内科第一学期-peptic ulcer

Peptic ProvincialHospital JiangJunmeiHelicobacterpyloriandNSAIDsledtoimportantchanges gnosticandtreatmentstrategiesTypes:gastriculcerandduodenalGastricMainClinicalManifestationsEndoscopicinvestigationsDifferentialdiagnosistogastriccancerInU.S:affect0.92%ofthepopulationInDenmark:lifetimeprevalenceis1.2%formenand0.6%forInJapan:1perInNorway:1.5per1000InScotland:2.7per1000Mortalityrate:1per100,000,basedon1979estimatesfromUSHigerinpatientsolderthanMaletofemale1:1inU.S., andinProtectiveMucusandbicarbonatesecretion,bloodAggressivefactors:acidsecretion,Majoretiologicalfactors:HpinfectionandNSAIDsShay＆Sun平衡理3HCO3粘 细血 更

无损 损

NSAIDsH.胃 胃

吸烟等防御因 因幽门螺杆 非甾体类抗炎 （>60岁）、既往溃疡病史和并发 NSAIDs在胃液中为非离子状态，可反弥散，后者进一步损伤细胞膜，使药物 胃酸和胃蛋白壁细胞对刺激物的敏感性增遗传因遗传因素受但是不能否其吸胃十二指肠运动异应激和心里因饮与消化性溃疡相关的疾Gross溃疡（DU>2cmGU>3cm)56、并发病变：穿孔。前壁穿孔多急性腹膜炎；后壁穿孔往往和邻近如胰、肝、横结肠等粘连，称性溃疡。深及肌层的溃疡球部的假憩室形成，幽门梗阻。合并大的溃疡，有时基底部可见露的血管。UnderClinicalWidevarietyofsymptoms,ortheymayremaincomple asymptomatic,GastricandduodenalulcerusuallycannotbedifferentiatedbasedonhistoryaloneAbdominalEpigastrium,rightupperPainaftermeals,oftenrelapsewhentheseasonischangingRadiationtothebackissuggestiveofaposteriorpenetratinggastriculcercomplicatedbypancreatitisOtherSourregurgitation,beltching,heartburn,epigastricdistention,vomiting,nausea,poorUppergastrointestinalhemorrhageHematemesis,melena,orepisodesofEpigastrictenderness,abdominaldistention,succussionsplash,InvoluntoryguardingisindicativeperitonitissecondarytogastricCilinical 上腹痛，典型的SIs痛长时间的缓解，以后又复发。以秋冬交替或冬春交替的季节 消化性溃疡的特殊类型和问 LABLabStudiesandspecialHppyloriInvasivetests:Biopsy,Culture,RapidureasetestNoninvasivetests:Antibodytesting,Ureabreathtesting,StoolantigenysisofgastricGastricendoscopy:activestage,healingstageandscarstagesUpperGIBenigngastriculcer:arenormallyfoundonthelessercurvature,theulcertendtoprojectthecontourofthestomach,withradiatingfoldsextendingtotheulcerMalignantUlcer:usuallyhaveirregularheaped-upmarginsthatprotrudeintothelumenoftheAcharacteristicclinicalRoutinelaboratoryGastricUpperGIDifferentialdiagnosisofbenignulcerandmalignantulcerBenignulcertendtohaveasmooth,roundedgewithaflatsmoothbaseandsurroundingmucosathatshowsradiatingMalignentulcerusuallyhaveirregularheaped-uporoverhangingmargins,Theulceratedmassoftenprorudesintothelumen,andthefoldssurroudingtheulcercraterareoftennodularandirregular鉴功能性消化不慢性胆囊炎和胆石胃胃泌素DifferentialGastricZollinger-EllisonFunctional并发上消化穿幽门梗Generaltreatment:生活规律，劳逸结合，避免过度劳累和精神紧张。良好的生活。避免NS