1、1 13 3 Gastritisn Acute Gastritisn Chronic Gastritis4 45 5Food and Drugs:(Nonsteroidal Antiinflammatory Drugs,NSAIDs)Severe stress state:Acute infection:Corrosive substances:Vagal stimulationAcid secretionRelease of vasoactive amine and cytokinesMicrocirculation disdurbanceGastric mucosal ischemiaIm
2、pairment of mucosal and mucous barriersBack-diffusion of hydrogen ions Shock,hydrocephalus,sudden trauma,serious infection,major operation,etc 6 6v A sudden onsetTypical manifestations:epigastric pain,nausea,vomiting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehyd
3、ration,electrolyte disturbances,acid-base imbalance,UGI bleeding7 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 hem
4、orrhage and mild corrupt lesion8 89 91010Hemorrhagic gastritis with multiple intramural bleeding spots 1111A.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:A
5、tropine,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,PPI121213131414vBy definition,is a histopathological entity characterized by chronic inflammation of the stomach
6、mucosa.vIt may present with an array of symptoms,the most common being nonspecific recurrent abdominal pain in children.vHigh frequency in children1515 Non-atrophic(Superficial):90-95%Chronic Gastritis Atrophic Specific types1616v Helicobacter pylori(HP)v Bile refluxv Dietary Habitv Sequela of acute
7、 gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOther factors17171818H 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.191920202121vGastrosc
8、opic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal examinationvHP detection2222vRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction 23232424Multiple papules
9、in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.2525Stomach mucosa diffusely covered with bile-stained mucus.2626Gastric candidiasis with extensive green-white exudates covering the antrum.2727Increased visibility of the antral vascular pattern with findi
10、ngs compatible with chronic athrophic gastritis associated with H.pylori infection.The rugal folds of the body running longitudinally towards the antrum.2828Recurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic examinationHistory:Inappropriate dietary habits,family history,me
11、dication taking,psychological stress2929Enterosite(ascaris infection)Enterospasm3030vEtiologic treatment:Dietary adjustment,quit irritant drugs or other stimulus,HP eradication,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acid3131Choose
12、one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronidazoleFuraxoneTriple regimens3232v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ranitiding Cimetidine PPI (for 2 weeks)Omeprazole Lansoprazole3333v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine Belladonna3434 Thank you
