Digestive System消化系统英文值得收藏.

1、L/O/G/O Digestive System Contents Part 1 Introduction Part 2 Peptic ulcer Part 3 Acute Pancreatitis Anatomy Anatomically,the digestive system consists of a 30-feet long mucous membrane-line tube beginning with the mouth and ending with the anus The digestive system is composed of nine main organs:mo

2、uth、pharynx、 esophagus、stomach、 small intestine、large intestine、liver、gallbladder and pancreas Mucous 粘液的粘液的 Anus 肛门肛门 Pharynx 咽部咽部 Esophagus 食管食管 Pancreas 胰腺胰腺 Overview 1 How many organs are there in the digestive system? What are they? The organs of the digestive system The primary functions of th

3、e digestive system Ingestion 摄入摄入 Digestion Absorption 吸收吸收 Elimination 排泄排泄 4 1 2 3 Physiology of the major organs Common Symptoms Loss of appetite Nausea and Vomitting Abdominal distension & pain Diarrhea 4 1 2 3 Common Symptoms Hematochezia 便血便血 Hematemesis 呕血呕血 Constipation 便秘便秘 Jaundice 黄疸黄疸8 5

4、 6 7 Epidemiological investigation Morbidity gastrointestinal diseases patients the morbidity of chronic gastritis is 3 0% peptic ulcer chronic gastritis 120 million people accounted for more than 7 0% the incidence of peptic ulcer is 10% the elderly 2012 Chinese cancer registration report Hepatic c

5、arcinoma Gastric carcinoma Esophageal cancer Colon cancer Cancer death rates list 04.autoimmunity 03.Diet and environmental factors 01.Infection with a bacterium called H. Pylori (Hp) 02.Use of drugs like nonsteroidal anti-inflammatory drugs (NSAIDs 非甾体抗炎药) Etiology Etiology Methods of examination B

6、iopsy 活检活检 Gastrointestinal dynamics Laparotomy 剖腹探查术剖腹探查术 4 5 6 Endoscopy 内窥镜内窥镜 Imageological examination Laboratory inspection:blood and stool routines, C-urea breath test 1 2 3 vocabulary vocabulary -stomy:造口术、吻合术 appendicostomy gastrostomy gastroduodenostomy -tomy:切开术 pancreatomy gastrotomy ana

7、tomy Peptic ulcer uPeptic ulcer(PU)：Mainly refers to the chronic ulcer occurs in the stomach and duodenum mucosa (n. 解剖 粘膜), namely, gastric ulcer (GU) and duodenal ulcer (DU). uThe basic formation of ulcer is the gastric acid and pepsin (n. 医胃蛋白酶) digestion . uClinically DU is more common than GU w

8、ith the ratio being about 3:1.DU occurs in young adults.The age of onset of GU is generally 10 years older than DU. Autumn, winter and spring are the seasons of PU. Overview 2 uHow many types can the peptic ulcer be classified? What are they? Etiology 1、 H.pylori infection: the main cause of peptic

9、ulcer. 2、 Gastric acid and pepsin ：PU is due to gastric acid and pepsin consisting gastric juice caused by their own digestion. 3、 Drug factors ： some NSAIDs, anticancer drugs have damaging effects on gastric and duodenal mucosa, which was most obvious in NSAIDs. NSAIDs in addition to direct effects

10、 on the gastric and duodenal mucosa caused the damage, mainly through the inhibition of prostaglandin synthesis. H.Pylori 幽门螺杆菌幽门螺杆菌 Pepsin 胃蛋白酶胃蛋白酶 Duodenal 十二指肠的十二指肠的 Mucosa 粘膜粘膜 Prostaglandin 前列腺素前列腺素 Synthesis 合成合成 4、Other risk factors Cigarette Psychological factors Genetic factors Pathology uL

11、ocation:95% of DU is in the duodenal bulb(十 二指肠球部). A few occurred in the back of bulb ；85% of GU locate in the lesser curvature of stomach （胃窦小弯）and the angle of stomach （胃 角）. uNumber: most of them are single, a few cases are crinosity（多发). uShape: round or oval（椭圆） uDepth: The shallow ulcer invol

12、ves mucosal muscular layer（粘膜肌层）,some ulcers reach to muscular layer（肌层）and even serous coat（浆膜 层）.A few ulcers leads to perforation（穿孔）. The bottom of ulcer is clean , with smooth edge and ashen or sallow coating（灰白或灰黄苔）. uRecover time :4-8W Clinical Features u symptomAbdominal Pain u 1、Long term ：

13、several years or even decades. u 2、Periodical(周期性的) attack: the attack and relieved stage appear alternately.发作期与缓解期交替出现 u 3、Rhythmic epigastric pain.节律性上腹疼 GU irregular gastric pain after meal Ingestion of food and antacids（制酸剂） can not relieve pain DU Burning pain worse when hungry or at night Ing

