1、2 Gastritisn Acute Gastritisn Chronic Gastritis34 Diffination Etiology&Pathogenesis Pathology5Food and Drugs:Severe stress state:Acute infection:Corrosive substances:Vagal stimulationAcid secretionRelease of vasoactive amine and cytokinesMicrocirculation disdurbanceGastric mucosal ischemiaImpairment
2、 of mucosal and mucous barriersBack-diffusion of hydrogen ions Shock,hydrocephalus,sudden trauma,serious infection,major operation,etc 6 A sudden onsetTypical manifestations:epigastric pain,nausea,vomiting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehydration,elec
3、trolyte disturbances,acid-base imbalance,UGI bleeding7 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 m
4、ild corrupt lesion8A.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 blee
5、dingC.Protection of gastric mucosa and inhibition of gastric acid Mucosal protector Antacids:H2-RA,PPI91011vBy 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 ab
6、dominal pain in children.vHigh frequency in children12 Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific types13v Helicobacter pylori(HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOthe
7、r factors1415H 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.161718vGastroscopic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal exa
8、minationvHP detection19vRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction 20Recurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits
9、,family history,medication taking,psychological stress21EnterositeEnterospasmAbdominal epilepsy22vEtiologic treatment:Dietary adjustment,quit irritant drugs or other stimulus,HP eradication,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric ac
10、id23Choose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimens24v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ra
11、nitiding Cimetidine PPI (for 2 weeks)Omeprazole Lansoprazole25v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine Belladonna262728Hemorrhagic gastritis with multiple intramural bleeding spots 29Multiple papules in the antrum corresponding to lymphoid hyperplasia i
12、nduced by Helicobacter pylori infection.30Stomach mucosa diffusely covered with bile-stained mucus.31Gastric candidiasis with extensive green-white exudates covering the antrum.32Increased 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.33
