acute gastritis in children
Introduction
Introduction to acute gastritis in children In the early diagnosis of gastritis, gastric mucosal biopsy specimens can only be obtained by surgical or aspiration methods, so the diagnosis of gastritis is very difficult. With the application of fiber endoscopy in the past decade, people's understanding of gastritis has also been significantly improved. Acute gastritis (acutegastritis) refers to acute extensive or localized gastric mucosal inflammatory lesions caused by various extrinsic and intrinsic factors. If combined with intestinal inflammation, it is called acute gastroenteritis. Clinically, it can be divided into three types: simple, erosive and corrosive. Children are more common in simple and erosive. basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: non-infectious Complications: dehydration anemia shock
Cause
Causes of acute gastritis in children
(1) Causes of the disease
Microbial infection or bacterial infection
In the acute gastritis caused by eating foods contaminated with microorganisms and bacterial toxins, Salmonella, halophilic bacteria and certain viruses are more common. Bacterial toxins are more common with Staphylococcus aureus, and occasionally botulinum toxins, which have been discovered in recent years. Helicobacter pylori (Hp), also a pathogen causing acute gastritis.
2. Chemical factors
(1) Drugs: salicylate drugs such as aspirin, indomethacin and the like.
(2) Ingestion of corrosive agents: strong acids (such as sulfuric acid, hydrochloric acid, nitric acid), strong alkali (such as sodium hydroxide, potassium oxyhydroxide) cause corrosive damage to the stomach wall.
(3) Ingestion of toxic substances: poisonous cockroaches, arsenic, insecticides, rodenticides and other chemical poisons can stimulate the gastric mucosa to cause inflammation.
3. Physical factors
Eating too cold, overheated food or rough food can damage the gastric mucosa and cause inflammation.
4. Stress status
Some critical diseases such as neonatal asphyxia, intracranial hemorrhage, sepsis, shock, extensive burns, etc., cause the child to be in a state of severe stress, which is the main cause of acute erosive gastritis.
5. Protein allergy
Exogenous protein allergy causes gastritis and is especially common in infants fed milk or milk products.
(two) pathogenesis
1. Exogenous causes
It can seriously damage the gastric mucus barrier, causing the reverse diffusion of hydrogen ions and pepsin, causing damage to the gastric mucosa and causing erosion and bleeding.
2. Stress state
A large amount of norepinephrine and adrenaline are secreted, visceral blood vessels contract, gastric blood flow is reduced, ischemia, hypoxia further reduce the mitochondrial function of the mucosal epithelium, affecting the oxidative phosphorylation process, and reducing the glycogen storage of the gastric mucosa. When the gastric mucosa is ischemia, the reverse-dispersed hydrogen ions cannot be removed; hypoxia and norepinephrine reduce the secretion of bicarbonate ions, reduce the synthesis of prostaglandins, weaken the gastric mucosal barrier function, and cause acute erosive inflammation of the gastric mucosa.
Prevention
Prevention of acute gastritis in children
Develop good eating habits, pay attention to food hygiene; take irritating drugs for gastric mucosa, take it after meals, reduce or change medicine if necessary, manage corrosives and toxic substances, prevent children from mistaking; avoid cold and irritation Food, etc.
Complication
Pediatric acute gastritis complications Complications, anemia, anemia, shock
Can cause dehydration and acidosis, such as massive bleeding can lead to anemia, and even shock, acute corrosive gastritis can cause stenosis or pyloric stenosis, obstruction.
Symptom
Acute gastritis in children, common symptoms, abdominal discomfort, nausea and vomiting, abdominal pain, bloating, nausea, anorexia, nausea, dehydration, repeated hematemesis
More acute onset, manifested as upper abdominal fullness, pain, belching, nausea and vomiting, vomit can be bloody coffee, can also occur more bleeding, manifested as hematemesis and melena, or even the first performance, such as Aggressive gastritis, aspirin-induced gastritis, infectious gastritis accompanied by diarrhea is called acute gastroenteritis, and some patients may be associated with fever and other symptoms of infection, vomiting can cause dehydration, acidosis, blood loss can cause shock.
1. Acute simple gastritis: more acute onset, more than a few hours after eating contaminated food, or 24h, the symptoms are different, showing upper abdominal discomfort, pain, and even severe abdominal cramps, anorexia, nausea, vomiting, if With enteritis, there may be diarrhea, if it is caused by drugs or irritating foods, the symptoms are milder, limited to the upper abdomen, physical examination has upper abdominal or umbilical tenderness, bowel sounds can be hyperthyroidism.
2. Acute erosive gastritis: more induced in the body under severe disease stress, rapid onset, often with hematemesis or black feces as a prominent symptom, a large number of bleeding can cause syncope or shock, accompanied by severe anemia.
3. Acute corrosive gastritis: accidental administration of strong acid, strong alkali history, in addition to oral mucosal erosion, edema, middle and upper abdominal pain, strangulation, nausea, vomiting, hematemesis and black feces, and stomach dysfunction, after the acute phase There may be residual stenosis of the cardia or pylorus, obstructive symptoms such as vomiting, and acute gastritis without characteristic clinical manifestations. The diagnosis depends mainly on medical history, performance and endoscopy.
Examine
Examination of acute gastritis in children
Infected by the infection factors, the peripheral white blood cell count is generally increased, the proportion of neutrophils is increased, diarrhea, stools are routinely examined with a small amount of mucus and red, white blood cells.
1. Endoscopy: gastric mucosa is obviously congested, edema, mucous membrane surface covered with thick viscous inflammatory exudate, erosive gastritis sees points on the above lesions, round, piece, linear or irregular shape erosion, center It is red fresh bleeding or brown-red old bleeding, with white moss or yellow moss, often multiple or single. When doing gastroscope, gastric mucosa should be taken for Helicobacter pylori detection.
2. X-ray examination: gastrointestinal barium meal examination of the lesions of the mucosa rough, local tenderness, but can not find erosive lesions, and can not be used for patients with acute or active bleeding.
Diagnosis
Diagnosis and diagnosis of acute gastritis in children
diagnosis
Diagnosis is based on clinical manifestations.
Differential diagnosis
The above symptoms of abdominal pain should be identified with the following diseases:
1. Acute pancreatitis: sudden onset of severe pain in the upper abdomen, radiation to the back and waist, elevated serum amylase, B-ultrasound or CT showed pancreatic enlargement, severe patients with abdominal puncture can draw hemorrhagic fluid and amylase increased.
2. Biliary tsutsugamushi: sudden onset of severe cramps in the upper abdomen, can be radiated to the left, right shoulder and back, twitching during the attack, obvious tenderness under the xiphoid, may be accompanied by vomiting, sometimes spit out aphids, B super biliary There are foreign bodies in the main body.
