儿童胃炎gastritisinchildren英ppt课件

CasevA 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gastritisinchildren英1CaseA 5-year-old girl 儿童胃炎儿童胃炎gast儿童胃炎gastritisinchildren英2儿童胃炎儿童胃炎gastritisinchildren英英2GASTRITIS IN GASTRITIS IN CHILDRENCHILDRENDr.Liu ChonghaiDr.Liu Chonghai儿童胃炎gastritisinchildren英GASTRITIS IN CHILDRENDr.Liu Gastritisn Acute Gastritisn Chronic Gastritis儿童胃炎gastritisinchildren英4 Gastritis儿童胃炎儿童胃炎gastritisinchildAcute Gastritis儿童胃炎gastritisinchildren英5Acute Gastritis儿童胃炎儿童胃炎gastritisinFood and Drugs:(Nonsteroidal Antiinflammatory 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,sudden trauma,serious infection,major operation,etc Acute gastritisEtiology&PathogenesisEtiology&Pathogenesis儿童胃炎gastritisinchildren英6Food and Drugs:(Nonsteroidal ManifestationsA sudden onsetTypical manifestations:epigastric pain,nausea,vomiting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehydration,electrolyte disturbances,acid-base imbalance,UGI bleedingAcute gastritisManifestationsManifestations儿童胃炎gastritisinchildren英7 ManifestationsAcute gastritisDiagnosis 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 lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion儿童胃炎gastritisinchildren英8Diagnosis Acute simple gastritNormal Gastric Mucosa NGMNGM儿童胃炎gastritisinchildren英9Normal Gastric Mucosa NGM儿童胃炎儿童胃炎ggastric mucosal edema NGMNGM儿童胃炎gastritisinchildren英10gastric mucosal edema NGM儿童胃炎儿童胃炎gHemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGMNGM儿童胃炎gastritisinchildren英11Hemorrhagic gastritis HemorrhA.Remove of offending agents Quit all irritants 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 gastric acid Mucosal protector Antacids:H2-RA,PPITreatment Acute gastritis儿童胃炎gastritisinchildren英12A.Remove of offending agentsTChronic gastritis儿童胃炎gastritisinchildren英13Chronic gastritis儿童胃炎儿童胃炎gastritisThe top two reasons for recurrent The top two reasons for recurrent abdominal pain in children are abdominal pain in children are chronic gastritischronic gastritis&PUDPUDAn estimated 10%school age children is affected by recurrent abdominal pain.儿童胃炎gastritisinchildren英14The top two reasons for recurrvBy 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 childrenChronic gastritis儿童胃炎gastritisinchildren英15By definition,is a histopathoClassification Non-atrophic(Superficial):90-95%Chronic Gastritis Atrophic Specific typesChronic gastritis儿童胃炎gastritisinchildren英16ClassificationChronic gastritiEtiologyv Helicobacter pylori(HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOther factorsChronic gastritis儿童胃炎gastritisinchildren英17Etiology Helicobacter pylori(Helicobacter ploriChronic gastritis儿童胃炎gastritisinchildren英18Helicobacter ploriChronic gastH 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儿童胃炎gastritisinchildren英19H Pylori is considered to infeClinical manifestationLL Recurrent abdominal painRecurrent abdominal painLL Dyspeptic symptoms Dyspeptic symptoms Excessive belching,acid regurgitation,Excessive belching,acid regurgitation,Excessive belching,acid regurgitation,hiccups,nausea,vomiting,diarrheahiccups,nausea,vomiting,diarrheahiccups,nausea,vomiting,diarrheaLL Growth retardation Growth retardationLL Upper GI bleeding Upper GI bleeding Chronic gastritis儿童胃炎gastritisinchildren英20Clinical manifestation RecurreClinical manifestationL A relatively minor manifestation of diseases L The smaller the children the more atypical manifestation Chronic gastritis儿童胃炎gastritisinchildren英21Clinical manifestation A relatAuxiliary examinationsvGastroscopic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal examinationvHP detectionChronic gastritis儿童胃炎gastritisinchildren英22Auxiliary examinationsGastroscDiagnostic methods of HP infectionvRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction Chronic gastritis儿童胃炎gastritisinchildren英23Diagnostic methods of HP infecNormal Gastric Mucosa NGMNGM儿童胃炎gastritisinchildren英24Normal Gastric Mucosa NGM儿童胃炎儿童胃炎gGastric Lymphoid HyperplasiaNormally there is no Normally there is no organized lymphoid tissue organized lymphoid tissue in the stomach.in the stomach.Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.NGMNGM儿童胃炎gastritisinchildren英25Gastric Lymphoid HyperplasiaNoAlkaline Reflux Gastritis Normal gastric Normal gastric mucosa mucosa Stomach mucosa diffusely covered with bile-stained mucus.NGMNGM儿童胃炎gastritisinchildren英26Alkaline Reflux Gastritis NormGastric Candidiasis Normal gastric Normal gastric mucosa mucosa Gastric candidiasis with extensive green-white exudates covering the antrum.儿童胃炎gastritisinchildren英27Gastric Candidiasis Normal gasChronic Antral 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.儿童胃炎gastritisinchildren英28Chronic Antral Gastritis IncreDiagnosisRecurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits,family history,medication taking,psychological stressChronic gastritis儿童胃炎gastritisinchildren英29DiagnosisRecurrent abdominal pDifferential DiagnosisChronic gastritisEnterosite(ascaris infection)Enterospasm儿童胃炎gastritisinchildren英30Differential DiagnosisChronic TreatmentvEtiologic treatment:Dietary adjustment,quit irritant drugs or other stimulus,HP eradication,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acidChronic gastritis儿童胃炎gastritisinchildren英31TreatmentEtiologic treatment:CHP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimensChronic gastritis儿童胃炎gastritisinchildren英32HP eradicationChoose one drug v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ranitiding Cimetidine PPI (for 2 weeks)Omeprazole LansoprazoleChronic gastritis儿童胃炎gastritisinchildren英33 Prevention of duodenogastric v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine BelladonnaChronic gastritis儿童胃炎gastritisinchildren英34 Enhancing mucosal defenseChroThank you.儿童胃炎gastritisinchildren英35Thank you.儿童胃炎儿童胃炎gastritisinchild