消化性潰瘍-5年制(七版)課件

消化性潰瘍5年制(第七版）課件消化性潰瘍5年制(第七版）課件消化性潰瘍5年制(第七版）課件Male，30yearsold，complainofrecurrentepigastricpainfor2years.Thepainbecomeworse2-3hoursaftermealandcanberelievedbyfoodandranitidine，usuallyaccompaniedwithbloating.IntheotherhospitalBultrasoundshowedcholecystitis.What’sthemostlikelydiagnosis？Whichexaminationshouldbedoneforthispatient？Andhowtotreat?CaseReview消化性潰瘍5年制(第七版）課件消化性潰瘍5年制(第七版）1消化性潰瘍-5年制(七版)課件消化性潰瘍-5年制(七版)課件消化性潰瘍-5年制(七版)課件消化性潰瘍-5年制(七版)課件

EpidemiologyOverview

M:FslightlymoreDU:GU3:1AgeofDUyoungpeopleAgeofGUmiddleageandelderOverview

M:FslightlyEtiology&Pathogenesis

病因和發(fā)病機(jī)制

Etiology&PathogenesisInjuryfactorDefensivefactorInjuryfactorDefensivefactorNormalPepticulcerInjuryfactorDefensiveDefensivefactors(防御因素）

Mucusandbicarbonate(黏液和碳酸氫鹽）

Mucosabarrier（粘膜屏障）

Therichedmucosalbloodflow（豐富的血流）

Otherfactors:PGE1,EGFetc.Defensivefactors(防御因素）MucusOtherriskfactorsdrinking,diet,viralinfection,stress,geneticfactorInjuryfactors（損傷因素）Hpinfection（幽門螺桿菌）NSAID（非甾體抗炎藥）

Non-steroidalanti-inflammatorydrugGastricacidandPepsin（胃酸和胃蛋白酶）OtherriskfactorsInjuryfact

HpinfectionGcellsfunction,Dcellsfunction,Gastrinacid-pepsinDecreasedduodenalbicarbonatesecretionGastricepitheliummetaplasiainduodenumHpinfectionGcellsfunctionDirectcytotoxicity(Localeffect)COXinhibitor(systematiceffect)COX1COX2PathogenesisofNSAID(二）胃腸道炎癥Directcytotoxicity(LocaleffGastricacidandPepsin(三）

Theformationofpepticulcereventuallyresultfrominvadingofacid-pepsin(directfactor)BAO↑MAO↑(Leakingroofhypothesis)

GastricacidandPepsin(三）Pathology

病理PathologyLocation:Thepepticulcerusuallylocatedinantrumandduodenalanteriorwall.Number:oneormoreSize:generallyDU<1.0cm;GU<2cm(>2cmgiantulcer)ComplicationPathologyLocation:ThepepticulcerusuClinicalpresentation

臨床表現(xiàn)ClinicalpresentationChronicityRhythmicity

FeaturesofPUPeriodicityandrecurrenceChronicityRhythmicityFeatures

abdominalpain--typicalsymptom

LocationQualityRhythmicityabdominalpain--typicalsympOthersymptoms

epigstricburningsensation（useful)

bloatingdyspepsia

epigastricmalaise

(notspecial,notdiagnostic)belch,acidreflux

asymptomaticcaseOthersymptoms

epigstricburPhysicalsignWithoutcomplication:

justmildepigastrictendernessWithcomplication:

presentcorrespondingphysicalsign(reboundtenderness,gastricform,splashingsound)PhysicalsignWithoutcomplicatSpecialtypesofPU

Compoundulcer(復(fù)合潰瘍）

Pyloricchannelulcer（幽門管潰瘍）

Postbulbarulcer（球后潰瘍）

Giantulcer（巨大潰瘍）Theagedpepticulcer（老年人消化性潰瘍）Asymptomaticulcer（無癥狀潰瘍）

SpecialtypesofPUCompounduLaboratoryexamination

實驗室檢查Laboratoryexamination

Endoscopy（胃鏡）TestingofHP（HP檢測）BariumRadiography（鋇餐）Gastricjuiceanalysis（胃液分析）Testingofserousgastrin(血清胃泌素）Laboratoryexamination

