内科学 消化系统总论-王吉耀.ppt

1、Digestive SystemIntroduction,Prof. Ji yao Wang,Assimilation of nutrients Elimination of waste,Structure and functions,Structure and functions,The two activities under voluntary control are swallowing and defecation.,Characteristics of Digestive System,Many normal GI reflexes involve extrinsic vagus

2、or splanchnic nerve pathways. An active brain-gut axis further alters function in regions,Immune organ Gastrointestinal-associated lymphoid tissue, (GALT),Characteristics of Digestive System,Not only a digestive organ but also endocrine organ pancreas gastrin (胃泌素) glucagon(胰高糖素) somatostatin( 生长抑素)

3、 VIP(血管活性肠肽) insulin(胰岛素),Characteristics of Digestive System,Structure /function and diseases,The biggest organ,Homeostasis Synthesis,Excretion,Filter Defense,symptoms signs,Death,inflammation(炎症) Ulcer (溃疡) bleeding(出血) perforation (穿孔) neoplasm (肿瘤) functional disturbances(功能失调 ),Common Lesions o

4、f Digestive System,Classification of GI Diseases,Impaired Digestion and Absorption (Biliary obstruction, Chronic pancreatitis) Altered Secretion (Zollinger-Ellison syndrome, atrophic gastritis, small intestinal bacterial overgrowth) Altered Gut Transit (obstruction by gastric cancer or colon cancer,

5、 Achalasia, constipation, diarrhea),Immune Dysregulation (ulcerative colitis, Crohns disease) Impaired Gut Blood Flow (intestinal and colonic ischemia) Neoplastic Degeneration (Esophageal, gastric, colon, pancreatic, biliary cancer) Disorders without Obvious Organic Abnormalities (IBS) Genetic Influ

6、ences,Classification of Liver Diseases,Viral Hepatits Nonalcoholic fatty liver Alcoholic liver disease Immune early/late; pre-cirrhotic/end-stage) Identifying the underlying cause Liver biopsy Child-Pugh classification/MELD,Child-Pugh classification Scorea Factor 1 2 3 1. Encephalopathy None Minimal

7、 Advanced 2. Ascites None Easily controlled poorly controlled 3. Bilirubin(umol/L) 51 4. Albumin(g/L) 35 30-35 6 Prothrombin Time(INR) 2.3 aScores is calculated by adding the scores of 5 factors to determine Child-Pugh class: class A=5-6 class B= 7-9 class C= 10-15,Model of End-Stage Liver Disease,

8、(MELD),MELD score =9.6 loge (serum creatinine mg/dL)+3.8 loge (serum bilirubin mg/dL)+ 11.2 loge(INR) +6.4 Score range from 640. MELD is currently used to establish priority listing for liver transplantation.,Reasonable application of examination,Indication The strength and weakness of every examina

9、tion Not the more up-to-the-minute the better, General treatments: modifications in dietary intake and lifestyle Pharmacotherapy : Anti helicobacter pylori, Proton pump inhibitor ( PPI), Anti-inflammatory & immunosuppressive drug, chemotherapy, beta blockers, anti HBV & HCV, antibiotics,Principles of Treatment,Principles of Treatment,Enteric Therapies/ Interventional Endoscopy and Radiology: nasogastric/nasoenteric tube, sclero