Pangastritis is a form of gastritis which only affects the whole stomach region.

1. Case study on Pangastritis with pancreatitis
J. Anisha Ebens
Pharm D intern

2. A male patient of age 48, was admitted in the hospital on
11.02.2019
C/O: Abdominal pain x 2days
Constipation x 1 week
23/2 - Abd. Pain
H/O: Vomiting 4-5 episodes on 6/2
Abdominal pain 2 weeks ago, admitted in Standley and
was diagnosed with small tiny cystic lesion of liver in CECT.
Past Medical History:
N/K/C/O- DM/SHT/IHD/Epilepsy/BA
Past case of Hyperthyroidism x 2years

3. Past Medication History:
T. Carbimazole 5mg OD
Personal History: Takes mixed diet, ash exposure in work x 4yrs, has a
family history of DM
Social Habits: Alcoholic for 6-8 yrs monthly 3-4 days, pan chewer
Vitals: Normal, mild pallor
General Examination:
Temp.: Afebrile BP: 140/80
PR : 78 beats/min RR: 20 breaths/min
Systems examination:
CVS: S₁S₂ + RS: NVBS +
CNS: NFND P/A: soft, tenderness lower abdomen++

4. Lab investigation: S. Amylase – 345.6 U/L (<140 U/L), S. Lipase – 380.3
U/L (<140 U/L)Parameters Report values Normal values
HB (On 1/2/19 – 8.5) 11.3 12 – 16 g/dl
TLC 7400 3800 – 11000 Cells/mm³
ESR 7/14 0 – 29 mm/hr
DC N-61, L-37, E-2 N: 45-75, L: 16-46, E: 0-8
BT/CT 2’00”/4’15” 2-7/8-15 mins
BUN 20 8 – 25mg/dl
Cr 0.5 0.5 – 1.1 mg/dl
Na+ 132 135-145 mEq/L
BILI (T) 0.6 0.1 – 1.2 mg/dL
BILI (D) 0.4 <0.3 mg/dL
ALT 21 7- 56 U/L
AST 19 10 – 40 U/L
Albumin 2.7 3.5 – 5.5 g/dL
ALP PHOS 99 44 – 147 IU/L
T. Protein 6.6 6 – 8.3 g/dL
FT4 2.9 0.9 – 1.7 ng/dL
TSH 0.01 0.3 – 4.2 mIU/L

5. Other investigation:
USG, Peripheral smear, OGD (oesophago-gastro-duodenoscopy) ,
Multislice CT, CT Angiogram, Stool occult blood.
Impression: USG – N, CT Angiogram – N, Peripheral smear – Microcytic
Hypochromic type
Multislice CT – Tiny cystic lesion in segment 4b of liver.
Suspicious filling defect noted in SMA (Superior Mesenteric Artery) –
suggested abd. Angiogram.
OGD- Pharynx, Vocal cord, Oesophagus – N; Stomach – Fundus, Body,
Antrum, Pylorus – Gastritis; Duodenum – N
Stool Occult Blood- 18/2 – Positive
22/2 - Negative
Diagnosis: Pancreatitis, Pangastritis with anemia

6. Pancreatitis:
• The pancreas is a large gland behind
the stomach and next to the small intestine.
• Pancreatitis is a disease in which the
pancreas becomes inflamed. Pancreatic
damage happens when the digestive enzymes
are activated before they are released into
the small intestine and begin attacking the
pancreas.
There are two forms of pancreatitis: acute and
chronic.
• Acute pancreatitis. Acute pancreatitis is a
sudden inflammation that lasts for a short
time.
• In severe cases, acute pancreatitis can result

7. • Chronic pancreatitis. Chronic pancreatitis is
long-lasting inflammation of the pancreas. It
most often happens after an episode of acute
pancreatitis. Heavy alcohol drinking is another
big cause. Damage to the pancreas from
heavy alcohol use may not cause symptoms
for many years, but then the person may
suddenly develop severe pancreatitis
symptoms.
Symptoms of acute pancreatitis:
• Upper abdominal pain that radiates into the
back; it may be aggravated by eating,
especially foods high in fat.
• Swollen and tender abdomen
• Nausea and vomiting
• Fever
• Increased heart rate

8. Symptoms of chronic pancreatitis:
• The symptoms of chronic pancreatitis are
similar to those of acute pancreatitis. Patients
frequently feel constant pain in the upper
abdomen that radiates to the back. In some
patients, the pain may be disabling.
Causes
• In most cases, acute pancreatitis is caused
by gallstones or heavy alcohol use. Other
causes include medications, autoimmune
disease, infections, trauma, metabolic
disorders, and surgery. In up to 15% of
people with acute pancreatitis, the cause is
unknown.
• In about 70% of people, chronic pancreatitis
is caused by long-time alcohol use.

