1、vChongqing Childrens HospitalvDivision of Infectious Disease vand Gastroenterology儿童胃炎英 Gastritisn Acute Gastritisn Chronic Gastritis儿童胃炎英2儿童胃炎英3 Diffination Etiology&Pathogenesis Pathology儿童胃炎英4Food and Drugs:Severe stress state:Acute infection:Corrosive substances:Vagal stimulationAcid secretionRe
2、lease 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 儿童胃炎英5 A sudden onsetTypical manifestations:epigastric pain,naus
3、ea,vomiting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehydration,electrolyte disturbances,acid-base imbalance,UGI bleeding儿童胃炎英6 Acute simple gastritis Historysymptoms and signsGI endoscopy&Biopsy(if necessary)Diffusive hyperemia and edema of the gastric mucosa A
4、cute inflammation:neutrophilic infiltration in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion儿童胃炎英7A.Remove of offending agents Quit all irritants or stimulus:drugs,alcohol Management of the original diseasesB.Symptomatic treatment 1)Replacement of fluid and elect
5、rolyte 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儿童胃炎英8儿童胃炎英9儿童胃炎英10vBy definition,is a histopathological entity characterized by c
6、hronic 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儿童胃炎英11 Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific types儿童胃炎英12v Helicobacter pylori
7、(HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOther factors儿童胃炎英13儿童胃炎英14H Pylori is considered to infect virtually all patients with chronic active gastritis and thought to be spread from person to person via
8、oral-oral and/or fecal-oral routes.儿童胃炎英15儿童胃炎英16儿童胃炎英17vGastroscopic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal examinationvHP detection儿童胃炎英18vRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for
9、HP stool antigenvPolymerase chain reaction 儿童胃炎英19Recurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits,family history,medication taking,psychological stress儿童胃炎英20EnterositeEnterospasmAbdominal epilepsy儿童胃炎英21vEtiologic treatme
10、nt:Dietary adjustment,quit irritant drugs or other stimulus,HP eradication,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acid儿童胃炎英22Choose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two an
11、tibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimens儿童胃炎英23v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ranitiding Cimetidine PPI (for 2 weeks)Omeprazole Lansoprazole儿童胃炎英24v Enhancing mucosal defense Bismuth co
12、mpounds Sucrafatev Symptomatic treatment Atropine Belladonna儿童胃炎英25儿童胃炎英26儿童胃炎英27Hemorrhagic gastritis with multiple intramural bleeding spots 儿童胃炎英28Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.儿童胃炎英29Stomach mucosa diffusely covered
13、with bile-stained mucus.儿童胃炎英30Gastric candidiasis with extensive green-white exudates covering the antrum.儿童胃炎英31Increased 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.儿童胃炎英32儿童胃炎英33
