“Here rest the bones of Susan Lowder Who burst while drinking Seidlitz powder Although she has gone to her heavenly rest She should have waited till it effervesced”
Definition
Inflammation of the stomach in histological terms, and divided into Acute or Chronic.
Prognosis
Would depend upon the cause. It is excellent in H.Pylori induced gastritis treated adequately. In initially-seropositive cases, undetectable antibody levels for H.Pylori at the end of a year after therapy would signify a cure.
Treatment
Case no.1:Mild dehydration
Child has watery loose motions, and mild dehydration as increased thirst and irritability.
Orolyte or Relyte is the most important part of the treatment, more important than drugs. Feed continuously, as much as the baby takes except when abdomen is distended or if vomiting.
Put one sachet of Relyte in 200ml of boiled and cooled water, in a clean glass. Home remedy= Take 200ml boiled cool water and add 1 tsp of sugar and a pinch of salt.
Dose of ORS= 80ml/ kg in first 4 hours then 50ml/kg/day + 50 -100ml for each watery stools. Keep feeding 1 tsp every 1-2 minutes. Syp. Kaltin with neomycin 1-2 tsp 4 hourly. (Anti-diarrhoeal combinations)
Add 1 capsule of Norflox 400 to the bottle or Syp. Walamycin tsp tds (colistin) or Syp. GRAMONEG tsp tds (Nalidixic acid) REDOTIL 15mg sachet x tds x till water motions stop. From 2nd day Cap. Sporalac- powder with 1 tsp. Honey twice daily. Syp. Spasmindon 10 drops tds (Antispasmotic If vomiting Inj. Siquil ¼ to 1cc IM or Inj. PERINORM 1.4 to 1cc IM. If vomiting controlled, then I.V. fluids. If fever or if severe attack:- Inj. Gentamycin 8mg/kg. IM 8 hourly (Injectible antibiotic = 7 A = Ampicillin, Cefalosporins) If stools contain mucus Syp. Flagyl tsp tds x 5 days (Metronidazole)
General Instructions
Instruct the mother to clean the nipples before breast feeding. If bottle feeding, Boil the bottle and milk before feeding. After every motion, clean and dry buttocks and apply talcum powder. If redness of skin is seen, apply zinc paste or siloderm. Breast feeding can be started after 1 day, but withhold if it triggers loose motions again. In addition to orolyte, give- rice Ganji, sago Ganji, buttermilk, biscuits, bananas, apples.
Case No.2: Moderate Dehydration
Child is very thirsty, tongue becomes dry, fontanelle becomes depressed, skin turgor is lost i.e. pinched skin fold takes a few seconds to become flat again, Eyes are sunken, Pulse and respiration are rapid and urine output reduces.
In addition to all the treatment as for mild dehydration, the child will require I.V. fluids and antibiotics. Refer the child to a Pediatrician.
Guidelines for I.V. fluids
Start Ringer’s lactate. Do not give Isolyte-P to a dehydrated child. Dose= 30ml/ kg every hour for 4 hours (Total 100ml/kg of Ringer’s lactate over 5-6 hours).
Assess the child after every 50 – 100ml. and continue RL till eyeballs become normal, skin becomes turgid and fontanelle becomes flat.
Once skin becomes turgid, stop RL and start Isolyte-P (Normally 200 to 400ml RL is required).
As soon as child passes urine, add 4ml Potassium chloride to the full bottle of Isolyte-P (KCI is never injected directly). Otherwise abdomen gets distended.
Mother or nurse should continue feeding orolyte by mouth.
If abdomen becomes distended, stop oral feeds and put ryle’s tube No.5.
Case No.3: Severe Dehydration
Child looks very sick, dehydrated and is still, quiet or unconscious, skin when pinched remains as a fold, pulse is feeble, Respiration is deep and sighing, and urine stops.
This child is very critical. Do not waste time trying to give I.V. Take immediately to a Hospital or Pediatrician.
Mothers often worry about 2 things that the child is drinking too much water, and that water is just flowing down. You must explain them, that it is the other way round, that what is lost in stools is being replaced and the child needs more water.
Gastroenteritis puts a great strain on the mother. She has to sit feeding the child day and night. But that has to be done. There is no alternative.
If orolyte is started in time and given with patience, 95% of the babies do not require I.V. fluids.
Never give 5% dextrose or Isolyte-P to a severly dehydrated baby.
Parenteral fluids and electrolytes, if vomiting prevent oral intake. Blood transfusion for acute gastritis with haemetemesis ant blood loss.
Advice to Patient
A voidance of alcohol, smoking, coffee and drugs known to have caused gastritis earlier, like aspirin or NSAIDs.
Follow Up
To repeat gastroscopy after 6 weeks for those with severe gastritis, and those whose symptoms persist despite therapy. It is important ot rule out gastric malignancy. Surveillance gastroscopy advised in patients with atrophic gastritis (increased risk of cancer).
Inadequate Response
Consider H.Pylori eradication.
Prevention
Avoidance of drugs known to cause acute gastritis in patients with history or active peptic ulcer, and history of drug induced gastritis
