Editing Stress gastritis


== Aetiology ==

* Physical trauma
* Shock
* Sepsis
* Haemorrhage
* Respiratory failure
* CNS disease causing elevated     intra-cranial pressure with resultant vagal nerve stimulation (Cushing     ulcer)
* Burns involving >30% TBSA     (Curling ulcer)

== Pathophysiology ==

* Likely multifactorial     relating to reduction in blood flow - leads to impaired defence systems     including reduction in mucus and bicarbonate secretion
* Gastric mucosal changes     usually develop 1-2 days after a traumatic event
* Risk factors for developing     clinically significant bleeding from stress gastritis
** Coagulopathy
** Respiratory failure      requiring mechanical ventilation

== Presentation ==

* Majority asymptomatic
* Painless UGIB - usually     low-volume

== Investigation ==

* Endoscopy
** Characterised by multiple      superficial non-ulcerating erosions, typically beginning in the proximal      stomach and progressing distally
** Early lesions are typically      multiple and shallow, with discrete areas of erythema along with focal      haemorrhage or adherent clot. Frank bleeding can result if it erodes into      the submucosa. Almost always seen purely in the fundus and not in the      distal stomach.
** Later lesions appear      identical to regenerating mucosa around a healing gastric ulcer

== Management ==

* Prophylaxis - controversial     as to what defines high-risk, but high-risk patients should be given IV     PPI
* Early enteral feeding is     protective
* Endoscopic control is usually     difficult due to diffuse inflammation, and re-bleeding rate is high
* Octreotide can probably help
* Reports of vasopressin     administration into left gastric artery (contra-indicated in cardiac and     liver disease) or embolisation (which is probably the best option)
* Surgery
** Standard
*** Most lesions are in the       proximal stomach or fundus, so a long anterior gastrotomy should expose       them
*** Oversew all areas of       bleeding
*** Consider performing a       truncal vagotomy and pyloroplasty
** Last-ditch
*** Subtotal gastrectomy

[[Category:UGIS]]