14、estion of food and antacids often relieve pain uOther symptoms： Belching Abdominal distension Nausea Satiety uSigns： Epigastric tenderness (not specificity) Belching 打嗝打嗝 Nausea 恶心恶心 Satiety 早饱早饱 Epigastric 上腹部的上腹部的 Tenderness 压痛压痛 laboratory examination u Barium meal（钡餐） Barium studies of the proxi

15、mal gastro-intestinal tract are still commonly used as a first test for documenting an ulcer. For a DU ,it appears as a well- demarcated crater, often seen in the bulb . For a GU ,it may represent benign or malignant disease. Typically,a benign GU also appears as a discrete crater with radiating muc

16、osal folds originating from the ulcer margin . （GU可能是良性和恶性。典型的良性表现为 游离龛影，粘膜皱襞从溃疡边缘向内放射集 中） Barium 钡钡 proximal 近端的近端的 demarcated 界定的界定的 crater 龛影龛影 discrete 游离的游离的 benign 良性的良性的 malignant 恶性的恶性的 uEndoscopy -most sensitive and specific uTest for detection of H. Pylori Invasive: Rapid urine screening t

17、est（快速尿素酶实 验）,Histology culture（组织学 培养）. Non-invasive:Serology，C- Urea breath test（碳呼气试验）. Urine 尿尿 Histology 组织学组织学 Serology 血清学血清学 Urea 尿素尿素 Diagnosis： uThe history and main symptoms can make a preliminary（初步的） diagnosis. uWhen Barium studies of the proximal gastrointestinal tract (上消化道钡餐)find the

18、 ulcer crater, the Peptic Ulcer can be confirmed. uPeptic Ulcer can also be confirmed by Endoscopy and mucosa biopsy. Differential diagnosisDifferential diagnosis Chronic gastritis characterized by epigastric distension, belching, pain after meal, without rhythm. Peptic ulcer is often combined with

19、chronic gastritis. Gastroscopy can distinguish their difference. Cholecystitis often induced by eating greasy（油腻的） things, and characterized with right upper quadrant pain, radiating to the right humeral back, accompanied by fever, jaundice（黄 疸）, etc. Ultrasound and gastroscope can help to identify.

20、 Treatment Therapeutic targets: to eliminate the causes, relieve symptoms, heal ulcer, prevent recurrence, avoid complications. （1）General treatment: proper rest, reasonable diet, regular life, less drinking strong tea, coffee, etc. （2）Drug treatment： Inhibition of gastric acid secretion： commonly u

21、sed drugs like H2RA or PPI。 anti-Hp therapy: classic triple therapy: a PPI, or a kind of colloidal bismuth agent combined with 2 kinds of antibiotics below- clarithromycin (or tetracycline), amoxicillin and metronidazole。 Recurrence 复发复发 Colloidal 胶体的胶体的 Bismuth 铋铋 clarithromycin 克拉霉素克拉霉素 tetracycli

22、ne 四环素四环素 amoxicillin 阿莫西林阿莫西林 Metronidazole 甲硝唑甲硝唑 Overview 3 uWhat is the classic triple therapy? （3）Protection of gastric mucosa drugs： Such as aluminium sulphate, bismuth potassium citrate and prostaglandin E, etc. （4）Surgical treatment: If medical treatment is invalid, acute perforation, cicatr

23、icial pyloric obstruction, such as cancer, surgical treatment should be considered. aluminium sulphate 硫糖铝 bismuth potassium citrate 枸橼酸铋钾 prostaglandin E 前列腺素E Perforation 穿孔 cicatricial pyloric 瘢痕性幽门的 Acute pancreatitis Acute pancretitis is an acute inflammatory process of the pancreas with variab

24、le involvement of other regional tissue or organs. sectional anatomy The anatomy of the pancreas and the surrounding n 1、Common Causes nGallstones (30 to 60%) nAlcoholism (15 to 30% ) nHyper-triglycerid-emia（高甘油三酯血症）(1.3 to 3.8% ) nEtc ETIOLOGY Overview 4 nWhich is the most common cause in China? 2、

25、Unconmom & Rare Causes nVasculitis nConnective tissue（结缔组织） disorders nPancreatoma nEtc. nAutodigestion is one pathogenic theory, according to which pancreatitis results when proteolytic enzymes are activated in the pancreas rather than in the intestinal lumen. PATHOLOGY Proteolytic 分解蛋白的 Enzyme 酶 L

26、umen 管腔 n-ly 融化，溶化，分解 proteo-ly-tic 分解蛋白的 thrombo-ly-sis 溶栓 sperm-ly-tic 溶精剂 Symptoms Abdominal pain severity: mild & toleratable severe, constant & incapacitating location: epigastrium , periumbilicus radiate to the back/ chest/ flank/ lower abdomen intense: supine relief: sitting with the trunk fl

27、exed and knees drawn up Vomit & Nausea Abdominal distention Tachycardia （心动过速） Hypotension & Shock Epi- 在之上 epi-gastric 胃上的 epi-thelium 上皮 Sub- 在之下 sub-arachnoid 蛛网膜下的 sub-cutaneous 皮下的 Peri- 在周围 peri-umbilical 脐周的 peri-cardium 心包 Tachy- 快速的 tachy-cardia 心动过速 tachy-pnea 呼吸急促 Brady- 慢速的 brady-pnea br

