消化性溃疡英文课件

Peptic Ulcer DiseasePeptic Ulcer Disease 消化性溃疡病消化性溃疡病 QuestionQuestion: Whats the meaning : Whats the meaning of “of “Peptic Ulcer DiseasePeptic Ulcer Disease”?”? DefinitionDefinition Peptic Ulcer DiseasePeptic Ulcer Disease is defined as an is defined as an ulcerulcer occurring in a region that touches occurring in a region that touches gastric acid(gastric acid(胃酸胃酸) ) and and pepsin(pepsin(胃蛋白酶胃蛋白酶) ) and usually refers to and usually refers to gastric ulcer(gastric ulcer(胃溃疡胃溃疡) ) or or duodenal ulcer(duodenal ulcer(十二指肠溃疡十二指肠溃疡) ). . Typical endoscopic appearance of a benign gastric Typical endoscopic appearance of a benign gastric ulcer. The ulcer is on the angularis, the most ulcer. The ulcer is on the angularis, the most common location for a gastric ulcer, and is well common location for a gastric ulcer, and is well circumscribed without any associated mass effect. circumscribed without any associated mass effect. The surrounding mucosa is mildly erythematousThe surrounding mucosa is mildly erythematous红 斑的 and without nodularity and without nodularity结节结节 . . Typical radiographic features of a benign Typical radiographic features of a benign gastric ulcer.gastric ulcer. A large well-circumscribed A large well-circumscribed ulcer is seen on the angularis. ulcer is seen on the angularis. a posterior duodenal ulcer a posterior duodenal ulcer Typical radiographic features of duodenal Typical radiographic features of duodenal ulcer. This duodenal bulb ulcer is associated ulcer. This duodenal bulb ulcer is associated with marked edema, resulting in the with marked edema, resulting in the appearance of radiating folds to the ulcer appearance of radiating folds to the ulcer crater. The bulb is also distored secondary crater. The bulb is also distored secondary to previously existing ulceration. to previously existing ulceration. QuestionsQuestions: : What does What does ulcerulcer 溃疡溃疡 mean?mean? How can we differentiate between How can we differentiate between ulcer ulcer and and erosion erosion 糜烂糜烂 ? ? Erosions in the duodenal bulb and Erosions in the duodenal bulb and a posterior duodenal ulcer a posterior duodenal ulcer ErosionErosion糜烂糜烂 : a superficial lesion caused : a superficial lesion caused by denudation of the surface epitheliumby denudation of the surface epithelium（ 上皮细胞）上皮细胞） ulcer ulcer 溃疡溃疡: a mucosal defect extending : a mucosal defect extending into the muscularis mucosa(into the muscularis mucosa(粘膜肌层粘膜肌层) ) Mucosa can be divided intoMucosa can be divided into: : Epithelium Epithelium 上皮 Lamina propria Lamina propria 固有层 Muscularis mucosae Muscularis mucosae 粘膜肌层 Clinical manifestations of Clinical manifestations of Peptic Ulcer DiseasesPeptic Ulcer Diseases 消化性溃疡病的临床表现消化性溃疡病的临床表现 symptomssymptoms 症状症状 abdominal pain abdominal pain 腹痛腹痛 located in the epigastric(located in the epigastric(上腹上腹) area;) area; burning in quality(burning in quality(烧灼样烧灼样); ); occurred on an empty stomach 2 to 4 hours after occurred on an empty stomach 2 to 4 hours after meals and/or at night (meals and/or at night (nocturnal painnocturnal pain夜间疼痛夜间疼痛); ); relieved by antacids(relieved by antacids(抗酸剂抗酸剂) and/or meals() and/or meals(进餐进餐); ); tend to wax and wane(tend to wax and wane(加重与缓解加重与缓解) ) over monthsover months “ “acid dyspepsiaacid dyspepsia酸消化不良酸消化不良” ” the majority of patients (approximately the majority of patients (approximately 70%) with epigastric distress 70%) with epigastric distress ( (“ “dyspepsiadyspepsia” ”) do not have evidence of ) do not have evidence of active ulcer disease;active ulcer disease; conversely up to 40% of patients with conversely up to 40% of patients with an active ulcer crater deny abdominal an active ulcer crater deny abdominal pain;pain; patients can present with an ulcer-patients can present with an ulcer- related complication, particularly related complication, particularly hemorrhage, without antecedent hemorrhage, without antecedent symptomssymptoms despite being both insensitive despite being both insensitive and non-specific, the symptom and non-specific, the symptom of epigastric abdominal pain, of epigastric abdominal pain, particularly burning after meals particularly burning after meals and at night and relieved with and at night and relieved with food or antacid, suggests the food or antacid, suggests the possibility of ulcer disease.possibility of ulcer disease. Other symptomsOther symptoms gastroesophageal reflux gastroesophageal reflux 胃食管反流胃食管反流 (including upright (including upright 直立位直立位 and supineand supine仰仰 卧位卧位 reflux and