【大学课件】消化性溃疡病

1、Peptic Ulcer Disease消化性溃疡病上海第二医科大学仁济医学院 薛惠平Question: Whats the meaning of “Peptic Ulcer Disease? Definition Peptic Ulcer Disease is defined as an ulcer occurring in a region that touches gastric acid(胃酸) and pepsin(胃蛋白酶) and usually refers to gastric ulcer(胃溃疡) or duodenal ulcer(十二指肠溃疡).Typical endo

2、scopic appearance of a benign gastric ulcer. The ulcer is on the angularis, the most common location for a gastric ulcer, and is well circumscribed without any associated mass effect. The surrounding mucosa is mildly erythematous红斑的 and without nodularity结节. Typical radiographic features of a benign

3、 gastric ulcer. A large well-circumscribed ulcer is seen on the angularis. a posterior duodenal ulcer Typical radiographic features of duodenal ulcer. This duodenal bulb ulcer is associated with marked edema, resulting in the appearance of radiating folds to the ulcer crater. The bulb is also distor

4、ed secondary to previously existing ulceration. Questions: What does ulcer 溃疡 mean?How can we differentiate between ulcer and erosion 糜烂?Erosions in the duodenal bulb and a posterior duodenal ulcer Erosion糜烂 : a superficial lesion caused by denudation of the surface epithelium上皮细胞ulcer 溃疡: a mucosal

5、 defect extending into the muscularis mucosa(粘膜肌层)Mucosa can be divided into: Epithelium 上皮Lamina propria 固有层Muscularis mucosae 粘膜肌层Clinical manifestations of Peptic Ulcer Diseases消化性溃疡病的临床表现 symptoms 病症 abdominal pain 腹痛located in the epigastric(上腹) area;burning in quality(烧灼样);occurred on an empty

6、 stomach 2 to 4 hours after meals and/or at night (nocturnal pain夜间疼痛);relieved by antacids(抗酸剂) and/or meals(进餐);tend to wax and wane(加重与缓解) over months “acid dyspepsia酸消化不良 the majority of patients (approximately 70%) with epigastric distress (“dyspepsia) do not have evidence of active ulcer disea

7、se;conversely up to 40% of patients with an active ulcer crater deny abdominal pain;patients can present with an ulcer-related complication, particularly hemorrhage, without antecedent symptoms despite being both insensitive and non-specific, the symptom of epigastric abdominal pain, particularly bu

8、rning after meals and at night and relieved with food or antacid, suggests the possibility of ulcer disease.Other symptomsgastroesophageal reflux 胃食管反流 (including upright 直立位 and supine仰卧位 reflux and non-cardiac chest pain非心源性胸痛);symptoms of indigestion 消化不良occurring with or shortly after eating and

9、 characterized by epigastric fullness and discomfort(上腹饱胀与不适), belching(打嗝), bloating(胀气), nausea(恶心), early satiety(早饱), and specific food intolerances); signs 体征Physical examination is of limited value in patients with uncomplicated ulcer.For epigastric tenderness 压痛 on deep palpation深部触诊, the sen

10、sitivity and specificity are all approximately 50% or less. Furthermore, many patients with non-ulcer diseases 非溃疡性消化不良also have epigastric tenderness on physical examination. In patients with free perforation穿孔 or ulcer penetration穿透 into the pancreas,findings of peritonitis腹膜炎are usually present.

11、In patients with gastric retention 胃潴留who have been fasting禁食 for a few hours, a succussion splash 振水声(produced by auscultating 听诊 the abdomen while rocking the patient back and forth) suggests retained gastric contents. Complications 并发症Hemorrhage 出血 the most common complication of ulcer disease (i

12、n approximately 15% of patients) Perforation穿孔 and Penetration穿透 (in approximately 7% of patients )Duodenal ulcers: perforate anteriorlyGastric ulcers: perforate along the anterior wall of the lesser curvature of the stomachPerforated peptic ulcer. Air is present under the right hemidiaphragm in a p

13、atient with acute severe abdominal pain. Penetration is similar pathologically to perforation, except that the ulcer crater壁龛 burrows打洞 through the entire wall of the intestine, and instead of leaking digestive contents into the peritoneal cavity腹腔, the crater bores钻孔 into an adjacent organ附近脏器.Gast

14、ric ulcers most commonly penetrate into the left lobe of the liver, while duodenal ulcers penetrate posteriorly into the adjacent pancreas胰腺, sometimes leading to pancreatitis胰腺炎. Rarely, gastric ulcers may penetrate into the colon结肠, resulting in a gastrocolic fistula胃结肠瘘. Gastric outlet obstructio

15、n 梗阻 (gastric retention or pyloric stenosis胃潴留或幽门狭窄)functional impairment of antral motility 胃窦动力功能不良due to the effects of acute inflammation and edema;mechanical obstruction 机械性梗阻 due to scarring near the gastroduodenal junction;manifest as gastroesophageal reflux, early satiety, weight loss, abdom

16、inal pain, and vomiting;As the degree of retention increases, the quantity of vomitus呕吐物 also increases, often containing food ingested 12 or more hours previously.Barium upper gastrointestinal study demonstrates the size of the stomach. Endoscopy demonstrates the pyloric obstruction with an active

17、ulcer crater seen in the pyloric channel. Canceration癌变(Gastric ulcer ) Questions for summary:(1) What does Peptic Ulcer Disease refer to?(2) What are the symptoms and signs you can find in the patients with peptic ulcer disease?(3) Which kind of complication most frequently occur? THANK YOU!騶寥賬恓禨撘鴬

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