GASTRITIS

DEFINITION: Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).

ETIOLOGY: Gastritis may be caused by:

Certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids Alcohol Eating or drinking corrosive substances Extreme stress Infections, such as the bacteria Helicobacter pylori, or much less often, cytomegalovirus or herpes simplex virus

Risk Factors:

Aspirin or NSAID use Recent heavy alcohol use Major surgery Kidney failure Liver failure Respiratory failure

PATHOPHYSIOLOGY:

ASSESSMENT/CLINICAL MANIFESTATIONS: Nausea or recurrent upset stomach Abdominal bloating Abdominal pain Vomiting Indigestion Burning or gnawing feeling in the stomach between meals or at night Hiccups Loss of appetite

Vomiting blood or coffee ground-like material Black, tarry stools

LAB/DIAGNOSTIC EXAMS: Upper endoscopy Blood tests Fecal occult blood test (stool test)

NURSING MANAGEMENT: Avoiding hot and spicy foods. Eliminating irritating foods from your diet such as lactose from dairy or gluten from wheat. Avoidance of alcohol intake Stoppage of NSAIDs

MEDICAL MANAGEMENT: Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas. For gastritis caused by H. pylori infection, your doctor will prescribe a regimen of several antibiotics plus an acid blocking drug (used for heartburn). If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given. Taking histamine blockers (H2 blockers), proton pump inhibitors (PPI's)

IDC - Invasive Ductal Carcinoma

DEFINITION: Invasive ductal carcinoma refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. INCIDENCE: More common as women grow older. About two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. Leading cause of cancer mortality in women, second to lung cancer Invasive ductal carcinoma also affects men.

ETIOLOGY: Family history suggests a predisposition to the disease Multiple relatives with breast cancer Early age at diagnosis Ovarian cancer Inherited genetic mutations

Risk Factors: Female History of previous breast cancer Age >40 years Menstrual history: early menarche, late menopause, or both Reproductive history: nulliparity; 1st child after 30 years Family history: mother, sister, or both

PATHOPHYSIOLOGY:

ASSESSMENT/CLINICAL MANIFESTATIONS:

swelling of all or part of the breast skin irritation or dimpling

breast pain nipple pain or the nipple turning inward redness, scaliness, or thickening of the nipple or breast skin a nipple discharge other than breast milk a lump in the underarm area

LAB/DIAGNOSTIC EXAMS: Tests for Diagnosing IDC:

Physical examination of the breasts Mammography Ultrasound Breast MRI Biopsy Fine needle aspiration Core needle biopsy Incisional biopsy Excisional biopsy

Tests for Staging IDC: Staging is the process used to figure out how far invasive ductal carcinoma may have spread from its original location. The stage of the cancer is based on three pieces of information: the size of the tumor whether the cancer has spread to any lymph nodes, and if so, how many whether the cancer has spread to other parts of the body

Invasive ductal carcinoma is described on a scale from stage I (the earliest stage) through stage IV (the most advanced stage).

Tests that could be done include: Bone scan CT (computerized tomography) scan, ultrasound, or MRI PET/CT scan

NURSING MANAGEMENT: MEDICAL MANAGEMENT: Local Treatments for IDC: Surgery and Radiation Therapy Local treatments treat the tumor and the surrounding areas, such as the chest and lymph nodes. Surgery Lumpectomy Mastectomy Partial or segmental mastectomy (sometimes also called quadrantectomy) Total or simple mastectomy Modified radical mastectomy

Unless the tumor is very small and has other features that lymph node spread is highly unlikely, you will need to have one of the following procedures as part of your surgery: Sentinel lymph node biopsy Axillary lymph node dissection

Radiation therapy External beam radiation Internal partial-breast irradiation External partial-breast irradiation

Systemic Treatments for IDC: Chemotherapy, Hormonal Therapy, Targeted Therapies Systemic treatments travel throughout the body to destroy any cancer cells that may have left the original tumor and to help reduce the risk of the cancer coming back.

 Chemotherapy Adriamycin (chemical name: doxorubicin) Ellence (chemical name: epirubicin) Cytoxan (chemical name: cyclophosphamide) Taxotere (chemical name: docetaxel) Taxol (chemical name: paclitaxel) Xeloda (chemical name: capecitabine) Ixempra (chemical name: ixabepilone) Methotrexate Fluorouracil (also called 5-fluorouracil or 5-FU)

Hormonal therapy There are two types of hormonal therapy that are most frequently used: Selective estrogen-receptor response modulators (SERMs) Aromatase inhibitors

Other types of hormonal therapy include: Estrogen-receptor downregulators (ERDs) Ovarian shutdown or removal

HER2-targeted therapies Herceptin (chemical name: trastuzumab) works at the cancer cells surface to block the chemical signals that stimulate uncontrolled cell growth. Tykerb (chemical name: lapatinib) is a type of anti-HER2 therapy that works inside the cell, rather than at the cell surface as Herceptin does. Perjeta (chemical name: pertuzumab) works like Herceptin by attaching itself to the HER2 receptors on the surface of breast cancer cells and blocking them from receiving growth signals.

 Other targeted therapies Avastin (chemical name: bevacizumab), a medication that targets a protein called VEGF, or vascular endothelial growth factor. VEGF plays a key role in stimulating the process cancer cells use to create new blood vessels, which is known as angiogenesis.