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）课件Male，30yearsold，complainofrecurrentepigastricpainfor2years.Thepainbecomeworse2-3hoursaftermealandcanberelievedbyfoodandranitidine，usuallyaccompaniedwithbloating.IntheotherhospitalBultrasoundshowedcholecystitis.What’sthemostlikelydiagnosis？Whichexaminationshouldbedoneforthispatient？Andhowtotreat?CaseReview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

EpidemiologyOverview

M:FslightlymoreDU:GU3:1AgeofDUyoungpeopleAgeofGUmiddleageandelderOverview

M:FslightlyEtiology&Pathogenesis

病因和发病机制

Etiology&PathogenesisInjuryfactorDefensivefactorInjuryfactorDefensivefactorNormalPepticulcerInjuryfactorDefensiveDefensivefactors(防御因素）

Mucusandbicarbonate(黏液和碳酸氢盐）

Mucosabarrier（粘膜屏障）

Therichedmucosalbloodflow（丰富的血流）

Otherfactors:PGE1,EGFetc.Defensivefactors(防御因素）MucusOtherriskfactorsdrinking,diet,viralinfection,stress,geneticfactorInjuryfactors（损伤因素）Hpinfection（幽门螺杆菌）NSAID（非甾体抗炎药）

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

HpinfectionGcellsfunction,Dcellsfunction,Gastrinacid-pepsinDecreasedduodenalbicarbonatesecretionGastricepitheliummetaplasiainduodenumHpinfectionGcellsfunctionDirectcytotoxicity(Localeffect)COXinhibitor(systematiceffect)COX1COX2PathogenesisofNSAID(二）胃肠道炎症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

临床表现ClinicalpresentationChronicityRhythmicity

FeaturesofPUPeriodicityandrecurrenceChronicityRhythmicityFeatures

abdominalpain--typicalsymptom

LocationQualityRhythmicityabdominalpain--typicalsympOthersymptoms

epigstricburningsensation（useful)

bloatingdyspepsia

epigastricmalaise

(notspecial,notdiagnostic)belch,acidreflux

asymptomaticcaseOthersymptoms

epigstricburPhysicalsignWithoutcomplication:

justmildepigastrictendernessWithcomplication:

presentcorrespondingphysicalsign(reboundtenderness,gastricform,splashingsound)PhysicalsignWithoutcomplicatSpecialtypesofPU

Compoundulcer(复合溃疡）

Pyloricchannelulcer（幽门管溃疡）

Postbulbarulcer（球后溃疡）

Giantulcer（巨大溃疡）Theagedpepticulcer（老年人消化性溃疡）Asymptomaticulcer（无症状溃疡）

SpecialtypesofPUCompounduLaboratoryexamination

实验室检查Laboratoryexamination

Endoscopy（胃镜）TestingofHP（HP检测）BariumRadiography（钡餐）Gastricjuiceanalysis（胃液分析）Testingofserousgastrin(血清胃泌素）Laboratoryexamination

Endoscopy（胃镜）Laboratoryexami

Endoscopyisthesensitive,specificandprecisemethodfordiagnosingpepticulcer,allowingdirectinspectionandbiopsy.EndoscopyEndoscopeEndoscopyisthese

Endoscopy--normalimagingGastricfundusGastricbodyGastricangleGastricantrum

duodenalbulbEndoscopy--normalimagingGas

Endoscopy--pyloricchannelulcerEndoscopy--pyloricchannelu

Endoscopy--BulbarulcerEndoscopy--Bulbarulcer

Invasiveassessment

Rapidureasetest（快速尿素酶法）

Histologicalexamination（组织学）

HPculture（HP培养）

PCRTestingofHP

rapidureasetesthistologicalexaminationInvasiveassessmentTestTestingforHP（二）Noninvasiveassessment

Ureabreathtesting(呼气试验）

Fecalantigenassay（粪便抗原分析）

Serologicantibodytesting（血清学分析）

13C-ureabreathtestTestingforHP（二）NoninvasiveDiagnosis诊断

Diagnosis

Endoscopy(内镜）Bariumradiography

（钡餐）DiagnosisPresenthistoryInitialdiagnosisFinaldiagnosis

Endoscopy(内镜）DiagnosisPreseDifferentialdiagnosis

鉴别诊断Differentialdiagnosis

Gastriccarcinoma

（胃癌）Zollinger-Ellisionsyndrome

（卓－艾综合症）DifferentialdiagnosisGUGCGastriccarcinomaDifferentialComplication

Hemorrhage(出血）

Perforation（穿孔）

Gastricoutletobstruction（梗阻）

Canceration（癌变）Complication

Hemorrhage(出血）Treatment

治疗Treatment

治疗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