儿童胃炎英文.ppt

GASTRITISINCHILDREN,ChongqingChildrensHospitalDivisionofInfectiousDiseaseandGastroenterology,2,GastritisAcuteGastritisChronicGastritis,3,AcuteGastritis,4,DiffinationEtiology&PathogenesisPathology,Acutegastritis,5,FoodandDrugs:Severestressstate:Acuteinfection:Corrosivesubstances:,VagalstimulationAcidsecretionReleaseofvasoactiveamineandcytokinesMicrocirculationdisdurbanceGastricmucosalischemiaImpairmentofmucosalandmucousbarriersBack-diffusionofhydrogenions,Shock,hydrocephalus,suddentrauma,seriousinfection,majoroperation,etc,Acutegastritis,Etiology&Pathogenesis,6,ManifestationsAsuddenonsetTypicalmanifestations:epigastricpain,nausea,vomiting,waterydiarrheaFever:causedbybacterialinfectionoritstoxinsComplications:dehydration,electrolytedisturbances,acid-baseimbalance,UGIbleeding,Acutegastritis,Manifestations,7,Diagnosis,AcutesimplegastritisHistorysymptomsandsignsGIendoscopy&Biopsy(ifnecessary),DiffusivehyperemiaandedemaofthegastricmucosaAcuteinflammation:neutrophilicinfiltrationinthelaminapropriaMayaccompaniedwithpunctatehemorrhageandmildcorruptlesion,8,A.RemoveofoffendingagentsQuitallirritantsorstimulus:drugs,alcoholManagementoftheoriginaldiseasesB.Symptomatictreatment1)Replacementoffluidandelectrolyteloss2)Spasmolysant:Atropine,Belladonna4)Antiemeticdrugs:Domperidone3)SpecialmanagementforupperGIbleedingC.ProtectionofgastricmucosaandinhibitionofgastricacidMucosalprotectorAntacids:H2-RA,PPI,Treatment,9,Chronicgastritis,10,Thetoptworeasonsforrecurrentabdominalpaininchildrenarechronicgastritis&PUD,Anestimated10%schoolagechildrenisaffectedbyrecurrentabdominalpain.,11,Bydefinition,isahistopathologicalentitycharacterizedbychronicinflammationofthestomachmucosa.Itmaypresentwithanarrayofsymptoms,themostcommonbeingnonspecificrecurrentabdominalpaininchildren.Highfrequencyinchildren,12,Classification,UpdateSydneySystemin1996SuperficialChronicGastritisAtrophicSpecifictypes,13,Etiology,Helicobacterpylori(HP)BilerefluxDietaryHabitSequelaofacutegastritisDrugsPsychologicalandgeneticfactors:EmotionalstressChronicDiseaseOtherfactors,14,Helicobacterplori,15,HPyloriisconsideredtoinfectvirtuallyallpatientswithchronicactivegastritisandthoughttobespreadfrompersontopersonviaoral-oraland/orfecal-oralroutes.,16,Clinicalmanifestation,RecurrentabdominalpainDyspepticsymptomsExcessivebelching,acidregurgitation,hiccups,nausea,vomiting,diarrheaGrowthretardationUpperGIbleeding,17,Clinicalmanifestation,ArelativelyminormanifestationofdiseasesThesmallerthechildrenthemoreatypicalmanifestation,18,Auxiliaryexaminations,GastroscopicexaminationisthemostreliablemethodfordiagnosisofgastritisBiopsyX-ray:BariummealexaminationHPdetection,19,DiagnosticmethodsofHPinfectionRapidureasetestUreabreathtest(C13)HistologySerumAntibodiestoHPBacterialCultureTestingforHPstoolantigenPolymerasechainreaction,20,Diagnosis,Recurrentabdominalpainand/ordyspepticsymptominchildren,Gastroendoscopicexamination,History:Inappropriatedietaryhabits,familyhistory,medicationtaking,psychologicalstress,21,DifferentialDiagnosis,EnterositeEnterospasmAbdominalepilepsy,22,Treatment,Etiologictreatment:Dietaryadjustment,quitirritantdrugsorotherstimulus,HPeradication,trytocontrolthebilereflux,etcSymptomatictreatmentProtectionofgastricmucosaInhibitionofgastricacid,23,HPeradication,Tripleregimens,24,PreventionofduodenogastricReflux.DoperidomeCisaprideReducinggastricacidsecretion.H2RT(for4weeks):RanitidingCimetidinePPI(for2weeks)OmeprazoleLansoprazole,25,EnhancingmucosaldefenseBismuthcompoundsSucrafateSymptomatictreatmentAtropineBelladonna,26,NormalGastricMucosa,NGM,27,gastricmucosaledema,NGM,28,Hemorrhagicgastritis,Hemorrhagicgastritiswithmultipleintramuralbleedingspots,NGM,29,GastricLymphoidHyperplasia,Normallythereisnoorganizedlymphoidtissueinthestomach.,MultiplepapulesintheantrumcorrespondingtolymphoidhyperplasiainducedbyHelicobacterpyloriinfection.,NGM,30,AlkalineRefluxGastritis,Normalgastricmucosa,Stomachmucosadiffuselycoveredwithbile-stainedmucus.,NGM,31,GastricCandidiasis,Normalgastricmucosa,Gastriccandidiasiswithextensivegreen-whiteexudatescoveringtheantrum.,32,ChronicAntra