消化性溃疡-5年制(七版)课件

消化性溃疡 5年制(第七版）课件消化性溃疡 5年制(第七版）课件消化性溃疡 5年制(第七版）1消化性溃疡-5年制(七版)课件 消化性溃疡-5年制(七版)课件消化性溃疡-5年制(七版)课件消化性溃疡-5年制(七版)课件EpidemiologyOverviewM:F slightly moreDU:GU 3:1 Age of DU young people Age of GU middle age and elderOverviewM:F slightly Etiology&Pathogenesis病因和发病机制病因和发病机制Etiology&Pathogenesis Injury factorDefensive factorInjury factorDefensive factorNormal Peptic ulcer Injury factorDefensive Defensivefactors(防御因素）防御因素）Mucusandbicarbonate(黏液和碳酸氢盐）黏液和碳酸氢盐）Mucosabarrier（粘膜屏障）（粘膜屏障）Therichedmucosalbloodflow（丰富的血流）（丰富的血流）Otherfactors:PGE1,EGFetc.Defensive factors(防御因素）Mucus Otherriskfactorsdrinking,diet,viralinfection,stress,geneticfactorInjuryfactors（损伤因素）（损伤因素）Hpinfection（幽门螺杆菌）（幽门螺杆菌）NSAID（非甾体抗炎药）（非甾体抗炎药）Non-steroidalanti-inflammatorydrugGastricacidandPepsin（胃酸和胃蛋白酶）（胃酸和胃蛋白酶）Other risk factorsInjury fact HpinfectionnGcellsfunction,Dcellsfunction,Gastrinacid-pepsinnDecreasedduodenalbicarbonatesecretionnGastricepitheliummetaplasiainduodenum Hp infectionG cells functionnDirectcytotoxicity(Local effect)nCOXinhibitor(systematic effect)COX1COX2PathogenesisofNSAID(二）二）胃肠道胃肠道炎症炎症Direct cytotoxicity(Local effGastricacidandPepsin(三）三）Theformationofpepticulcereventuallyresultfrominvadingofacid-pepsin(direct factor)BAOMAO(Leakingroofhypothesis)Gastric acid and Pepsin(三）Pathology病病理理PathologyLocation:The peptic ulcer usually Location:The peptic ulcer usually located in antrum and duodenal anterior located in antrum and duodenal anterior wall.wall.Number:one or moreNumber:one or moreSize:generally DU1.0cm;GU 2cm Size:generally DU1.0cm;GU 2cm giant ulcer)giant ulcer)Complication Complication PathologyLocation:The peptic ulcer usu Clinicalpresentation临床表现临床表现Clinical presentationChronicityRhythmicity FeaturesofPUPeriodicityandrecurrenceChronicityRhythmicity Features abdominalpain-typicalsymptom Location Quality Rhythmicity abdominal pain-typical sympOthersymptomsepigstricburningsensation（useful)bloatingdyspepsiaepigastricmalaise(notspecial,notdiagnostic)belch,acidrefluxasymptomaticcaseOther symptoms epigstric burPhysicalsignnWithout complication:just mild epigastric tendernessnWith complication:present corresponding physical sign(rebound tenderness,gastric form,splashing sound)Physical signWithout complicatSpecialtypesofPU nCompoundulcer(复合溃疡）复合溃疡）nPyloricchannelulcer（幽门管溃疡）（幽门管溃疡）nPostbulbarulcer（球后溃疡）（球后溃疡）nGiantulcer（巨大溃疡）（巨大溃疡）nTheagedpepticulcer（老年人消化性溃疡）（老年人消化性溃疡）nAsymptomaticulcer（无症状溃疡）（无症状溃疡）Special types of PU Compound u Laboratoryexamination实验室检查实验室检查Laboratory examinationnEndoscopy（胃镜）（胃镜）nTestingofHP（HPHP检测）检测）nBariumRadiography（钡餐）（钡餐）nGastricjuiceanalysis（胃液分析）（胃液分析）nTestingofserousgastrin(血清胃泌素）血清胃泌素）LaboratoryexaminationEndoscopy（胃镜）Laboratory exami Endoscopy is the sensitive,specific and precise method for diagnosing peptic ulcer,allowing direct inspection and biopsy.EndoscopyEndoscope Endoscopy is the se Endoscopy-normalimagingGastricfundusGastricbodyGastricangleGastricantrumduodenalbulb Endoscopy-normal imagingGas Endoscopy-pyloricchannelulcer Endoscopy-pyloric channel u