《儿科学教学课件》17、儿童慢性胃炎(下).ppt

Chronic Gastritis in Children,Introduction,Chronic gastritis is a chronic inflammation of the gastric mucosa caused by long-term or repeated harmful factorsChronic gastritis is a common disease of the upper digestive tract in childhoodThe main diagnosic method are gastroscopy and pathological examination,Classification,1.Chronic superficial gastritis(CSG):90-95%2.Chronic atrophic gastritis,Etiology,1.Infection of Helicobacter Pylori(HP)2.Bile reflux3.The further development of acute gastritis Bad eating habits or improper diet Adverse reaction of medicine Non-steroidal anti-inflammatory drugs NSAIDs Cortisone,etc food allergy 4.Othersneuropsychiatric factors Stress,fatigue or overworkchronic diseasesgenetic factos,Helicobacter Pylori(HP),Etiology,1.Infection of Helicobacter Pylori(HP)2.Bile reflux3.The further development of acute gastritis Bad eating habits or improper diet Adverse reaction of medicine Non-steroidal anti-inflammatory drugs NSAIDs Cortisone,etc food allergy 4.Othersneuropsychiatric factors Stress,fatigue or overworkchronic diseasesgenetic factos,The severity is varying.The course is varying1.Recurrent abdominal pain：recurrent lack of regularity intensity location the relationship with diet2.Other dyspepsia symptoms3.Growth stunted：4.Upper gastrointestinal bleeding：,Clinical manifestations,The younger the children,the less typical of abdominal pain,1.Gastroscope：the first choice for examinationthe basis of diagnosis2.Pathological examination of gastric mucosaChronic superficial gastritis(CSG)Chronic atrophic gastritis3.Barium meal X-ray examination4.Bacteriological examination for HP infectionbacterial culturetissue section staining Hp ureaserapid urease test13C-urea breath test urea NH4+CO2examination of serum Antibody against HP,Auxiliary examination,Normal gastric mucosa,Edema of gastric mucosa,Hemorrhagic gastritis,Hemorrhagic gastritis with multiple intramural bleeding spots,Normal gastric mucosa,Lymphatic hyperplastic nodule in antrum of stomach caused by HP,Gastritis caused by bile reflux,Chronic antral gastritis,1.Gastroscope：the first choice for examinationthe basis of diagnosis2.Pathological examination of gastric mucosaChronic superficial gastritis(CSG)Chronic atrophic gastritis3.Barium meal X-ray examination4.Bacteriological examination for HP infectionbacterial culturetissue section staining Hp ureaserapid urease test13C-urea breath test urea NH4+CO2examination of serum Antibody against HP,Auxiliary examination,Helicobacter Pylori(HP)Silver stain,1.Gastroscope：the first choice for examinationthe basis of diagnosis2.Pathological examination of gastric mucosaChronic superficial gastritis(CSG)Chronic atrophic gastritis3.Barium meal X-ray examination4.Bacteriological examination for HP infectionbacterial culturetissue section staining Hp ureaserapid urease test13C(14C)-urea breath test urea NH4+CO2examination of serum antibody against HP,Auxiliary examination,1.Clinical manifestations2.Medical history3.Gastroscope and pathological examination of gastric mucosa4.Bacteriological examination for HP infection,Diagnosis,Intestinal ascariasis Enterospasm Functional abdominal pain caused by psychological factors,Differential diagnosis,1.Remove the causes 1)anti-HP infection 2)discontinuation drugs causing gastric mucosal injury3)reduce stress2.Dietotherapy3.Pharmacotherapy 1)symptomatic treatment 2)gastric mucosal protective agent:Sucralfate Bismuth potassium citrate,etc 3)antacids:H2 receptor inhibitor(H2RI)PPI Aluminum hydroxide 4)gastroprokinetic agent:Domperidone(Motilium),Treatment,Anti-HP drugsAntibiotics:AmoxycillinClarithromycinMetronidazole,etc.Bismuth agent:Bismuth potassium citrate,etcPPI,Treatment,Anti-HP regimen1.PPI triple therapy PPI+2 antibiotics 1w or 2w2.bismuth agent triple therapy Bismuth potassium citrate+2 antibiotics 4w6w 2w3.bismuth agent Quadruple therapy Bismuth potassium citrate+H2RI+2 antibiotics 4w6w 4w8w 2w,Treatment,1.Remove the causes 1)anti-HP infection 2)discontinuation drugs causing gastric mucosal injury3)reduce stress2.Dietotherapy3.Pharmacotherapy 1)symptomatic treatment 2)gastric mucosal protective agent:Sucralfate Bismuth potassium citrate,etc 3)antacids:H2 receptor inhibitor(H2RI)PPI Aluminum hydroxide 4)gastroprokinetic agent:Domperidone(Motilium),Treatment,