PG patients typically present with acute abdominal pain, vomiting and fever. But although this symptom triad is considered characteristic of PG [4], retrospective studies have shown that considerable shares of patients don't experience any complaints besides an acute abdomen. In detail, epigastric pain has been reported in 95% of cases, whereas nausea, vomiting and fever are described by two thirds of affected individuals only [1]. A certain relief of pain may be achieved by changing from a supine to a sitting position (Deininger's sign) [5], and fever may be accompanied by chills. Patients less commonly present hematemesis or coffee-ground emesis [6]. Moreover, purulent emesis has been reported and is considered pathognomonic for PG [7].

Upon perforation, patients deteriorate rapidly and develop signs of diffuse peritonitis, sepsis and multiple organ failure [8]. There is one case report describing the discharge of pus to liver and spleen, giving rise to multiple hepatic and splenic abscesses [9].

• Fever

  On day 10, the patient developed neutropenic fever, and the white blood count (WBC) noted to be <0.1 × 109/L with absolute neutrophil count (ANC) of 0. [hindawi.com]

  PG patients typically present with acute abdominal pain, vomiting and fever. [symptoma.com]

  A 63-year-old woman was admitted with high fever. Laboratory tests showed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal ultrasonography and computed tomography revealed multiple liver and splenic tumors. [ncbi.nlm.nih.gov]

• Gangrene

  Keywords: Acute necrotizing gastritis, gastric gangrene, subtotal gastrectomy How to cite this article: Perigela HC, Vasamsetty MK, Bangi VP, Nagabhushigari S. Gastric gangrene due to acute necrotizing gastritis. [jdrntruhs.org]

  Treatment includes surgery, antibiotics, and analgesics. acute necrotising gastritis A clinical variant of phlegmonous gastritis in which all four major gastric vessels are patent; gastric gangrene typically ensues in the face of overwhelming necrobiotic [medical-dictionary.thefreedictionary.com]

  Mukhopadhyay, M., Saha, A.K., Sarkar, A., Tripathi, S.N., Biswas, S., Mandal, D. and Mukherjee, S. (2011) Gastric Gangrene Due to necrotizing Gastritis. [file.scirp.org]

  A rare cause of stomach gangrene: Necrotizing gastritis. Open Journal of Gastroenterology. 2015;5:7–10. Article Mukhopadhyay M, Saha A, Sarkar A, et al. Gastric gangrene due to necrotizing gastritis. Indian J Surg. 2011;73(1):65–7. [acgcasereports.gi.org]

• Sepsis

  Sepsis and multiorgan failure are common. However, the rarity of this disease makes the diagnosis and choice of appropriate treatment difficult. Early recognition and therapy are important for survival. [kjim.org]

  Upon perforation, patients deteriorate rapidly and develop signs of diffuse peritonitis, sepsis and multiple organ failure. [symptoma.com]

  The impression was acute phlegmonous gastritis with sepsis. The patient was admitted to the intensive care unit (ICU) for management. [onlinelibrary.wiley.com]

  Our presumptive diagnosis was to rule out infection of gastrointestinal tract, and sepsis. Broad spectrum antibiotics and fluid infusion were administered. [ncbi.nlm.nih.gov]

• Vomiting

  M 66 None Epigastric pain, nausea, vomiting Klebsiella, Acinetobacter CT, EGD with biopsy Antibiotics Nil Discharge Liu YJ, 2013 M 84 Colon cancer, prostate cancer Fever, nausea, vomiting Polymicrobial (gram positive and gram negative organisms) CT, [hindawi.com]

  Four days prior, the patient complained of severe epigastric pain with high fever (highest temperature was 39.2 °C) and vomited. [journals.lww.com]

• Nausea

  Antibiotics, gastrectomy Nil Discharge Matsumoto H, 2015 M 74 Myelofibrosis, multiple myeloma, neutropenia Epigastric pain, nausea Bacillus spp. [hindawi.com]

  A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. [ncbi.nlm.nih.gov]

  It usually presents with upper gastrointestinal symptoms, such as nausea, vomiting, and hematemesis, along with systemic symptoms, including fever, chills, and fatigue. [cureus.com]

  Kim and Kim: Phlegmonous gastritis in an ankylosing spondylitis patient treated with infliximab A 51-year old man, with a 2-year history of ankylosing spondylitis (AS), was hospitalized for severe nausea and vomiting. [kjim.org]

• Epigastric Pain

  Park CW, 2010 F 73 Gastric outlet narrowing Epigastric pain, abdominal distension E. coli, Acinetobacter CT, EGD with biopsy Antibiotics, pyloric stent Nil Discharge Rada-Palomino et al., 2014 [8] M 62 HIV Epigastric pain, hematemesis, diarrhea Streptococcus [hindawi.com]

