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1、1 Gastritisn Acute Gastritisn Chronic Gastritis2Acute Gastritis3 Diffination Etiology&Pathogenesis PathologyAcute gastritis4Food and Drugs:Severe stress state:Acute infection:Corrosive substances:Vagal stimulationAcid secretionRelease of vasoactive amine and cytokinesMicrocirculation disdurbanceGast
2、ric mucosal ischemiaImpairment of mucosal and mucous barriersBack-diffusion of hydrogen ions Shock,hydrocephalus,sudden trauma,serious infection,major operation,etc Acute gastritisEtiology&PathogenesisEtiology&Pathogenesis5 ManifestationsA sudden onsetTypical manifestations:epigastric pain,nausea,vo
3、miting,watery diarrheaFever:caused by bacterial infection or its toxinsComplications:dehydration,electrolyte disturbances,acid-base imbalance,UGI bleedingAcute gastritisManifestationsManifestations6Diagnosis Acute simple gastritis Historysymptoms and signsGI endoscopy&Biopsy(if necessary)Acute gastr
4、itis Diffusive hyperemia and edema of the gastric mucosa Acute inflammation:neutrophilic infiltration in the lamina propriaMay accompanied with punctate hemorrhage and mild corrupt lesion7A.Remove of offending agents Quit all irritants or stimulus:drugs,alcohol Management of the original diseasesB.S
5、ymptomatic 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 Mucosal protector Antacids:H2-RA,PPITreatment Acute gastritis8Chr
6、onic gastritis9The 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 affected by recurrent abdominal pain.10vBy definition,is a histopathologica
7、l 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 gastritis11Classification Update Sydney System in 1996 Superficial Chronic Gastriti
8、s Atrophic Specific typesChronic gastritis12Etiologyv Helicobacter pylori(HP)v Bile refluxv Dietary Habitv Sequela of acute gastritisv Drugsv Psychological and genetic factors:Emotional stressvChronic DiseasevOther factorsChronic gastritis13Helicobacter ploriChronic gastritis14H Pylori is considered
9、 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 gastritis15Clinical manifestationLL Recurrent abdominal painRecurrent abdominal painLL Dyspeptic symptoms Dyspeptic symptoms Excessive belchin
10、g,acid regurgitation,Excessive belching,acid regurgitation,Excessive belching,acid regurgitation,hiccups,nausea,vomiting,diarrheahiccups,nausea,vomiting,diarrheahiccups,nausea,vomiting,diarrheaLL Growth retardation Growth retardationLL Upper GI bleeding Upper GI bleeding Chronic gastritis16Clinical
11、manifestationL A relatively minor manifestation of diseases L The smaller the children the more atypical manifestation Chronic gastritis17Auxiliary examinationsvGastroscopic examination is the most reliable method for diagnosis of gastritisvBiopsyvX-ray:Barium meal examinationvHP detectionChronic ga
12、stritis18Diagnostic methods of HP infectionvRapid urease test vUrea breath test(C13)vHistology vSerum Antibodies to HPvBacterial Culture vTesting for HP stool antigenvPolymerase chain reaction Chronic gastritis19DiagnosisRecurrent abdominal pain and/or dyspeptic symptom in childrenGastroendoscopic e
13、xaminationHistory:Inappropriate dietary habits,family history,medication taking,psychological stressChronic gastritis20Differential DiagnosisChronic gastritisEnterositeEnterospasmAbdominal epilepsy21TreatmentvEtiologic treatment:Dietary adjustment,quit irritant drugs or other stimulus,HP eradication
14、,try to control the bile reflux,etcvSymptomatic treatmentvProtection of gastric mucosavInhibition of gastric acidChronic gastritis22HP eradicationChoose one drug belowPPIOmeprazoleLansoprazoleBismuth preparationBismuth Subsalicylate Basic Choose two antibiotics belowAmoxicillinClarithromycinMetronid
15、azoleFuraxoneTriple regimensChronic gastritis23v Prevention of duodenogastric Reflux.Doperidome Cisapridev Reducing gastric acid secretion.H2RT(for 4 weeks):Ranitiding Cimetidine PPI (for 2 weeks)Omeprazole LansoprazoleChronic gastritis24v Enhancing mucosal defense Bismuth compounds Sucrafatev Sympt
16、omatic treatment Atropine BelladonnaChronic gastritis25Normal Gastric Mucosa NGMNGM26gastric mucosal edema NGMNGM27Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGMNGM28Gastric Lymphoid HyperplasiaNormally there is no Normally there is no organized lymphoid tiss
17、ue organized lymphoid tissue in the stomach.in the stomach.Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.NGMNGM29Alkaline Reflux Gastritis Normal gastric Normal gastric mucosa mucosa Stomach mucosa diffusely covered with bile-stained mu
18、cus.NGMNGM30Gastric Candidiasis Normal gastric Normal gastric mucosa mucosa Gastric candidiasis with extensive green-white exudates covering the antrum.31Chronic Antral Gastritis 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.32Thank you.