儿童胃炎英课件

1、GASTRITIS IN CHILDRENChongqing Childrens HospitalDivision of Infectious Disease and Gastroenterology儿童胃炎英GASTRITIS IN CHILDRENChongqin Gastritis Acute Gastritis Chronic Gastritis儿童胃炎英2 Gastritis儿童胃炎英2Acute Gastritis儿童胃炎英3Acute Gastritis儿童胃炎英3 Diffination Etiology & Pathogenesis PathologyAcute gastri

2、tis儿童胃炎英4Acute gastritis儿童胃炎英4Food and Drugs: Severe stress state:Acute infection: Corrosive substances:Vagal stimulationAcid secretionRelease of vasoactive amine and cytokinesMicrocirculation disdurbanceGastric mucosal ischemiaImpairment of mucosal and mucous barriersBack-diffusion of hydrogen ions

3、 Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc Acute gastritisEtiology & Pathogenesis儿童胃炎英5Food and Drugs: Vagal stimulat ManifestationsA sudden onsetTypical manifestations: epigastric pain, nausea, vomiting, watery diarrheaFever: caused by bacterial infection or its t

4、oxinsComplications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleedingAcute gastritisManifestations儿童胃炎英6 ManifestationsAcute gastritisDiagnosis Acute simple gastritis Historysymptoms and signsGI endoscopy & Biopsy (if necessary)Acute gastritis Diffusive hyperemia and edema of

5、the gastric mucosa Acute inflammation: neutrophilic infiltration in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion儿童胃炎英7Diagnosis Acute simple gastritA. Remove of offending agents Quit all irritants or stimulus: drugs, alcohol Management of the original diseasesB.

6、 Symptomatic treatment 1)Replacement of fluid and electrolyte loss 2)Spasmolysant: Atropine, Belladonna 4)Antiemetic drugs: Domperidone 3)Special management for upper GI bleedingC. Protection of gastric mucosa and inhibition of gastric acid Mucosal protector Antacids: H2-RA, PPITreatment Acute gastr

7、itis儿童胃炎英8A. Remove of offending agentsTChronic gastritis儿童胃炎英9Chronic gastritis儿童胃炎英9The top two reasons for recurrent abdominal pain in children are chronic gastritis & PUDAn estimated 10% school age children is affected by recurrent abdominal pain.儿童胃炎英10The top two reasons for recurrBy definitio

8、n, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. It may present with an array of symptoms, the most common being nonspecific recurrent abdominal pain in children.High frequency in childrenChronic gastritis儿童胃炎英11By definition, is a histopathoClassificatio

9、n Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific typesChronic gastritis儿童胃炎英12Classification Update Sydney Etiology Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Psychological and genetic factors: Emotional stressChronic DiseaseOthe

10、r factorsChronic gastritis儿童胃炎英13Etiology Helicobacter pylori (Helicobacter ploriChronic gastritis儿童胃炎英14Helicobacter ploriChronic gastH Pylori is considered to infect virtually all patients with chronic active gastritis and thought to be spread from person to person via oral-oral and/or fecal-oral

11、routes.Chronic gastritis儿童胃炎英15H Pylori is considered to infeClinical manifestation Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding Chronic gastritis儿童胃炎英16Clinical manifestation RecurreClini

12、cal manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Chronic gastritis儿童胃炎英17Clinical manifestation A relatAuxiliary examinationsGastroscopic examination is the most reliable method for diagnosis of gastritisBiopsyX-ray: Barium meal

13、examinationHP detectionChronic gastritis儿童胃炎英18Auxiliary examinationsGastroscDiagnostic methods of HP infectionRapid urease test Urea breath test(C13)Histology Serum Antibodies to HPBacterial Culture Testing for HP stool antigenPolymerase chain reaction Chronic gastritis儿童胃炎英19Diagnostic methods of

14、HP infecDiagnosisRecurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits, family history, medication taking, psychological stressChronic gastritis儿童胃炎英20DiagnosisRecurrent abdominal pDifferential DiagnosisChronic gastritisEnterosi

15、teEnterospasmAbdominal epilepsy儿童胃炎英21Differential DiagnosisChronic TreatmentEtiologic treatment: Dietary adjustment, quit irritant drugs or other stimulus, HP eradication, try to control the bile reflux, etcSymptomatic treatmentProtection of gastric mucosaInhibition of gastric acidChronic gastritis

16、儿童胃炎英22TreatmentEtiologic treatment:CHP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimensChronic gastritis儿童胃炎英23HP eradicationChoose one drug Prevention of

17、 duodenogastric Reflux. Doperidome Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole LansoprazoleChronic gastritis儿童胃炎英24 Prevention of duodenogastric Enhancing mucosal defense Bismuth compounds Sucrafate Symptomatic treatment Atropine

18、BelladonnaChronic gastritis儿童胃炎英25 Enhancing mucosal defenseChroNormal Gastric Mucosa NGM儿童胃炎英26Normal Gastric Mucosa NGM儿童胃炎英gastric mucosal edema NGM儿童胃炎英27gastric mucosal edema NGM儿童胃炎英Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM儿童胃炎英28Hemorrhagic gastritis HemorrhGastric Lymphoid HyperplasiaNormally there is no organized lymphoid tissue in the stomach. Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.NGM儿童胃炎英29Gastric Lymphoid Hyp