《病理学》消化系统疾病-课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,ppt课件,*,第十九章 消化系统疾病,P,278,Diseases of the Digestive System,1,ppt课件,1,组成,消化管：口腔,肛门消化腺：涎腺、肝、胰及消化管的粘膜腺体,一、消化系统解剖组织结构复习,2,ppt课件,（,1,）粘膜层（,2,）粘膜下层（,3,）肌层（,4,）浆膜层,2,共同的结构特点,3,ppt课件,第一节 胃炎,P,278,一,急性胃炎,二,.,慢性胃炎,（一）慢性浅表性胃炎,（二）慢性萎缩性胃炎,4,ppt课件,一、胃炎,(gastritis),胃粘膜的炎症性病变 常见、多发,急性胃炎：原因较清楚，嗜中性粒细胞浸润,慢性胃炎：自身免疫、胆汁返流、急性迁延，幽门螺杆菌,（一）急性胃炎,(acute gastritis),依据病因、胃粘膜病变分型,gastritis,）,5,ppt课件,（二）慢性胃炎,(chronic gastritis),病因机制：,1,）幽门螺杆菌（,HP,）慢性感染,2,）长期慢性刺激,3,）自身免疫,4,）胆汁返流,幽门螺杆菌（,Helicobacter Pylori,HP,）,粘附胃上皮细胞：产生粘附素,适应高酸环境：分泌尿素酶，水解尿素,氨、,CO2,降解表面粘液：细胞毒素相关蛋白，细胞空泡毒素等,空泡变性,6,ppt课件,1.,慢性浅表性胃炎,(chronic superficial gastritis,，,CSG),最常见、胃镜检出率,20 40%,（,1,）病变,部位：多累及,胃窦部,、可见于胃体,肉眼：多灶或弥漫分布、粘膜充血、水肿、或出血、糜烂,光镜：固有腺体保持完整粘膜浅层内淋巴细胞、浆细胞浸润,7,ppt课件,2.,慢性萎缩性胃炎,(,chronic atrophic gastritis,CAG,),（,1,）病变,胃镜：,a.,粘膜变薄、皱襞变平或消失、表面呈细颗粒状,b.,正常胃粘膜橘红色,灰白或灰黄,c.,粘膜下血管分支清晰可见，出血、糜烂,8,ppt课件,2.,慢性萎缩性胃炎,(,chronic atrophic gastritis,CAG,),光镜：,粘膜全层内大量淋巴细胞、浆细胞浸润、淋巴滤泡形成,胃粘膜固有腺体（胃体腺、幽门腺、贲门腺）萎缩或消失，囊状扩张,肠上皮化生或假幽门腺化生（粘液分泌细胞化生）灶状或片状，弥漫分布,肠上皮化生,:,胃粘膜上皮被肠粘膜上皮取代,完全型化生（小肠型）：吸收细胞、杯状细胞、潘氏细胞,不完全型化生（结肠型化生）：粘液细胞、杯状细胞,与胃癌关系密切,假幽门腺化生：胃底和胃体部的壁细胞和主细胞消失，由分泌粘液的细胞取代后似幽门腺,9,ppt课件,慢性浅表性胃炎,（,Chronic superficial gastritis,）,慢性萎缩性胃炎,（,Chronic atrophic gastritis,）,肠上皮化生（,intestinal metaplasia,）,肠上皮化生（,intestinal metaplasia,）,10,ppt课件,This is a more typical acute gastritis with a diffusely hyperemic gastric mucosa,.There are many causes for acute gastritis:alcoholism,drugs,infections,etc.,11,ppt课件,第二节 胃溃疡,P,280,一病因和发病机制,（一）胃溃疡的发病机制,（二）十二指肠的发病机制,二,.,病理变化,三,.,结局和并发症,12,ppt课件,（三）病因及发病机制,pathogenesis,1.,胃黏膜屏障功能减低,1,）迷走神经兴奋性降低,2,）烟、酒、水杨酸盐,药物、环境因素、遗传因素、胃排空延缓和胆汁返流,HP,感染、,2.,胃液消化作用,胃粘膜屏障破坏,胃液自身消化,消化性溃疡,3.,十二指肠溃疡常见原因是胃酸持续性增高,正常的胃粘膜防御屏障：,粘液,-,碳酸氢盐屏障,粘膜上皮屏障,丰富的粘膜血流,13,ppt课件,Normal Mucosal defence,14,ppt课件,15,ppt课件,Helicobacter,pylori,16,ppt课件,Gastritis is often accompanied by infection with Helicobacter pylori.This small curved to spiral rod-shaped bacterium is found in the surface epithelial mucus of most patients with active gastritis.The rods are seen here with a methylene,blue stain.,17,ppt课件,二、,消化性溃疡病（,peptic ulcer disease,）,（一）概述,1.,常见病，成人多见，反复发作，慢性经过；胃、十二指肠球部，十二指肠,胃,=70%25%,复合性溃疡,5%,；与胃酸、蛋白酶消化作用有关,-,消化性溃疡,（二）病理变化（胃溃疡）,1,、肉眼,（,1,）部位,（,2,）数目,（,3,）大小,（,4,）形状,（,5,）深度,（,6,）边缘,（,7,）底部,（,8,）切面,（,9,）周围胃粘膜,（,10,）浆膜面,18,ppt课件,This is the normal appearance of the stomach,which has been opened along the greater curvature.The esophagus is at the left.In the fundus can be seen the lesser curvature.Just beyond the