INTENSIVE CARE NURSING

Intensive Care Nursing

Abstract

Background: eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines.

Case presentation: A 56 years old lady is moved to the ICU from the medical ward with a 3 day history of hospitalization for small bowel obstruction. She is complaining of abdominal bloating and intermittent pain in her abdominal area. She has a naso-gastric tube to low continuous suction draining dark brown fluid and a cannula in her right forearm with an IVI of 4% Dextrose and 1/5 normal saline with 30meq KCL infusing at 100ml/hr. Her abdomen is distended with hyperactive bowel sounds in the upper and lower quadrants. The RN reports that the patient vomited 100ml coffee ground fluid 2 hours ago. vital signs are recorded as BP 102/54, PR 22, T-37.9 degrees C., Oxygen Sat 96% on 2L oxygen via nasal prongs. Her WBC count is elevated , as is her creatinine and BUN

Conclusions: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3), granulocyte macrophage colony stimulating factor (GM-CSF) and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.

Intensive Care Nursing

Background

eosinophilic gastritis is a serious disease manifesting with eosinophilia of the blood and stomach with vomiting, diarrhea, melena, weight loss and/or cachexia. Although the cause is mostly unknown, food hypersensitivity has been blamed in several cases. The disease causes edema and thickening of the bowel which may cause stenosis of the lumen in some cases. Ascites and local lymphadenopathy may be present. Microscopic examination reveals lamina propria and submucosal infiltration of eosinophils. Treatment usually consist of glucocorticoid therapy although leukotriene modifier drugs are showing effectiveness at preventing eosinophil chemotaxis. This report describes a patient with eosinophilic gastritis and discusses the disease and the differential diagnosis along with treatment options.

Case presentation

A 56 years old lady is moved to the ICU from the medical ward with a 3 day history of hospitalization for small bowel obstruction. She is complaining of abdominal bloating and intermittent pain in her abdominal area. She has a naso-gastric tube to low continuous suction draining dark brown fluid and a cannula in her right forearm with an IVI of 4% Dextrose and 1/5 normal saline with 30meq KCL infusing at 100ml/hr.This was associated with extreme weakness and cachexia. The patient had kept a food diary and was unable to associate the symptoms with any particular food. The episodes were not related to activity and occurred both at work and ...