1、Case,A 5-year-old girl Thief complain: vomited 5 times for 3 hours.What history of present illness do you want to know?,2,GASTRITIS IN CHILDREN,Dr. Liu Chonghai,4,Gastritis Acute Gastritis Chronic Gastritis,5,Acute Gastritis,6,Food and Drugs: (Nonsteroidal Antiinflammatory Drugs,NSAIDs)Severe stress
2、 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, sudden trauma, serious infection, m
3、ajor operation, etc,Acute gastritis,Etiology & Pathogenesis,7,ManifestationsA sudden onsetTypical manifestations: epigastric pain, nausea, vomiting, watery diarrheaFever: caused by bacterial infection or its toxinsComplications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleedin
4、g,Acute gastritis,Manifestations,8,Diagnosis,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 mild c
5、orrupt lesion,9,Normal Gastric Mucosa,NGM,10,gastric mucosal edema,NGM,11,Hemorrhagic gastritis,Hemorrhagic gastritis with multiple intramural bleeding spots,NGM,12,A. Remove of offending agents Quit all irritants or stimulus: drugs, alcohol Management of the original diseasesB. Symptomatic treatmen
6、t 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 Mucosal protector Antacids: H2-RA, PPI,Treatment,13,Chronic gastritis,14,The top
7、 two reasons for recurrent abdominal pain in children are chronic gastritis & PUD,An estimated 10% school age children is affected by recurrent abdominal pain.,15,By definition, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. It may present with an array of
8、 symptoms, the most common being nonspecific recurrent abdominal pain in children.High frequency in children,16,Classification,Non-atrophic(Superficial):90-95% Chronic Gastritis Atrophic Specific types,17,Etiology,Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Ps
9、ychological and genetic factors: Emotional stressChronic DiseaseOther factors,18,Helicobacter plori,19,H 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.,20,Clinical manifestatio
10、n,Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding,21,Clinical manifestation,A relatively minor manifestation of diseases The smaller the children the more atypical manifestation,22,Auxiliary
11、examinations,Gastroscopic examination is the most reliable method for diagnosis of gastritisBiopsyX-ray: Barium meal examinationHP detection,23,Diagnostic methods of HP infectionRapid urease test Urea breath test(C13)Histology Serum Antibodies to HPBacterial Culture Testing for HP stool antigenPolym
12、erase chain reaction,24,Normal Gastric Mucosa,NGM,25,Gastric Lymphoid Hyperplasia,Normally there is no organized lymphoid tissue in the stomach.,Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.,NGM,26,Alkaline Reflux Gastritis,Normal gast
13、ric mucosa,Stomach mucosa diffusely covered with bile-stained mucus.,NGM,27,Gastric Candidiasis,Normal gastric mucosa,Gastric candidiasis with extensive green-white exudates covering the antrum.,28,Chronic Antral Gastritis,Increased visibility of the antral vascular pattern with findings compatible
14、with chronic athrophic gastritis associated with H. pylori infection.,The rugal folds of the body running longitudinally towards the antrum.,29,Diagnosis,Recurrent abdominal pain and/or dyspeptic symptom in children,Gastroendoscopic examination,History:Inappropriate dietary habits, family history, m
15、edication taking, psychological stress,30,Differential Diagnosis,Enterosite(ascaris infection)Enterospasm,31,Treatment,Etiologic treatment: Dietary adjustment, quit irritant drugs or other stimulus, HP eradication, try to control the bile reflux, etcSymptomatic treatmentProtection of gastric mucosaI
16、nhibition of gastric acid,32,HP eradication,Triple regimens,33,Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole,34,Enhancing mucosal defense Bismuth compounds Sucrafate Symptomatic treatment Atropine Belladonna,35,Thank you.,
