精选儿童胃炎gastritisinchildre课件.ppt

1、vA 5-year-old girl vThief complain: vomited 5 times for 3 hours.vWhat history of present illness do you want to know?24 Gastritisn Acute Gastritisn Chronic Gastritis56Food and Drugs: (Nonsteroidal Antiinflammatory Drugs,NSAIDs)Severe stress state:Acute infection: Corrosive substances:Vagal stimulati

2、onAcid secretionRelease of vasoactive amine and cytokinesMicrocirculation disdurbanceGastric mucosal ischemiaImpairment of mucosal and mucous barriersBack-diffusion of hydrogen ions Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc 7 A sudden onsetTypical manifestations: e

3、pigastric pain, nausea, vomiting, watery diarrheaFever: caused by bacterial infection or its toxinsComplications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleeding8 Acute simple gastritis Historysymptoms and signsGI endoscopy & Biopsy (if necessary) Diffusive hyperemia and ede

4、ma of the gastric mucosa Acute inflammation: neutrophilic infiltration in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion91011Hemorrhagic gastritis with multiple intramural bleeding spots 12A. Remove of offending agents Quit all irritants or stimulus: drugs, alcoho

5、l Management of the original diseasesB. 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 An

6、tacids: H2-RA, PPI131415vBy definition, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. vIt may present with an array of symptoms, the most common being nonspecific recurrent abdominal pain in children.vHigh frequency in children16 Non-atrophic(Superficial)

7、:90-95% Chronic Gastritis Atrophic Specific types17v Helicobacter pylori (HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors: Emotional stressvChronic DiseasevOther factors1819H Pylori is considered to infect virtually all patients with chronic acti

8、ve gastritis and thought to be spread from person to person via oral-oral and/or fecal-oral routes.202122vGastroscopic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray: Barium meal examinationvHP detection23vRapid urease test vUrea breath test(C13)vHistology vSerum Ant

9、ibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction 2425Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.26Stomach mucosa diffusely covered with bile-stained mucus. 27Gastric candidiasis with extensive g

10、reen-white exudates covering the antrum. 28Increased visibility of the antral vascular pattern with findings compatible with chronic athrophic gastritis associated with H. pylori infection. The rugal folds of the body running longitudinally towards the antrum. 29Recurrent abdominal pain and/or dyspe

11、ptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits, family history, medication taking, psychological stress30Enterosite(ascaris infection)Enterospasm31vEtiologic treatment: Dietary adjustment, quit irritant drugs or other stimulus, HP eradication, try to control

12、 the bile reflux, etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acid32Choose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimens33v Prevention of duodenogastric Reflux. Doperidome Cisapridev Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole34v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine Belladonna35