兒童胃炎GASTRITIS IN CHILDREN(英文)課件

CaseA5-year-oldgirlThiefcomplain:vomited5timesfor3hours.Whathistoryofpresentillnessdoyouwanttoknow?2GASTRITISINCHILDREN

Dr.LiuChonghai5AcuteGastritis6FoodandDrugs:(NonsteroidalAntiinflammatoryDrugs,NSAIDs)Severestressstate:Acuteinfection:

Corrosivesubstances:VagalstimulationAcidsecretionReleaseofvasoactiveamineandcytokinesMicrocirculationdisdurbanceGastricmucosalischemiaImpairmentofmucosalandmucousbarriersBack-diffusionofhydrogenions

Shock,hydrocephalus,suddentrauma,seriousinfection,majoroperation,etcAcute

gastritisEtiology&Pathogenesis7

ManifestationsAsuddenonsetTypicalmanifestations:epigastricpain,nausea,vomiting,waterydiarrheaFever:causedbybacterialinfectionoritstoxinsComplications:dehydration,electrolytedisturbances,acid-baseimbalance,UGIbleedingAcute

gastritisManifestations8DiagnosisAcutesimplegastritisHistorysymptoms

and

signsGIendoscopy&Biopsy(ifnecessary)Acute

gastritis

DiffusivehyperemiaandedemaofthegastricmucosaAcuteinflammation:neutrophilicinfiltrationinthelaminapropriaMayaccompaniedwithpunctatehemorrhageandmildcorruptlesion10gastricmucosaledemaNGM12A.RemoveofoffendingagentsQuitallirritantsorstimulus:drugs,alcoholManagementoftheoriginaldiseasesB.Symptomatictreatment1)Replacementoffluidandelectrolyteloss2)Spasmolysant:Atropine,Belladonna4)Antiemeticdrugs:Domperidone3)SpecialmanagementforupperGIbleedingC.ProtectionofgastricmucosaandinhibitionofgastricacidMucosalprotectorAntacids:H2-RA,PPITreatmentAcute

gastritis14Thetoptworeasonsforrecurrentabdominalpaininchildrenare

chronicgastritis

&

PUDAnestimated10%schoolagechildrenisaffectedbyrecurrentabdominalpain.15Bydefinition,isahistopathologicalentitycharacterizedbychronicinflammationofthestomachmucosa.Itmaypresentwithanarrayofsymptoms,themostcommonbeingnonspecificrecurrentabdominalpaininchildren.HighfrequencyinchildrenChronic

gastritis16Classification

Non-atrophic(Superficial):90-95%

ChronicGastritis

Atrophic

SpecifictypesChronic

gastritis17EtiologyHelicobacterpylori(HP)BilerefluxDietaryHabitSequelaofacutegastritisDrugsPsychologicalandgeneticfactors:EmotionalstressChronicDiseaseOtherfactorsChronic

gastritis18HelicobacterploriChronic

gastritis20Clinicalmanifestation

RecurrentabdominalpainDyspepticsymptoms

Excessivebelching,acidregurgitation,hiccups,nausea,vomiting,diarrheaGrowthretardationUpperGIbleedingChronic

gastritis21Clinicalmanifestation

ArelativelyminormanifestationofdiseasesThesmallerthechildrenthemoreatypicalmanifestationChronic

gastritis23DiagnosticmethodsofHPinfectionRapidureasetestUreabreathtest(C13)HistologySerumAntibodiestoHPBacterialCultureTestingforHPstoolantigenPolymerasechainreactionChronic

gastritis24NormalGastricMucosaNGM26AlkalineRefluxGastritis

NormalgastricmucosaStomachmucosadiffuselycoveredwithbile-stainedmucus.

NGM27GastricCandidiasis

NormalgastricmucosaGastriccandidiasiswithextensivegreen-whiteexudatescoveringtheantrum.

28ChronicAntralGastritis

IncreasedvisibilityoftheantralvascularpatternwithfindingscompatiblewithchronicathrophicgastritisassociatedwithH.pyloriinfection.

Therugalfoldsofthebodyrunninglongitudinallytowardstheantrum.

30DifferentialDiagnosisChronic

gastritisEnterosite(ascarisinfection)Enterospasm31TreatmentEtiologictreatment:Dietaryadjustment,quitirritantdrugsorotherstimulus,HPeradication,trytocontrolthebilereflux,etcSymptomatictreatmentProtectionofgastricmucosaInhibitionofgastricacidChronic

gastritis32HPeradicationChooseonedrugbelowPPIOmeprazoleLansoprazoleBismuthpreparationBismuthSubsalicylateBasicChoosetwoantibioticsbelowAmoxicillinClarithromycinMetronidazoleFuraxoneTripleregimensChronic

gastritis33

PreventionofduodenogastricReflux.

DoperidomeCisapride

Reducinggastricacidsecretion.

H2RT(for4weeks):

RanitidingCimetidinePPI(for2weeks)