5,1 ) mmol/l , Chlorida 103 ( 97- 111 ) mmol/l. - Routine urine : Sediment : WBC 1015 / HPF,RBC 4- 6 /HPF.
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WORKING DIAGNOSIS : - Dyspepsia THERAPY :

- IVFD KAEN 3 B : 44 drops/min. - Vitamin B Complex 2 x 1 tab
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FOLLOW UP Third day :

- General condition was weak

- BT : 38,1C - Stomach pain (+) Therapy : IVFD KAEN 3 B Semisolid food

44 drops/min

Ranitidine 2 x 150 mg/oral/day.

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Urine : WBC +25/ul, sediment 1013/HPF. Fifth day : - Stomach pain Therapy continue Abdominal USG : - Normal limit
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Sixth day : - BT : 38 C - Nausea (+), vomiting (+), headache (+) - Suprapubic pain (+) - Stomach pain (+) Therapy continue
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Nineth day : - BT : 38,3 C - Suprapubic pain (-) - Stomach pain (-) Therapy : - Advise from supervisor gastroenterology subdivision : Antacid 3 x 500 mg/oral/day, Ranitidine 2 x 150 mg/oral/day, Amoxicillin 3 x 500 mg/oral/day, Tetracyclin 4 x 500 mg/oral/day.
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MDO Examination : - Chronic gastritis with hypersecretion signs.

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Tenth day : - BT : 38 C - Her appetite was good Therapy continue Parents of patient was discharged. DEFINITIVE DIAGNOSE : - Chronic Gastritis
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PROGNOSIS :
- Qua ad vitam : bonam - Qua ad sanationen : dubia

DISCUSSION : Gastritides can be classified based on the underlying etiologic agent : - Helicobacter pylori, - bile reflux, - nonsteroidal anti-inflammatory drugs [NSAIDs], - autoimmunity, - allergic response 16 - alcohol,

- severe stress - viral infection - fungal infection - injury - radiation treatment and the histopathological pattern: H pylori associated multifocal atrophic gastritis. endoscopic appearance of the gastric mucosa : varioliform gastritis.
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H.Pylori

main cause of true gastritis

H. Pylori Spiral, S 0,5 x 0,3 m, Gr (-) rods, highly motile because of multiple unipolar flagella ( 3-5 ), potent producers of the enzyme urease, catalase,and oksidase. .
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For this case : Helicobacter gastritis because of : - Gastritis H.pylori main cause of gastritis. - There wasnt hystory of drink drugs or other causes. Chronic gastritis because of : - There was histrory stomach pain about 1 year. - X ray contrast.
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Diagnosis Helicobacter gastritis : - Urea Breath Test : (NH) 13-14 CO + H2O + 2H+ 13-14CO2 + 2 NH4 - Endoscopy - Biopsy
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Therapy : - Dual Therapy : Proton pump inhibitor + Ab - Triple Therapy : between Ab or bismuth subsalicylate. - Combination of triple therapy + anti secretory drugs.
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SUMMARY A case of chronic gastritis in a 13 years old girl is reported. The diagnosis was established on the basis of clinical features and conrast x ray . The prognosis qua ad vitam : bonam and qua ad sanationem : dubia.
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Picture 1. Helicobacter pyloricaused chronic active gastritis. 29 Genta stain (20X). Multiple organisms (brown) are visibly adherent

Picture 2. Chronic gastritis associated with Helicobacter pylori 30 infection. Numerous plasma cells in the lamina propria.

Picture 6. Chronic gastritis. Chemical gastropathy. Courtesy of Sydney Finkelstein, MD, PhD, University of 31 Pittsburgh.

Picture 4. Chronic gastritis. Mycobacterium avium-intracellulare in gastric lamina propria macrophages. Courtesy of Sydney 32 Finkelstein, MD, PhD, University of Pittsburgh.