9. Diagnosis:
• Pancreatic function test to find out if the pancreas is making
the right amounts of digestive enzymes
• Glucose tolerance test to measure damage to the cells in the
pancreas that make insulin
• Ultrasound, CT scan, and MRI, which make images of the
pancreas so that problems may be seen
• Biopsy, in which a needle is inserted into the pancreas to
remove a small tissue sample for study
Treatment for acute pancreatitis
• People with acute pancreatitis are typically treated with IV
fluids and pain medications in the hospital.
• An acute attack of pancreatitis caused by gallstones may
require removal of the gallbladder or surgery of the bile duct.
After the gallstones are removed and the inflammation goes
away, the pancreas usually returns to normal.
Treatment for chronic pancreatitis
• Chronic pancreatitis can be difficult to treat. Doctors will try to
relieve the patient's pain and improve the nutrition problems.
Patients are generally given pancreatic enzymes and may
need insulin. A low-fat diet may also help.

10. Pangastritis
• Acute gastritis is a term covering a broad
spectrum of entities that induce inflammatory
changes in the gastric mucosa.
• The inflammation may involve the entire stomach
(eg, pangastritis) or a region of the stomach (eg,
antral gastritis). Acute gastritis can be broken
down into 2 categories: erosive (eg, superficial
erosions, deep erosions, hemorrhagic erosions)
and nonerosive (generally caused by Helicobacter
pylori).
• Symptoms include nausea, vomiting, loss of
appetite, belching, and bloating. Occasionally,
acute abdominal pain can be a presenting
symptom. Fever, chills, and hiccups also may be
present.
• The diagnosis of acute gastritis may be
suspected from the patient's history and can be
confirmed histologically by biopsy specimens

11. • Acute gastritis has a number of causes,
including certain drugs; alcohol; bacterial,
viral, and fungal infections; acute stress
(shock); radiation; allergy and food
poisoning; bile; ischemia; and direct
trauma.
Medications used to treat gastritis include:
• Antibiotic medications to kill H. pylori
antibiotics
• Medications that block acid production
and promote healing. Proton pump
inhibitors (omeprazole)
• Medications to reduce acid

12. Drug Chart:
S.No Drug name Dose ROA Freq. No. of days
1 IVF. RL 2 pint IV BD 11, 14, 23-26
2 Inj. Ciprofloxacin 200mg IV BD 11-13
3 Inj. Ranitidine 50 mg IV 1-0-1 11-14, 22
4 Inj. Metronidazole 400mg IV BD 11-13
5 Inj. Ondansetron 1cc IV Stat 11, 23-26
6 T. Serratiopeptidase 10mg P/O TDS 12- 20
7 Inj. Dicyclomine 20mg/2ml IM BD 12 - 18
8 Inj. Pantoprazole 40mg IV 1-0-1 14 - 24
9 Syp. Lactulose 10ml P/O HS 15 – 26
10 T. Dicyclomine 10mg P/O 1-1-1 14 - 22
11 Cap. Bifilac I cap P/O OD 21 - 26
12 T. Acetaminophen 500mg P/O TDS 22
13 T. Lupizyme 1 tab P/O 0-1-0 23 - 26
14 Inj. Tramadol 2CC IM SOS 23, 24

13. Discarge advice:
Patient discharged on 27.2.19 with the following drugs
T. Ondansetron 4mg BD
T. Rantac 150mg 1-0-1
Syp. Lactulose 10ml HS
T. Lupizyme 1 tab 0-1-0
The patient was asked to review after 2 weeks.

14. FARM Notes:
Findings: Major interaction: Tamadol & Ondansetron
Ciprofloxacin & Metronidazole
Assesment: Tamadol & Ondansetron – concurrent use result in
increase risk of serotonin syndrome
Ciprofloxacin & Metronidazole– concurrent use results
in QT prolongation.
Resolution: Avoid concurrent administration.
Monitoring: Monitor ECG during the course of therapy.