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gastritisinchildren英1儿童胃炎gastritisinchildren英2儿童胃炎gastritisinchildren英 Gastritisn Acute Gastritisn Chronic Gastritis儿童胃炎gastritisinchildren英4儿童胃炎gastritisinchildren英5Food and Drugs
2、:(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 S
3、hock,hydrocephalus,sudden trauma,serious infection,major operation,etc 儿童胃炎gastritisinchildren英6 A sudden onsetTypical manifestations:epigastric pain,nausea,vomiting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehydration,electrolyte disturbances,acid-base imbalance
4、,UGI bleeding儿童胃炎gastritisinchildren英7 Acute simple gastritis Historysymptoms and signsGI endoscopy&Biopsy(if necessary)Diffusive hyperemia and edema of the gastric mucosa Acute inflammation:neutrophilic infiltration in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesi
5、on儿童胃炎gastritisinchildren英8儿童胃炎gastritisinchildren英9儿童胃炎gastritisinchildren英10Hemorrhagic gastritis with multiple intramural bleeding spots 儿童胃炎gastritisinchildren英11A.Remove of offending agents Quit all irritants or stimulus:drugs,alcohol Management of the original diseasesB.Symptomatic treatment 1
6、)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,PPI儿童胃炎gastritisinchildren英12儿童胃炎gastritisinchildren英1
7、3儿童胃炎gastritisinchildren英14vBy 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 children儿童胃炎gastritisinchildren英15 N
8、on-atrophic(Superficial):90-95%Chronic Gastritis Atrophic Specific types儿童胃炎gastritisinchildren英16v Helicobacter pylori(HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOther factors儿童胃炎gastritisinchildren英17儿童胃炎ga
9、stritisinchildren英18H 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.儿童胃炎gastritisinchildren英19儿童胃炎gastritisinchildren英20儿童胃炎gastritisinchildren英21vGastroscopic examination is t
10、he most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal examinationvHP detection儿童胃炎gastritisinchildren英22vRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction 儿童胃炎gastritisinchildren英
11、23儿童胃炎gastritisinchildren英24Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.儿童胃炎gastritisinchildren英25Stomach mucosa diffusely covered with bile-stained mucus.儿童胃炎gastritisinchildren英26Gastric candidiasis with extensive green-white exudat
12、es covering the antrum.儿童胃炎gastritisinchildren英27Increased 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28Recurrent
13、abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits,family history,medication taking,psychological stress儿童胃炎gastritisinchildren英29Enterosite(ascaris infection)Enterospasm儿童胃炎gastritisinchildren英30vEtiologic treatment:Dietary adjustment
14、,quit irritant drugs or other stimulus,HP eradication,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acid儿童胃炎gastritisinchildren英31Choose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two anti
15、biotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimens儿童胃炎gastritisinchildren英32v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ranitiding Cimetidine PPI (for 2 weeks)Omeprazole Lansoprazole儿童胃炎gastritisinchildren英33v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine Belladonna儿童胃炎gastritisinchildren英34儿童胃炎gastritisinchildren英35