Endoscopy-Bulbarulcer Endoscopy-Bulbar ulcer Invasive assessment Rapid urease test（快速尿素酶法）（快速尿素酶法）Histological examination（组织学）（组织学）HP culture（HP培养）培养）PCRTestingofHP rapid urease testhistological examination Invasive assessmentTestTestingforHP（二）（二）Noninvasive assessment Ureabreathtesting(呼气试验）呼气试验）Fecalantigenassay（粪便抗原分析）（粪便抗原分析）Serologicantibodytesting（血清学分析）（血清学分析）13C-urea breath testTesting for HP（二）Noninvasive Diagnosis诊诊 断断Diagnosis nEndoscopy(内镜）内镜）nBariumradiography（钡餐）（钡餐）DiagnosisPresenthistoryInitial Initial diagnosisdiagnosisFinal Final diagnosisdiagnosisEndoscopy(内镜）DiagnosisPrese Differential diagnosis 鉴别诊断Differential diagnosis nGastriccarcinoma（胃癌）（胃癌）nZollinger-Ellisionsyndrome（卓艾综合症）（卓艾综合症）DifferentialdiagnosisGUGCGastric carcinomaDifferential ComplicationHemorrhage(出血）出血）Perforation（穿孔）（穿孔）Gastricoutletobstruction（梗阻）（梗阻）Canceration（癌变）（癌变）Complication Hemorrhage(出血）Treatment 治 疗Treatment 治 疗RemovetheinducementDrugtherapySurgicaltherapyAntacids Antacids TherapyTherapyMucosal Mucosal protectionprotectionTreatment Hp eradicationHp eradicationRemove the inducementDrug therRemovetheinducementLivingandDietregularlyMentalstatuswellAvoidingbadhabitRemove the inducementLiving annProton pump inhibitors(PPIs)are the most potent Antacid agents.omaprazole(20mg)lansoprazole(30mg)pantoprazole(40mg)rebaprazole(10mg)nH2-receptor antagonist cimetidine(200mg)ranitidine(150mg)famotidine(20mg)nizatidine Drugtherapy-AntacidsTherapyProton pump inhibitors(PPIs)LithiumandMagnesiumCarbonateProstaglandinDrugtherapy-MucosalprotectivetherapyDrug therapy-Mucosal protectiDrugtherapy-HperadicationnPPI+Clarithromycin0.5+Amoxicillin1.0nPPI+Furazolidone0.1+Amoxicillin1.0nPPI+Amoxicillin1.0+Metronidazole0.4nPPI+Clarithromycin0.5+Metronidazole0.4BidX7daysDrug therapy-Hp eradicationDrugtherapy-HperadicationBismuthagent(480mg/d）+twotypesofantibiotics(Clarithromycin、FurazolidoneAmoxicillin、Metronidazole）Drug therapy-Hp eradicationBiFailureofHPeradicationnAlteranothertwoantibioticsnPPI+Bismuth+othertwoantibioticsFailure of HP eradicationAlterSurgicaltherapy Indication：nmassive hemorrhagenAcute perforationnObstruction caused by scarnSuspected canceration nRefractory ulcerSurgical therapy Indication：nMale，30yearsold，complainofrecurrentepigastricpain for 2 years.The pain become worse 2-3 hoursaftermealandcanberelievedbyfoodandranitidine，usually accompanied with bloating.In the otherhospitalBultrasoundshowedcholecystitis.nWhatsthemostlikelydiagnosis？nWhichexaminationshouldbedoneforthispatient？Andhowtotreat?CaseReviewMale，30 years old，complain of Question nWhat is the mechanism of HpcausingDU?nTypicalsymptomofpepticulcer?Question What is the mechanismSummarynClinicalpresentationnLaboratoryexaminationnDiagnosisandDifferentialdiagnosisnTreatmentSummaryThank you!Thank you!Thank you!Thank you!骑封篙尊慈榷灶琴村店矣垦桂乖新压胚奠倘擅寞侥蚀丽鉴晰溶廷箩侣郎虫林森-消化系统疾病的症状体征与检查林森-消化系统疾病的症状体征与检查11、越是没有本领的就越加自命不凡。邓拓12、越是无能的人，越喜欢挑剔别人的错儿。爱尔兰13、知人者智，自知者明。胜人者有力，自胜者强。老子14、意志坚强的人能把世界放在手中像泥块一样任意揉捏。歌德15、最具挑战性的挑战莫过于提升自我。迈克尔F斯特利谢谢骑封篙尊慈榷灶琴村店矣垦桂乖新压胚奠倘擅寞侥蚀丽鉴晰溶廷48