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Gastritis (À§¿°)

The Root of Ambulatory Care (¿Ü·¡ Áø·á Áöħ¼­) Àüü ¸ñ·Ï º¸±â
KEYWORDS: ..Acute gastritis i. Acute H.pylori infection ii. Other acute infectious gastritides (bacterial, viral, parasitic, fungal) ..Chronic atrophic gastritis i. Type A: less common than type B body-predominant, autoimmune (Ab to parietal cell and intrinsic factor) ii. Type B: more common Antral predominant, H.pylori-related, environmental ..Others-uncommon i. Lymphocytic gastritis ii. Eosinophilic gastritis iii. Granulomatous gastritis : Crohn's disease, Sarcoidosis 1. Epigastric pain ..Acute gastritis symptomsÀº ¶§¶§·Î nausea, vomiting, flatulence, excess salivation, headache, malaise¸¦ µ¿¹ÝÇÒ ¼ö ÀÖ´Ù. ..Chronic gastritis´Â Á¾Á¾ asymptomaticÇϸç, chronic epigastric pain, vague dyspepsia, mild ulcer-like symptoms, nausea, anorexia, malodorous breath µî À» ³ªÅ¸³¾ ¼öµµ ÀÖ´Ù. 1. Epigastric tenderness ..Chronic gastritis´Â Á¾Á¾ clinical findingÀÌ ¾ø´Ù. Gastritis Key symptoms Key signs 1. Endoscopy : biopsy 149 The Root of ambulatory care Key tests ¢º Erythematous/exudative gastritis ¢º Flat erosive gastritis ¢º Raised erosive gastritis ¢º Atrophic gastritis ¢º Hemorrhagic gastritis Key treatments Gastritis 1. Antacid & Adsorbents ..Mucosta.. 1T tid ¾ÆÄ§, Àú³á, Ãëħ Àü ..Ulcerlmin.. 1P tid, qid ½ÄÀü 1½Ã°£ ¹× Ãëħ Àü ..Albis.. 2T bid ¾ÆÄ§, Ãëħ Àü 2. Antagonist of gastric juice ..Cimetidine.. 200mg 1T qid ¾ÆÄ§, Á¡½É, Àú³á, Ãëħ Àü(2T) ..Curan.. 150mg 1T bid ..Albis.. 2T bid ¾ÆÄ§, Ãëħ Àü 3. Prokinetics ..Ganaton.. 50mg 1T tid ½ÄÀü ..Gasmotin.. 5mg 1T tid ½ÄÀü ȤÀº ½ÄÈÄ 4. Antispasmodics - º¹ÅëÀÌ ½ÉÇÑ °æ¿ì ..Tiropa.. 1T tid ..Algiron.. 1T tid 5. Minor Tranquilizer ..Amitriptyline.. 10mg 1T, 1T-5T pohs ..Xanax.. 0.25mg 1T, 1/2-1T tid ..Buspar.. 5mg 1T, 1/2-1T tid 6. Digestants( & Simethicone) ..Festal-gold.. 1T tid ..Phazyme.. 1T tid ..Bearse.. 1T tid ..Mucosta.. - Rebamipide ..Ulcerlmin.. - Sucralfate ..Albis.. - Sucralfate, bismuth succinate, ranitidine HCL ..Gasmotin.. - Mosapride citrate ..Ganaton.. - Itopride hydrochloride ..Tiropa.. -Tiropamide ..Algiron.. - Cimetropium ..Xanax.. - Alprazolam ..Buspar.. - Buspirone 151 The Root of ambulatory care ..Minor tranquilizer ó¹æ½Ã addictive potential·Î ÀÎÇØ °¡´ÉÇϸé benzodiazepine °è¿­Àº ó¹æÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁÀ¸¸ç, SSRI³ª other anxiolytic drugs(buspirone) µîÀÌ ÁÁ´Ù. ¸¸ÀÏ benzodiazepine °è¿­ÀÇ ¾à¹°À» ó¹æÇß´Ù¸é 1°³¿ù ÀÌ»ó ó¹æÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁÀ¸¸ç ²÷À» ¶§´Â taperingÀÌ ÇÊ¿äÇÏ´Ù. ..Bloating SxÀÌ Àִ ȯÀÚ¿¡°Õ ƯÈ÷ Simethicone ¼ººÐÀÌ ÀÖ´Â ¼ÒÈ­Á¦ ó¹æÀÌ ÁÁ´Ù. ..Menetrier¡¯s disease - ÁÖ·Î À§ üºÎ¿Í ±âÀúºÎ¿¡ ½ÉÇÑ ¼Ò¿Í¼¼Æ÷ °úÁõ½Ä(foveolar hyperplasia)À¸·Î À§º® ÁÖ¸§ÀÌ ºñÈÄ µÇ´Â ÁúȯÀ¸·Î ¿øÀÎÀ» ¾Ë ¼ö ¾øÀ¸¸ç TGF-¥á°°Àº ¼ºÀåÀÎÀÚ°¡ °ú¹ßÇöµÇ¾î ÀÖ´Ù. »óº¹ºÎ ÅëÁõ, üÁß°¨¼Ò, ¿À½É, ±¸Åä µîÀÇ Áõ»óÀÌ ÀÖÀ¸¸ç ´Ü¹éÁú ¼Õ½Ç¼º À§º´ÁõÀ» º¸À̱⵵ ÇÑ´Ù. ³»½Ã°æÀû ¼Ò°ß°ú Á¶Á÷°Ë»ç¸¦ ÅëÇÏ¿© Áø´ÜÇϸç Ä¡·á´Â Ç×Äݸ°¼º ¾àÁ¦, ÇÁ·Î½ºÅ¸±Û¶õµò Á¦Á¦, À§»êºÐºñ ¾ïÁ¦Á¦, ÇÁ·¹µå´Ï¼Õ µîÀ» »ç¿ëÇϸç À§ÀüÀýÁ¦¼úÀ̳ª À§ºÎºÐÀýÁ¦¼úÀÌ ÇÊ¿äÇÑ °æ¿ìµµ ÀÖ´Ù. °¨ º°ÁúȯÀ¸·Î Á¹¸°°Å-¿¤¸®½¼ ÁõÈıº, Á¾¾ç(À§¾Ï, ¸²ÇÁ¾Ï), °¨¿°(°Å´ë¼¼Æ÷¹ÙÀÌ·¯½º, È÷½ºÅäÇöóÁî ¸¶Áõ, ¸Åµ¶), ħÀ±¼º Áúȯ(À¯À°Á¾Áõ, ¾Æ¹Ð·ÎÀ̵åÁõ) µîÀÌ ÀÖ´Ù. Helicobacter pylori ¢º G(-) microaerophilic rod, S-shaped ¢º Commonly found in the deeper portions of the mucous gel coating the gastric mucosa or between the mucous layer and the gastric epithelium ¢º Initially H.pylori resides in the antrum and then migrates toward the more proximal segments ¢º À§³»ÀÇ PH°¡ Áõ°¡ÇÏ´Â »óȲ¿¡¼­ ¼ö°¡ °¨¼ÒÇϴµ¥ ÀÌ´Â ´Ù¸¥ ¼¼±ÕµéÀÌ À§³»¿¡ Áõ½ÄÇϱ⠶§¹®ÀÌ´Ù. ¢º H.pylori Gastritis ¢º 1998³â ¿ªÇבּ¸¿¡ ÀÇÇÏ¸é ¿ì¸®³ª¶ó 16¼¼ÀÌ»ó ¼ºÀÎÀÇ 66.9%¿¡¼­ H.pylori ab(+)¿´À¸¸ç, 15 ¼¼ ÀÌÇÏÀÇ ¼Ò¾Æ¿¡¼­´Â 17.2%¿´À¸³ª, º¸Åë À¯³â½ÃÀý oral to oral, fecal to oral route¸¦ ÅëÇØ °¨¿°µÇ´Â °É·Î ¾Ë·ÁÁ® ÀÖ´Ù. ¶ÇÇÑ ¿À¿°µÈ ³»½Ã°æÀ» ÅëÇØ¼­µµ ÀüÆÄ°¡ °¡´ÉÇÏ´Ù. ¢º H.pylori¿¡ ÀÇÇØ À¯¹ßµÇ´Â Áúȯ - ¸¸¼º Ç¥À缺 À§¿°, ¸¸¼º À§Ã༺ À§¿° - À§½ÊÀÌÁöÀå ±Ë¾ç - À§¼±¾Ï - À§ MALT lymphoma ¢º Risk factors for H.pylori infection ..Birth or residence in a developing country ..Low socioeconomic status ..Domestic crowding ..Unsanitary living conditions ..Unclean food or water ..Exposure to gastric contents of infected individual ..¿ì¸®³ª¶ó¿¡¼± endoscopy with biopsy¸¦ ÅëÇÑ rapid urease test°¡ Áø´Ü ¸ñÀûÀ¸·Î Ãßõ µÈ´Ù. Âü°í ¹®Çå John B. Pope : Gastritis, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 425-427 Á¶Á¤Áø : À§¿°, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí. ¼­¿ï, °èÃø¹®È­»ç, 2002, P 943-948 Sripathi R. Kethu, M.D., Steven F. Moss, M.D. : Gastritis and Peptic Ulcer Disease, in Conn's Current Therapy 2004, Robert E. Rakel(ed), Edward T. Bope(ed_). Philadelphia, Saunders, 2004, P 542-549 °¡Å縯Àǰú´ëÇÐ ³»°úÇб³½Ç : À§¿°. in Current Principles and Clinical Practice of Internal Medicine. ¼­¿ï, ±ºÀÚÃâÆÇ»ç, 2005, P 401-410 ¿Àâ¼®(ed) : À§¿°, in Complete Guide To Practical Based Prescription Medicine. ¼­¿ï, Çѿ츮, 2005, P 65-66 ¼º±Õ°ü´ëÇб³Àǰú´ëÇÐ »ï¼º¼­¿ïº´¿ø³»°ú : Gastropathy and gastritis. in Handbook of Internal Medicine, 2nd ed. ¼­¿ï, ±ºÀÚÃâÆÇ»ç, 2004, P 7-14 ¹Î¿µÀÏ ¿Ü : »óºÎÀ§Àå°ü ³»½Ã°æ. ¼­¿ï, ±ºÀÚÃâÆÇ»ç, 2001, P 174~176 ¹ÚÀμ­ ¿ª : À§»êÁúȯ¿¬°üÀÇ º´ÅÂ¿Í Ä¡·á. ¼­¿ï, ±ºÀÚÃâÆÇ»ç, 2005, P 550