Endoscopy（胃鏡）Laboratoryexami

Endoscopyisthesensitive,specificandprecisemethodfordiagnosingpepticulcer,allowingdirectinspectionandbiopsy.EndoscopyEndoscopeEndoscopyisthese

Endoscopy--normalimagingGastricfundusGastricbodyGastricangleGastricantrum

duodenalbulbEndoscopy--normalimagingGas

Endoscopy--pyloricchannelulcerEndoscopy--pyloricchannelu

Endoscopy--BulbarulcerEndoscopy--Bulbarulcer

Invasiveassessment

Rapidureasetest（快速尿素酶法）

Histologicalexamination（組織學(xué)）

HPculture（HP培養(yǎng)）

PCRTestingofHP

rapidureasetesthistologicalexaminationInvasiveassessmentTestTestingforHP（二）Noninvasiveassessment

Ureabreathtesting(呼氣試驗）

Fecalantigenassay（糞便抗原分析）

Serologicantibodytesting（血清學(xué)分析）

13C-ureabreathtestTestingforHP（二）NoninvasiveDiagnosis診斷

Diagnosis

Endoscopy(內(nèi)鏡）Bariumradiography

（鋇餐）DiagnosisPresenthistoryInitialdiagnosisFinaldiagnosis

Endoscopy(內(nèi)鏡）DiagnosisPreseDifferentialdiagnosis

鑒別診斷Differentialdiagnosis

Gastriccarcinoma

（胃癌）Zollinger-Ellisionsyndrome

（卓－艾綜合癥）DifferentialdiagnosisGUGCGastriccarcinomaDifferentialComplication

Hemorrhage(出血）

Perforation（穿孔）

Gastricoutletobstruction（梗阻）

Canceration（癌變）Complication

Hemorrhage(出血）Treatment

治療Treatment

治療RemovetheinducementDrugtherapySurgicaltherapyAntacidsTherapyMucosalprotectionTreatment

HperadicationRemovetheinducementDrugtherRemovetheinducementLivingandDietregularlyMentalstatuswellAvoidingbadhabitRemovetheinducementLivinganProtonpumpinhibitors(PPIs)arethemostpotentAntacidagents.

omaprazole(20mg)lansoprazole(30mg)pantoprazole(40mg)rebaprazole(10mg)H2-receptorantagonist

cimetidine(200mg)ranitidine(150mg)famotidine(20mg)nizatidine

Drugtherapy--AntacidsTherapyProtonpumpinhibitors(PPIs)

LithiumandMagnesiumCarbonate

ProstaglandinDrugtherapy--MucosalprotectivetherapyDrugtherapy--MucosalprotectiDrugtherapy--HperadicationPPI+Clarithromycin0.5+Amoxicillin1.0PPI+Furazolidone0.1+Amoxicillin1.0PPI+Amoxicillin1.0+Metronidazole0.4PPI+Clarithromycin0.5+Metronidazole0.4BidX7daysDrugtherapy--HperadicationDrugtherapy--HperadicationBismuthagent(480mg/d）+twotypesofantibiotics(Clarithromycin、FurazolidoneAmoxicillin、Metronidazole）Drugtherapy--HperadicationBiFailureofHPeradicationAlteranothertwoantibioticsPPI+Bismuth+othertwoantibioticsFailureofHPeradicationAlterSurgicaltherapy

Indication：massivehemorrhageAcuteperforationObstructioncausedbyscarSuspectedcancerationRefractoryulcerSurgicaltherapyIndication：Male，30yearsold，complainofrecurrentepigastricpainfor2years.Thepain

becomeworse2-3hoursaftermealandcanberelievedbyfoodandranitidine，usuallyaccompaniedwithbloating.IntheotherhospitalBultrasoundsh