  Phlegmonous gastritis is an acute inflammatory process of the stomach clinically characterized by acute localized noncolicky epigastric pain, purulent vomiting, fever, and leukocytosis. [ncbi.nlm.nih.gov]

  It presents with epigastric pain and vomiting. Other symptoms include fevers, chills, diarrhea, and hematemesis [4]. The diagnosis can be made using abdominal ultrasound, CT scan, endoscopy, and endoscopic ultrasound. [cureus.com]

  Superficial palpation produced epigastric pain and no organomegaly. [gastromexico.elsevier.es]

• Severe Abdominal Pain

  A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. [ncbi.nlm.nih.gov]

  We treated a patient with a high fever who complained of severe abdominal pain after ESD. Abdominal computed tomography (CT) revealed a diffuse, submucosal, minimally attenuated lesion and mucosal irregularity. [dbpia.co.kr]

  The authors report a case of a 59-year-old man who had severe abdominal pain with signs of peritonitis. [kci.go.kr]

  You should see a doctor if you have any of the following: Blood when you have a bowel movement Severe abdominal pain Heartburn not relieved by antacids Unintended weight loss Ongoing vomiting or diarrhea NIH: National Institute of Diabetes and Digestive [icdlist.com]

  Clinical symptoms are severe abdominal pain, inability to tolerate food, fever, and chills. 4,6 At present, treatment ranging from antibiotic therapy to gastric resection is controversial. 3,4 A 35-year-old man had a past history of non-atrophic gastritis [gastromexico.elsevier.es]

• Upper Abdominal Pain

  The authors report a case of a 32-year-old woman who had severe upper abdominal pain without signs of peritoneal irritation. Endoscopy showed edematous and reddened gastric mucosa with a mass lesion in the gastric antrum. [ncbi.nlm.nih.gov]

  In a patient with a history of large ethanol intake, a recent bout of "gastritis," or recent upper respiratory infection, who presents with acute upper abdominal pain, peritonitis… CONTINUE READING [semanticscholar.org]

  When admitted to the emergency department, he initially presented with upper abdominal pain, and fever for three days. [onlinelibrary.wiley.com]

Laboratory analyses of blood samples should be conducted to assess the patient's general condition and typically yield the following results [5]:

• Moderate to severe leukocytosis
• Increased erythrocyte sedimentation rate
• Elevation of C-reactive protein
• Unaltered levels of amylase and lipase (contrary to patients suffering from acute pancreatitis)

Such results are non-specific, though, and it is necessary to perform diagnostic imaging in order to correlate the clinical picture with severe gastritis. Endoscopy is very helpful to this end, but computed tomography scans may also be carried out. During an endoscopic examination, multiple lesions of the gastric mucosa may be observed. In general, they are largely covered by mucopurulent exudate and are prone to bleed. Generalized edema and erythema are also seen. Endosonography may allow for a better examination of deeper layers of the gastric wall. In this context, hypoechoic lesions in the submucosal layer have been described [1]. Images obtained by means of computed tomography typically show marked thickening of the gastric wall and intramural hypodense regions [10].

• Gastric Lesion

  Endoscopic submucosal dissection (ESD) is widely used to treat a variety of gastric lesions including early gastric cancer and gastric adenoma. Bleeding and perforation are the most common complications of ESD. [dbpia.co.kr]

The patient was given empirical antibiotic treatment, and the white blood cell decreased dramatically. Surgical intervention was discussed but deferred. Despite continued antibiotics treatment, the patient died. [ncbi.nlm.nih.gov]

Acute PG has an extremely high mortality rate, and the key to successful treatment is early diagnosis and treatment. [journals.lww.com]

Phlegmonous gastritis is an unusual infection of the gastric wall, which is extremely rare and associated with a poor prognosis. [ncbi.nlm.nih.gov]

Prognosis: —The prognosis is always unfavorable. Usually death results within a few days. In an occasional case the symptoms may be milder, but there is chilliness, with erratic temperature, increasing prostration and ultimate death. [henriettes-herb.com]

Prognosis In most cases prognosis for acute gastritis is good if the stomach was cleansed in time and the right treatment was prescribed. [ahealthgroup.com]

Treatment and prognosis Phlegmonous gastritis therapy requires aggressive supportive care with powerful antimicrobial agents. Occasionally surgery might be required. There is risk of developing peritonitis is 70% of cases. [radiopaedia.org]

The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection. [ncbi.nlm.nih.gov]

Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDS autoimmune caustic ingestion [radiopaedia.org]

Etiology: —The disease appears at all ages of adult life, very rarely as a primary disorder. Usually it follows as a sequel to acute infectious fevers, notably those strictly designated as septic fevers. [henriettes-herb.com]