antrum is the pylorus emptying into the first portion of duodenum is at the lower right.The normal appearance of the gastric fundus on upper GI endoscopy,is shown below at the left,with the normal duodenal appearance at the right.,19,ppt课件,This is the normal appearance of the gastric antrum,extending to the pylorus at the right of center.The first portion of the duodenum(duodenal bulb)is at the far right.,20,ppt课件,21,ppt课件,肉眼：多位于胃小弯、近幽门部；溃疡多单个、圆或椭圆，,D2.0cm,；边缘整齐，状如刀割，底部平坦，深浅不一，可 达浆膜层；贲门侧,-,深，潜掘状 幽门状,-,浅，阶梯状；周围粘膜皱壁轮辐状集中。,2,、镜下（底部）,（,1,）,Zone of inflammatory exudate,（渗出层）,（,2,）,Zone of necrotic materials,（坏死层）,（,3,）,Zone of granulation tissue,（肉芽组织层）,（,4,）,Zone of collagenous,scar,（疤痕层）,22,ppt课件,增殖性动脉内膜炎（管壁增厚、管腔狭窄）：妨碍组织再生不易愈合；防止溃疡底血管出血,神经细胞、神经纤维变性、断裂,球状增生（创伤性神经纤维瘤）,疼痛,溃疡边缘粘膜肌层与肌层粘连,诊断溃疡病的重要依据,十二指肠溃疡：球部多见，前壁或后壁，较胃溃疡小、浅，,D1.0cm,23,ppt课件,24,ppt课件,This is the normal appearance of the gastric fundal mucosa,with short pits lined by pale columnar mucus cells leading into long glands which contain bright pink parietal cells that secrete hydrochloric acid.,25,ppt课件,Microscopically,the ulcer here is sharply demarcated,with normal gastric mucosa on the left falling away into a deep ulcer whose base contains infamed,necrotic debris.An arterial branch at the ulcer base is eroded and bleeding.,26,ppt课件,The mucosa at the upper right merges into the ulcer at the left which is eroding through the mucosa.Ulcers will penetrate over time if they do not heal.Penetration leads to pain.If the ulcer penetrates through the muscularis and through adventitia,then the ulcer is said to perforate and leads to an acute abdomen.An abdominal radiograph may demonstrate free air with a perforation.,27,ppt课件,The ulcer at the right is penetrating through the muscularis,and approaching an artery.Erosion of the ulcer into the artery will lead to another major complication of ulcers-hemorrhage.This hemorrhage can be life threatening.Chronic blood loss may lead to an iron deficiency anemia.,28,ppt课件,Duodenal Ulcer,Gastric Ulcer,29,ppt课件,30,ppt课件,31,ppt课件,（四）结局及合并症（,fate and complications,）,1,、愈合,healing,肉芽组织增生,-,机化,-,瘢痕,2,、出血,hemorrhage,1/3,，最多见；小血管,潜血、黑便；大血管,呕血、失血性休克,3,、穿孔,perforation,5%,，十二指肠易发生（壁薄），前壁多见,-,腹膜炎（急性弥漫性）后壁溃疡如穿透较慢，与邻近器官粘连,穿透性溃疡,局限性腹膜炎,4,、幽门狭窄,pyloric stenosis,2%,3%,瘢痕收缩,胃扩张、呕吐,5,、癌变,malignant transformation 1%,胃溃疡约,1%,，十二指肠溃疡几乎不癌变,32,ppt课件,5.,临床病理联系：,上腹部长期性、周期性和节律性疼痛；钝痛、烧灼痛或饥饿样痛；剧痛穿孔,十二指肠溃疡空腹痛、饥饿痛、夜间痛,胃溃疡进食后痛,33,ppt课件,34,ppt课件,35,ppt课件,In the endoscopic,views,the normal appearance of the pylorus