儿童胃炎gastritisinchildren英.ppt

Case,A5-year-oldgirlThiefcomplain:vomited5timesfor3hours.Whathistoryofpresentillnessdoyouwanttoknow?,2,GASTRITISINCHILDREN,Dr.LiuChonghai,4,GastritisAcuteGastritisChronicGastritis,5,AcuteGastritis,6,FoodandDrugs:(NonsteroidalAntiinflammatoryDrugs,NSAIDs)Severestressstate:Acuteinfection:Corrosivesubstances:,VagalstimulationAcidsecretionReleaseofvasoactiveamineandcytokinesMicrocirculationdisdurbanceGastricmucosalischemiaImpairmentofmucosalandmucousbarriersBack-diffusionofhydrogenions,Shock,hydrocephalus,suddentrauma,seriousinfection,majoroperation,etc,Acutegastritis,Etiology&Pathogenesis,7,ManifestationsAsuddenonsetTypicalmanifestations:epigastricpain,nausea,vomiting,waterydiarrheaFever:causedbybacterialinfectionoritstoxinsComplications:dehydration,electrolytedisturbances,acid-baseimbalance,UGIbleeding,Acutegastritis,Manifestations,8,Diagnosis,AcutesimplegastritisHistorysymptomsandsignsGIendoscopy&Biopsy(ifnecessary),DiffusivehyperemiaandedemaofthegastricmucosaAcuteinflammation:neutrophilicinfiltrationinthelaminapropriaMayaccompaniedwithpunctatehemorrhageandmildcorruptlesion,9,NormalGastricMucosa,NGM,10,gastricmucosaledema,NGM,11,Hemorrhagicgastritis,Hemorrhagicgastritiswithmultipleintramuralbleedingspots,NGM,12,A.RemoveofoffendingagentsQuitallirritantsorstimulus:drugs,alcoholManagementoftheoriginaldiseasesB.Symptomatictreatment1)Replacementoffluidandelectrolyteloss2)Spasmolysant:Atropine,Belladonna4)Antiemeticdrugs:Domperidone3)SpecialmanagementforupperGIbleedingC.ProtectionofgastricmucosaandinhibitionofgastricacidMucosalprotectorAntacids:H2-RA,PPI,Treatment,13,Chronicgastritis,14,Thetoptworeasonsforrecurrentabdominalpaininchildrenarechronicgastritis&PUD,Anestimated10%schoolagechildrenisaffectedbyrecurrentabdominalpain.,15,Bydefinition,isahistopathologicalentitycharacterizedbychronicinflammationofthestomachmucosa.Itmaypresentwithanarrayofsymptoms,themostcommonbeingnonspecificrecurrentabdominalpaininchildren.Highfrequencyinchildren,16,Classification,Non-atrophic(Superficial):90-95%ChronicGastritisAtrophicSpecifictypes,17,Etiology,Helicobacterpylori(HP)BilerefluxDietaryHabitSequelaofacutegastritisDrugsPsychologicalandgeneticfactors:EmotionalstressChronicDiseaseOtherfactors,18,Helicobacterplori,19,HPyloriisconsideredtoinfectvirtuallyallpatientswithchronicactivegastritisandthoughttobespreadfrompersontopersonviaoral-oraland/orfecal-oralroutes.,20,Clinicalmanifestation,RecurrentabdominalpainDyspepticsymptomsExcessivebelching,acidregurgitation,hiccups,nausea,vomiting,diarrheaGrowthretardationUpperGIbleeding,21,Clinicalmanifestation,ArelativelyminormanifestationofdiseasesThesmallerthechildrenthemoreatypicalmanifestation,22,Auxiliaryexaminations,GastroscopicexaminationisthemostreliablemethodfordiagnosisofgastritisBiopsyX-ray:BariummealexaminationHPdetection,23,DiagnosticmethodsofHPinfectionRapidureasetestUreabreathtest(C13)HistologySerumAntibodiestoHPBacterialCultureTestingforHPstoolantigenPolymerasechainreaction,24,NormalGastricMucosa,NGM,25,GastricLymphoidHyperplasia,Normallythereisnoorganizedlymphoidtissueinthestomach.,MultiplepapulesintheantrumcorrespondingtolymphoidhyperplasiainducedbyHelicobacterpyloriinfection.,NGM,26,AlkalineRefluxGastritis,Normalgastricmucosa,Stomachmucosadiffuselycoveredwithbile-stainedmucus.,NGM,27,GastricCandidiasis,Normalgastricmucosa,Gastriccandidiasiswithextensivegreen-whiteexudatescoveringtheantrum.,28,ChronicAntralGastritis,IncreasedvisibilityoftheantralvascularpatternwithfindingscompatiblewithchronicathrophicgastritisassociatedwithH.pyloriinfection.,Therugalfoldsofthebodyrunninglongitudinallytowardstheantrum.,29,Diagnosis,Recurrentabdominalpainand/ordyspepticsymptominchildren,Gastroendoscopicexamination,History:Inappropriatedietaryhabits,familyhistory,medicationtaking,psychologicalstress,30,DifferentialDiagnosis,Enterosite(ascarisinfection)Enterospasm,31,Treatment,Etiologictreatment:Dietaryadjustment,quitirritantdrugsorotherstimulus,HPeradication,trytocontrolthebilereflux,etcSymptomatictreatmentProtectionofgastricmucosaInhibitionofgastricacid,32,HPeradication,Tripleregimens,33,PreventionofduodenogastricReflux.Doperido