儿童胃炎gastritisinchildren英文课件

1、CaseA 5-year-old girl Thief complain: vomited 5 times for 3 hours.What history of present illness do you want to know?第1页，共35页。2第2页，共35页。GASTRITIS IN CHILDRENDr. Liu Chonghai第3页，共35页。4 Gastritis Acute Gastritis Chronic Gastritis第4页，共35页。5Acute Gastritis第5页，共35页。6Food and Drugs: (Nonsteroidal Antiinf

2、lammatory Drugs,NSAIDs)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 Shock, hydrocephalus,

3、sudden trauma, serious infection, major operation, etc Acute gastritisEtiology & Pathogenesis第6页，共35页。7 ManifestationsA sudden onsetTypical manifestations: epigastric pain, nausea, vomiting, watery diarrheaFever: caused by bacterial infection or its toxinsComplications: dehydration, electrolyte dist

4、urbances, acid-base imbalance, UGI bleedingAcute gastritisManifestations第7页，共35页。8Diagnosis Acute simple gastritis Historysymptoms and signsGI endoscopy & Biopsy (if necessary)Acute gastritis Diffusive hyperemia and edema of the gastric mucosa Acute inflammation: neutrophilic infiltration in the lam

5、ina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion第8页，共35页。9Normal Gastric Mucosa NGM第9页，共35页。10gastric mucosal edema NGM第10页，共35页。11Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM第11页，共35页。12A. Remove of offending agents Quit all irri

6、tants or stimulus: drugs, alcohol 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 g

7、astric acid Mucosal protector Antacids: H2-RA, PPITreatment Acute gastritis第12页，共35页。13Chronic gastritis第13页，共35页。14The top two reasons for recurrent abdominal pain in children are chronic gastritis & PUDAn estimated 10% school age children is affected by recurrent abdominal pain.第14页，共35页。15By defi

8、nition, 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第15页，共35页。16Classification Non-atrophic(Super

9、ficial):90-95% Chronic Gastritis Atrophic Specific typesChronic gastritis第16页，共35页。17Etiology Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Psychological and genetic factors: Emotional stressChronic DiseaseOther factorsChronic gastritis第17页，共35页。18Helicobacter p

10、loriChronic gastritis第18页，共35页。19H 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 routes.Chronic gastritis第19页，共35页。20Clinical manifestation Recurrent abdominal pain Dyspeptic symptoms

11、 Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding Chronic gastritis第20页，共35页。21Clinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Chronic gastritis第21页，共35页。22Aux

12、iliary examinationsGastroscopic examination is the most reliable method for diagnosis of gastritisBiopsyX-ray: Barium meal examinationHP detectionChronic gastritis第22页，共35页。23Diagnostic methods of HP infectionRapid urease test Urea breath test(C13)Histology Serum Antibodies to HPBacterial Culture Te

13、sting for HP stool antigenPolymerase chain reaction Chronic gastritis第23页，共35页。24Normal Gastric Mucosa NGM第24页，共35页。25Gastric Lymphoid HyperplasiaNormally there is no organized lymphoid tissue in the stomach. Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacte

14、r pylori infection.NGM第25页，共35页。26Alkaline Reflux Gastritis Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGM第26页，共35页。27Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. 第27页，共35页。28Chronic Antral

15、 Gastritis 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. 第28页，共35页。29DiagnosisRecurrent abdominal pain and/or dyspeptic symptom

16、in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits, family history, medication taking, psychological stressChronic gastritis第29页，共35页。30Differential DiagnosisChronic gastritisEnterosite(ascaris infection)Enterospasm第30页，共35页。31TreatmentEtiologic treatment: Dietary adjustment

17、, quit irritant drugs or other stimulus, HP eradication, try to control the bile reflux, etcSymptomatic treatmentProtection of gastric mucosaInhibition of gastric acidChronic gastritis第31页，共35页。32HP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimensChronic gastritis第32页，共35页。33 Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gas