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1、CasevA 5-year-old girl vThief complain: vomited 5 times for 3 hours.vWhat history of present illness do you want to know?2GASTRITIS IN GASTRITIS IN CHILDRENCHILDRENDr. Liu ChonghaiDr. Liu Chonghai4 Gastritisn Acute Gastritisn Chronic Gastritis5Acute Gastritis6Food and Drugs: (Nonsteroidal Antiinflam
2、matory 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, sud
3、den trauma, serious infection, major operation, etc Acute gastritisEtiology & PathogenesisEtiology & Pathogenesis7 ManifestationsA sudden onsetTypical manifestations: epigastric pain, nausea, vomiting, watery diarrheaFever: caused by bacterial infection or its toxinsComplications: dehydration, elect
4、rolyte disturbances, acid-base imbalance, UGI bleedingAcute gastritisManifestationsManifestations8Diagnosis Acute simple gastritis Historysymptoms and signsGI endoscopy & Biopsy (if necessary)Acute gastritis Diffusive hyperemia and edema of the gastric mucosa Acute inflammation: neutrophilic infiltr
5、ation in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion9Normal Gastric Mucosa NGMNGM10gastric mucosal edema NGMNGM11Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGMNGM12A. Remove of offending agents Quit all irritants or stim
6、ulus: 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 M
7、ucosal protector Antacids: H2-RA, PPITreatment Acute gastritis13Chronic gastritis14The 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 affe
8、cted by recurrent abdominal pain.15vBy 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
9、16Classification Non-atrophic(Superficial):90-95% Chronic Gastritis Atrophic Specific typesChronic gastritis17Etiologyv Helicobacter pylori (HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors: Emotional stressvChronic DiseasevOther factorsChronic ga
10、stritis18Helicobacter ploriChronic gastritis19H 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 gastritis20Clinical manifestationLL Recurrent abdominal painRecurrent abdo
11、minal 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 Gr
12、owth retardationLL Upper GI bleeding Upper GI bleeding Chronic gastritis21Clinical manifestationL A relatively minor manifestation of diseases L The smaller the children the more atypical manifestation Chronic gastritis22Auxiliary examinationsvGastroscopic examination is the most reliable method for
13、 diagnosis of gastritisvBiopsyvX-ray: Barium meal examinationvHP detectionChronic gastritis23Diagnostic methods of HP infectionvRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction Chronic gastritis24Norm
14、al Gastric Mucosa NGMNGM25Gastric 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.NGMNGM26Al
15、kaline Reflux Gastritis Normal gastric Normal gastric mucosa mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGMNGM27Gastric Candidiasis Normal gastric Normal gastric mucosa mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. 28Chronic Antral Gastriti
16、s 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. 29DiagnosisRecurrent abdominal pain and/or dyspeptic symptom in childrenGastroen
17、doscopic examinationHistory:Inappropriate dietary habits, family history, medication taking, psychological stressChronic gastritis30Differential DiagnosisChronic gastritisEnterosite(ascaris infection)Enterospasm31TreatmentvEtiologic treatment: Dietary adjustment, quit irritant drugs or other stimulu
18、s, HP eradication, try to control the bile reflux, etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acidChronic gastritis32HP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinCla
19、rithromycinMetronidazoleFuraxoneTriple regimensChronic gastritis33v Prevention of duodenogastric Reflux. Doperidome Cisapridev Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole LansoprazoleChronic gastritis34v Enhancing mucosal defense Bismuth compounds Sucrafatev Symptomatic treatment Atropine BelladonnaChronic gastritis35Thank you.
