《儿童胃炎英》PPT课件.ppt

GASTRITISINCHILDREN ChongqingChildren sHospitalDivisionofInfectiousDiseaseandGastroenterology 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 ChronicAn