兒童胃炎gastritisinchildren英文課件

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頁，共35頁。2第2頁，共35頁。GASTRITIS IN CHILDRENDr. Liu Chonghai第3頁，共35頁。4 Gastritis Acute Gastritis Chronic Gastritis第4頁，共35頁。5Acute Gastritis第5頁，共35頁。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頁，共35頁。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頁，共35頁。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頁，共35頁。9Normal Gastric Mucosa NGM第9頁，共35頁。10gastric mucosal edema NGM第10頁，共35頁。11Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM第11頁，共35頁。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頁，共35頁。13Chronic gastritis第13頁，共35頁。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頁，共35頁。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頁，共35頁。16Classification Non-atrophic(Super

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

10、loriChronic gastritis第18頁，共35頁。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頁，共35頁。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頁，共35頁。21Clinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Chronic gastritis第21頁，共35頁。22Aux

12、iliary examinationsGastroscopic examination is the most reliable method for diagnosis of gastritisBiopsyX-ray: Barium meal examinationHP detectionChronic gastritis第22頁，共35頁。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頁，共35頁。24Normal Gastric Mucosa NGM第24頁，共35頁。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頁，共35頁。26Alkaline Reflux Gastritis Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGM第26頁，共35頁。27Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. 第27頁，共35頁。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頁，共35頁。29DiagnosisRecurrent abdominal pain and/or dyspeptic symptom

16、in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits, family history, medication taking, psychological stressChronic gastritis第29頁，共35頁。30Differential DiagnosisChronic gastritisEnterosite(ascaris infection)Enterospasm第30頁，共35頁。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頁，共35頁。32HP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimensChronic gastritis第32頁，共35頁。33 Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gas