兒童胃炎GASTRITIS-IN-CHILDREN(英文版)-課件

CaseA5-year-oldgirlThiefcomplain:vomited5timesfor3hours.Whathistoryofpresentillnessdoyouwanttoknow?1ppt課件2ppt課件GASTRITISINCHILDREN

Dr.LiuChonghaippt課件Gastritis

AcuteGastritisChronicGastritis4ppt課件AcuteGastritis5ppt課件FoodandDrugs:(NonsteroidalAntiinflammatoryDrugs,NSAIDs)Severestressstate:Acuteinfection:

Corrosivesubstances:VagalstimulationAcidsecretionReleaseofvasoactiveamineandcytokinesMicrocirculationdisdurbanceGastricmucosalischemiaImpairmentofmucosalandmucousbarriersBack-diffusionofhydrogenions

Shock,hydrocephalus,suddentrauma,seriousinfection,majoroperation,etcAcute

gastritisEtiology&Pathogenesis6ppt課件

ManifestationsAsuddenonsetTypicalmanifestations:epigastricpain,nausea,vomiting,waterydiarrheaFever:causedbybacterialinfectionoritstoxinsComplications:dehydration,electrolytedisturbances,acid-baseimbalance,UGIbleedingAcute

gastritisManifestations7ppt課件DiagnosisAcutesimplegastritisHistorysymptoms

and

signsGIendoscopy&Biopsy(ifnecessary)Acute

gastritis

DiffusivehyperemiaandedemaofthegastricmucosaAcuteinflammation:neutrophilicinfiltrationinthelaminapropriaMayaccompaniedwithpunctatehemorrhageandmildcorruptlesion8ppt課件NormalGastricMucosaNGM9ppt課件gastricmucosaledemaNGM10ppt課件HemorrhagicgastritisHemorrhagicgastritiswithmultipleintramuralbleedingspots

NGM11ppt課件A.RemoveofoffendingagentsQuitallirritantsorstimulus:drugs,alcoholManagementoftheoriginaldiseasesB.Symptomatictreatment1)Replacementoffluidandelectrolyteloss2)Spasmolysant:Atropine,Belladonna4)Antiemeticdrugs:Domperidone3)SpecialmanagementforupperGIbleedingC.ProtectionofgastricmucosaandinhibitionofgastricacidMucosalprotectorAntacids:H2-RA,PPITreatmentAcute

gastritis12ppt課件Chronicgastritis13ppt課件Thetoptworeasonsforrecurrentabdominalpaininchildrenare

chronicgastritis

&

PUDAnestimated10%schoolagechildrenisaffectedbyrecurrentabdominalpain.14ppt課件Bydefinition,isahistopathologicalentitycharacterizedbychronicinflammationofthestomachmucosa.Itmaypresentwithanarrayofsymptoms,themostcommonbeingnonspecificrecurrentabdominalpaininchildren.HighfrequencyinchildrenChronic

gastritis15ppt課件Classification

Non-atrophic(Superficial):90-95%

ChronicGastritis

Atrophic

SpecifictypesChronic

gastritis16ppt課件EtiologyHelicobacterpylori(HP)BilerefluxDietaryHabitSequelaofacutegastritisDrugsPsychologicalandgeneticfactors:EmotionalstressChronicDiseaseOtherfactorsChronic

gastritis17ppt課件HelicobacterploriChronic

gastritis18ppt課件HPyloriisconsideredtoinfectvirtuallyallpatientswithchronicactivegastritisandthoughttobespreadfrompersontopersonviaoral-oraland/orfecal-oralroutes.Chronic

gastritis19ppt課件Clinicalmanifestation

RecurrentabdominalpainDyspepticsymptoms

Excessivebelching,acidregurgitation,hiccups,nausea,vomiting,diarrheaGrowthretardationUpperGIbleedingChronic

gastritis20ppt課件Clinicalmanifestation

ArelativelyminormanifestationofdiseasesThesmallerthechildrenthemoreatypicalmanifestationChronic

gastritis21ppt課件AuxiliaryexaminationsGastroscopicexaminationisthemostreliablemethodfordiagnosisofgastritisBiopsyX-ray:BariummealexaminationHPdetectionChronic

gastritis22ppt課件DiagnosticmethodsofHPinfectionRapidureasetestUreabreathtest(C13)HistologySerumAntibodiestoHPBacterialCultureTestingforHPstoolantigenPolymerasechainreactionChronic

gastritis23ppt課件NormalGastricMucosaNGM24ppt課件GastricLymphoidHyperplasiaNormallythereisnoorganizedlymphoidtissueinthestomach.MultiplepapulesintheantrumcorrespondingtolymphoidhyperplasiainducedbyHelicobacterpyloriinfection.

NGM25ppt課件AlkalineRefluxGastritis

NormalgastricmucosaStomachmucosadiffuselycoveredwithbile-stainedmucus.

NGM26ppt課件GastricCandidiasis

NormalgastricmucosaGastriccandidiasiswithextensivegreen-whiteexudatescoveringtheantrum.

27ppt課件ChronicAntralGastritis

IncreasedvisibilityoftheantralvascularpatternwithfindingscompatiblewithchronicathrophicgastritisassociatedwithH.pyloriinfection.

Therugalfoldsofthebodyrunninglongitudinallytowardstheantrum.

28ppt課件DiagnosisRecurrentabdominalpainand/ordyspepticsymptominchildrenGastroendoscopicexaminationHistory:Inappropriatedietaryhabits,familyhistory,medicationtaking,psychologicalstressChronic

gastritis29ppt課件DifferentialDiagnosisChronic

gastritisEnterosite(ascarisinfection)Enterospasm30ppt課件TreatmentEtiologictreatment:Dietaryadjustment,quitirritantdrugsorotherstimulus,HPeradication,trytocontrolthebilereflux,etcSymptomatictreatmentProtectionofgastricmucosaInhibitionofgastricacidChronic

gastritis31ppt課件HPeradicationChooseonedrugbelowPPIOmeprazoleLansoprazoleBismuthpreparationBismuthSubsalicylateBasicChoosetwoantib