non-cardiac chest painreflux and non-cardiac chest pain 非心源性胸痛非心源性胸痛 ); ); symptoms of indigestion symptoms of indigestion 消化不良消化不良 occurring with or shortly after eating occurring with or shortly after eating and characterized by epigastric fullness and characterized by epigastric fullness and discomfort(and discomfort(上腹饱胀与不适上腹饱胀与不适), ), belching(belching(打嗝打嗝), bloating(), bloating(胀气胀气), nausea(), nausea( 恶心恶心), early satiety(), early satiety(早饱早饱), and specific ), and specific food intolerances);food intolerances); signssigns 体征体征 Physical examination is of limited value Physical examination is of limited value in patients with uncomplicated ulcer.in patients with uncomplicated ulcer. For epigastric tenderness For epigastric tenderness 压痛压痛 on deep on deep palpationpalpation深部触诊深部触诊, the sensitivity and , the sensitivity and specificity are all approximately 50% or specificity are all approximately 50% or less. less. Furthermore, many patients with non-Furthermore, many patients with non- ulcer diseases ulcer diseases 非溃疡性消化不良非溃疡性消化不良also have also have epigastric tenderness on physical epigastric tenderness on physical examination.examination. In patientsIn patients with with free perforationfree perforation穿孔穿孔 or or ulcer penetrationulcer penetration穿透穿透 into the into the pancreas,findings of pancreas,findings of peritonitisperitonitis腹膜炎腹膜炎 are usually present.are usually present. In patientsIn patients with with gastric retentiongastric retention 胃潴胃潴 留留who have been fastingwho have been fasting禁食禁食 for a few for a few hours, a hours, a succussion splashsuccussion splash 振水声振水声 (produced by auscultating (produced by auscultating 听诊听诊 the the abdomen while rocking the patient abdomen while rocking the patient back and forth)back and forth) suggestssuggests retained gastric contents.retained gastric contents. C Complicationsomplications 并发症并发症 Hemorrhage Hemorrhage 出血出血 the most common complication of ulcer the most common complication of ulcer disease (in approximately 15% of patients) disease (in approximately 15% of patients) PerforationPerforation穿孔穿孔 and Penetrationand Penetration 穿透穿透 (in approximately 7% of patients )(in approximately 7% of patients ) Duodenal ulcersDuodenal ulcers: perforate anteriorly: perforate anteriorly Gastric ulcersGastric ulcers: : perforate along the perforate along the anterior wall of the lesser curvature of anterior wall of the lesser curvature of the stomachthe stomach Perforated peptic ulcer. Air is present Perforated peptic ulcer. Air is present under the right hemidiaphragm in a under the right hemidiaphragm in a patient with acute severe abdominal patient with acute severe abdominal pain. pain. Penetration Penetration is similar pathologically to is similar pathologically to perforationperforation, except that the ulcer crater, except that the ulcer crater 壁龛壁龛 burrowsburrows打洞打洞 through the entire through the entire wall of the intestine, and instead of wall of the intestine, and instead of leaking digestive contents into the leaking digestive contents into the peritoneal cavityperitoneal cavity腹腔腹腔, the crater bores, the crater bores 钻孔钻孔 into an adjacent organinto an adjacent organ附近脏器附近脏器. . Gastric ulcersGastric ulcers most commonly most commonly penetrate into the left lobe of the liver, penetrate into the left lobe of the liver, while while duodenal ulcersduodenal ulcers penetrate penetrate posteriorly into the adjacent pancreasposteriorly into the adjacent pancreas胰胰 腺腺, sometimes leading to pancreatitis, sometimes leading to pancreatitis胰胰 腺炎腺炎. Rarely, gastric ulcers may . Rarely, gastric ulcers may penetrate into the colonpenetrate into the colon结肠结肠, resulting , resulting in a gastrocolic fistulain a gastrocolic fistula胃结肠瘘胃结肠瘘. . GastricGastric outlet obstruction outlet obstruction 梗阻梗阻 ( (gastric gastric retention or pyloric stenosisretention or pyloric stenosis胃潴留或胃潴留或幽门狭窄幽门狭窄 ) ) functional impairment of antral motilityfunctional impairment of antral motility 胃胃 窦动力功能不良窦动力功能不良due to the effects of acute due to the effects of acute inflammation and edema;inflammation and edema; mechanical obstructionmechanical obstruction 机械性梗阻机械性梗阻 due to due to scarring near the gastroduodenal junction;scarring near the gastroduodenal junction; manifest as gastroesophageal reflux, early manifest as gastroesophageal reflux, early satiety, weight loss, abdominal pain, and satiety, weight loss, abdominal pain, and vomiting;vomiting; As the degree of retention increases, the As the degree of retention increases, the quantity of vomitusquantity of vomitus呕吐物