Otorhinolaryngology (26) Medical Chemistry and Biochemistry (24) Dermatology (17) Cardiology, Angiology (15) Dentistry (15) Endocrinology, Metabolism (14) Immunology, Allergology (13) Respiratory Medicine (13) Diabetology, Dietetics (12) Obstetrics, Gynaecology (11) Epidemiology [portal.mefanet.cz]

Updated content prepares you for today's practice with the latest on morbidity, mortality, and epidemiology; invasive squamous cell carcinoma; scoliosis; joint replacements; chest tubes and lines; MRSA (antibiotic-resistant staph infection); systemic [books.google.de]

There are 4 epidemiologic types of KS. Classic KS is an indolent cutaneous form mainly found on lower extremities and affecting older men of Mediterranean and Jewish origin. [archivesofpathology.org]

[…] conventional thinking was that no bacterium could live in the acid environment of the La gastritis puede ser aguda es decir de inicio reciente o crnica. knowledge & awareness; causes of injury; road safety behaviours; Software Configuration Management Epidemiology [banksuenden.eu]

The clinical epidemiology of GERD is related to diet. It has been speculated that certain dietary factors may play a role in the pathogenesis or course of GERD. [search.koreanstudies.net]

Am Surg. 1970; 36: 225-231 Weinstein WM Other types of gastritis and gastrophathies, including Menetrier's Disease. in: Sleisenger MH Fordtran JS Gastrointestinal and liver disease: pathophysiology/diagnosis/management. [clinicalimaging.org]

[…] speculated that patients with a medical history of recurrent gastritis, those suffering from chronic ulcer that may or may not be the result of drug abuse, as well as immunocompromised individuals are at higher risks of developing PG, but the disease' pathophysiology [symptoma.com]

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Pathophysiology There are a large number of different causes of acute gastritis but the most common ones include direct trauma, food poisoning, allergies, radiation, shock, acute stress, fungal infections, viral infections, bacterial infections, ischemia [ic.steadyhealth.com]

The pathophysiology of PG is not fully understood. Patients present with abdominal pain, nausea, vomiting, and fever. [cureus.com]

Several randomized clinical trials have demonstrated the efficacy of ICDs in the primary prevention of SCD. [search.koreanstudies.net]

A proton pump inhibitor and a steroid hormone were administered every day to prevent peptic ulcer formation and secondary adrenal insufficiency. [jstage.jst.go.jp]

Remedies that exercise a soothing influence upon the stomach should be used in conjunction with echinacea, baptisia and calcium sulphid, to prevent or retard the development of pus and to antagonize pyemia. [henriettes-herb.com]

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Dry skin Comprehensive overview covers causes risk factors treatment and prevention. These foods also be included in your diet. [fcemprague2016.eu]

Phlegmonous gastritis (PG), sometimes also referred to as suppurative gastritis, is a rare type of stomach infection and inflammation. It is provoked by pyogenic bacteria, most commonly by pathogens of the genus Streptococcus [1], and is associated with high mortality [2]. It has been speculated that patients with a medical history of recurrent gastritis, those suffering from chronic ulcer that may or may not be the result of drug abuse, as well as immunocompromised individuals are at higher risks of developing PG [3], but the disease' pathophysiology remains poorly understood. About half of PG patients have no medical history of stomach disease. PG may be restricted to determined parts of the stomach lining, or may affect the whole stomach. Accordingly, localized and diffuse PG may be distinguished. Successful treatment regimens comprise the administration of antibiotics and surgery. Because survival rates are similar in either case, most patients are initially prescribed antibiotics and surgical interventions are postponed for refractory cases and complications [2]. If necessary, partial or complete gastrectomy may be performed.

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2. Rada-Palomino A, Muñoz-Duyos A, Pérez-Romero N, et al. Phlegmonous gastritis: A rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. Rev Esp Enferm Dig. 2014; 106(6):418-424.
3. Kavalar R, Skok P, Kramberger KG. Phlegmonous gastritis in a patient with rheumatoid arthritis. Wien Klin Wochenschr. 2005; 117(9-10):364-368.
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5. Alonso JV, de la Fuente Carillo JJ, Gutierrez Solis MA, Vara Morate FJ, Lopez Ruiz DJ. Gastric wall abscess presenting as thoracic pain: rare presentation of an old disease. Ann Gastroenterol. 2013; 26(4):360-362.
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7. Nicholson BW, Maull KI, Scher LA. Phlegmonous gastritis: clinical presentation and surgical management. South Med J. 1980; 73(7):875-877.
8. Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol. 2014; 20(12):3383-3387.
9. Sakata T, Narita M, Ohtani N, et al. A case of phlegmonous gastritis with multiple liver and splenic abscesses. Nihon Shokakibyo Gakkai Zasshi. 2011; 108(1):50-58.
10. Sood BP, Kalra N, Suri S. CT features of acute phlegmonous gastritis. Clin Imaging. 2000; 24(5):287-288.