28、ady-cardia 心动过缓 Physical Signs Mild Acute Pancreatitis (MAP) merely no signs Severe Acute Pancreatitis (SAP) -muscle rigidity -bowel sound diminished or absent -jaundice -cullens sign / Turners sign Rigidity 强直 Bowel sound 肠鸣音 Diminish 减弱 Complications Local Abcess: fever epigastric mass toxicity sy

29、mptoms Pseudocyst: form in 3-4 weeks necrotic fluids Abcess 脓肿 Pseudocyst 假性囊肿 Abcess 脓肿 pulmonary abcess 肺脓肿 abcessocentesis 脓肿穿刺术 abcessotomy 脓肿切开术 Pseudo- 假的 pseudocyst 假性囊肿 pseudocyesis 假孕 Complications Systemic Pulmonary: acute respiratory distress syndrome (ARDS) Cardiovascular: hypotension, h

30、ypovolemia, pericadial effusion Hematology: DIC Gastrointestinal hemorrhage Portal vein thrombosis Renal：oliguria, azotemia, acute renal failure (ARF) etc Hypovolemia 低血容量 Pericardial effusion 心包积液 Hemorrhage 出血 Portal vein 门静脉 Thrombosis 栓塞 Oliguria 少尿 Azotemia 氮质血症 Olig- 少，低 oliguria 少尿 oligarchy

31、寡头的 oligomer 低聚物 Azot- 氮 azotemia 氮质血症 azotobacter 固氮菌 azotometer 氮定量计 LABORATORY DATA 1.Amylase About 75% of patients have an increased level of serum amylase valuing threefold or more above normal in 24 hours. Amylase elevations in serum and urine occur in many conditions other than pancreatitis.

32、But the level will not reach threefold above normal. Theres no definite correlation between the severity of pancreatitis and the degree of serum amylase elevation 2.Lipase Serum lipase activity increases in parallel with amylase activity, and this elevation may also have diagnostic value, especially

33、 when its 3 times higher than normal. Amylase 淀粉酶 Serum 血清 Threefold 三倍 Lipase 脂肪酶 In parallel with 与同步 -ase 酶 lip-ase 脂肪酶 amyl-ase 淀粉酶 phospho-lip-ase 磷脂酶 elast-ase 弹性蛋白酶 3.Other biochemistry data Leukocytosis Hyperglycemia Hypocalcemia Hyperbilirubinemia Hypertriglyceridemia Hypoxemia Leuko-cyt-os

34、is 白细胞增多 Hyper-glyc-emia 高血糖 Hypo-calc-emia 低血钙 Hyper-bilirubin-emia 高胆红素血症 Hyper-triglycerid-emia 高甘油三酯血症 Hyp-ox-emia 低氧血症 Glyc- 糖，葡萄糖糖，葡萄糖 glycose 葡萄糖葡萄糖 hyperglycemia 高血糖高血糖 hypoglycemia 低血糖低血糖 Glycer(i)- 甘油甘油 nitroglycerin 硝酸甘油硝酸甘油 triglyceride 甘油三酯甘油三酯 Calc- 钙钙 calcium 钙钙 hypocalcemia 低血钙低血钙 Bi

35、lirubin- 胆红素胆红素 hyperbilirubinemia 高胆红素血症高胆红素血症 bilirubinic acid 胆红酸胆红酸 Ox- 氧氧 hypoxemia 低氧血症低氧血症 carbon dioxide 二氧化碳二氧化碳 hydrogen peroxide 过氧化氢过氧化氢 Auxiliary Examination CT scan Electrocardiogram X-rays Sonography（超声图像） Diagnosis Patients with severe and constant abdominal pain, nausea, emesis, fev

36、er, tachycardia, and abnormal findings on abdominal examination,and an elevated level of serum amylase should be suspected as acute pancreatitis. But not all the features above have to be present for the diagnosis to be established. Differential Diagnosis Acute pancreatitis should be distinguished f

37、rom these diseases with acute abdominal pain: perforated viscus, especially peptic ulcer characterized by the disapperance of hepatic dullness. acute cholecystitis and biliary colic can be confirmed by sonography or CT scan. acute intestinal obstruction abdominal x-ray examination is very helpful in

38、 diagnosis. Perforated viscus 内脏穿孔 Hepatic dullness 肝浊音界 Biliary colic 胆绞痛 Treatment Mild Acute Pancreatitis In most cases, it subsides spontenously after receiving proper treatments: -Diet (fasting) -Nasogastric suction -Intravenous fluids & colloids -Analgesics Nasogastric suction 经鼻胃管抽吸 Intravenous 静脉内的 Colloid 胶体 Analgesic 止痛剂 Severe Acute Pancreatitis conventional therapy -close attention vital signs, s