儿童胃炎gastritisinchildren英课件

1、儿童胃炎儿童胃炎gastritisinchildren英英1 1 vA 5-year-old girl vThief complain: vomited 5 times for 3 hours. vWhat history of present illness do you want to know? 儿童胃炎儿童胃炎gastritisinchildren英英2 2 儿童胃炎儿童胃炎gastritisinchildren英英 儿童胃炎儿童胃炎gastritisinchildren英英4 4 Gastritis n Acute Gastritis n Chronic Gastritis 儿童胃炎

2、儿童胃炎gastritisinchildren英英5 5 儿童胃炎儿童胃炎gastritisinchildren英英6 6 Food and Drugs: (Nonsteroidal Antiinflammatory Drugs,NSAIDs) Severe stress state: Acute infection: Corrosive substances: Vagal stimulation Acid secretion Release of vasoactive amine and cytokines Microcirculation disdurbance Gastric mucos

3、al ischemia Impairment of mucosal and mucous barriers Back-diffusion of hydrogen ions Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc 儿童胃炎儿童胃炎gastritisinchildren英英7 7 v A sudden onset Typical manifestations: epigastric pain, nausea, vomiting, watery diarrhea Fever: cause

4、d by bacterial infection or its toxins Complications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleeding 儿童胃炎儿童胃炎gastritisinchildren英英8 8 Acute simple gastritis History symptoms and signs GI endoscopy & Biopsy (if necessary) Diffusive hyperemia and edema of the gastric mucosa A

5、cute inflammation: neutrophilic infiltration in the lamina propria May accompanied with punctate hemorrhage and mild corrupt lesion 儿童胃炎儿童胃炎gastritisinchildren英英9 9 儿童胃炎儿童胃炎gastritisinchildren英英1010 儿童胃炎儿童胃炎gastritisinchildren英英1111 Hemorrhagic gastritis with multiple intramural bleeding spots 儿童胃炎儿

6、童胃炎gastritisinchildren英英1212 A. Remove of offending agents Quit all irritants or stimulus: drugs, alcohol Management of the original diseases B. Symptomatic treatment 1)Replacement of fluid and electrolyte loss 2)Spasmolysant: Atropine, Belladonna 4)Antiemetic drugs: Domperidone 3)Special management

7、 for upper GI bleeding C. Protection of gastric mucosa and inhibition of gastric acid Mucosal protector Antacids: H2-RA, PPI 儿童胃炎儿童胃炎gastritisinchildren英英1313 儿童胃炎儿童胃炎gastritisinchildren英英1414 儿童胃炎儿童胃炎gastritisinchildren英英1515 vBy definition, is a histopathological entity characterized by chronic in

8、flammation 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 children 儿童胃炎儿童胃炎gastritisinchildren英英1616 Non-atrophic(Superficial):90-95% Chronic Gastritis Atrophic Specific types 儿童胃炎儿童胃炎gastri

9、tisinchildren英英1717 v Helicobacter pylori (HP) v Bile reflux v Dietary Habit v Sequela of acute gastritis v Drugs v Psychological and genetic factors: Emotional stress vChronic Disease vOther factors 儿童胃炎儿童胃炎gastritisinchildren英英1818 儿童胃炎儿童胃炎gastritisinchildren英英1919 H Pylori is considered to infect

10、 virtually all patients with chronic active gastritis and thought to be spread from person to person via oral-oral and/or fecal-oral routes. 儿童胃炎儿童胃炎gastritisinchildren英英2020 儿童胃炎儿童胃炎gastritisinchildren英英2121 儿童胃炎儿童胃炎gastritisinchildren英英2222 vGastroscopic examination is the most reliable method for

11、 diagnosis of gastritis vBiopsy vX-ray: Barium meal examination vHP detection 儿童胃炎儿童胃炎gastritisinchildren英英2323 vRapid urease test vUrea breath test(C13) vHistology vSerum Antibodies to HP vBacterial Culture vTesting for HP stool antigen vPolymerase chain reaction 儿童胃炎儿童胃炎gastritisinchildren英英2424 儿

12、童胃炎儿童胃炎gastritisinchildren英英2525 Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection. 儿童胃炎儿童胃炎gastritisinchildren英英2626 Stomach mucosa diffusely covered with bile-stained mucus. 儿童胃炎儿童胃炎gastritisinchildren英英2727 Gastric candidiasis with exten

13、sive green-white exudates covering the antrum. 儿童胃炎儿童胃炎gastritisinchildren英英2828 Increased 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. 儿

14、童胃炎儿童胃炎gastritisinchildren英英2929 Recurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress 儿童胃炎儿童胃炎gastritisinchildren英英3030 Enterosite(ascaris infection) Enterospasm 儿童胃炎儿

15、童胃炎gastritisinchildren英英3131 vEtiologic treatment: Dietary adjustment, quit irritant drugs or other stimulus, HP eradication, try to control the bile reflux, etc vSymptomatic treatment vProtection of gastric mucosa vInhibition of gastric acid 儿童胃炎儿童胃炎gastritisinchildren英英3232 Choose one drug below PPIOmeprazole Lansoprazole Bismuth preparation Bismuth Subsalicylate Basic Choose two antibiotics below Amoxicillin Clarithromycin Metronidazole Furaxone Triple regimens 儿童胃炎儿童胃炎gastritisinchildren英英3333 v Prevention of duodenogastric Reflux. Doperidome Cisapride v Reducing gastric acid secretion.