（消化内科课件）（参考翻译）

Peptic Ulcer Disease 消化性溃疡病 (PUD) Bingqiang Zhang Department of Gastroenterology, the First Affiliated Hospital of Chongqing Medical University 1. Definition 2. Epidemiology 3. Etiology and pathogenesis 4. Clinical presentations 5. Diagnosis 6. Complications 7. Treatment Main Contents 1.Defenition of PUD PUD is Ulceration 溃疡 of gastrointestinal mucosa 胃肠道黏膜 resulting from auto- digestion 自身消化 of gastric acid and pepsin 胃蛋白酶. Stomach 胃 (gastric ulcer, GU) Duodenum 十二指肠肠 (deodenal ucler, DU) Esophagus 食管 Gastro-jejunal anastomosis 胃-空肠吻合术 (post subtotal gastrectomy 胃大部切除术后) Terminal ileum diverticulum（回肠末段憩室） (Meckels diverticulum，heterotopic gastric mucosa 胃 粘膜异位) Sites of peptic ulcer Sites of peptic ulcer Anastomotic ulcer Sites of peptic ulcer Sites of peptic ulcer Difference of ulcer and erosion Ulcer 溃疡 is a mucosal defect 黏 膜损害 that penetrates 穿透 the muscularis mucosa（粘膜肌层） Erosion 糜烂 is a small, superficial mucosal break that no more than the muscularis mucosa（粘膜肌层） 2.Epidemiology lPrevalence rate 患病率 about 10% overall lifetime lThe incidence of DU was higher than GU lThe incidence of was male higher than female lThe predominant 主导的 age of DU is between 20 and 50 years old, whereas 然而 GU occurs in patients more than 40 years old lThe disease is more common in smokers 3. Etiology and pathogenesis Gastric Mucosa vital signs are normal. Which of the following diagnostic studies should be done next? A) Abdominal ultrasonography B) Serologic testing for H. pylori C) Upper endoscopy D) Upper gastrointestinal barium study Case 2: A 65-year-old woman was recently discharged from the hospital after treatment of upper gastrointestinal bleeding secondary to a duodenal ulcer. While hospitalized, she underwent 行 upper endoscopy, and antral biopsy specimens 胃窦活检标本 showed H. pylori. The patient was treated with appropriate antibiotics and a proton pump inhibitor. When seen for a follow-up visit 6 weeks after completing her medical regimen 治疗过程, she is asymptomatic 有症状的, and her hemoglobin is normal. Which of the following diagnostic studies should be done next? A) Repeat upper endoscopy with antral biopsies B) Hydrogen breath test C) 13C-urea breath test D) Serologic testing for H. pylori E) No additional studies are indicated Case 3: A 59-year-old man has a 3-month history of epigastric discomfort and nausea without weight loss, melena 黑便, or vomiting. Over-the-counter H2-receptor antagonists have been ineffective. The patient is otherwise healthy and takes no other medications. Physical examination reveals mild epigastric tenderness to palpation. Upper endoscopy shows a 1-cm duodenal ulcer, and antral biopsy specimens demonstrate chronic gastritis and H. pylori infection. Which of the following is the most appropriate therapy for this patient? A) A proton pump inhibitor for 2 months B) An H2-receptor antagonist for 2 months C) A proton pump inhibitor and amoxicillin for 2 weeks D)