消化系统笔记（Digestive note）.docVIP

消化系统笔记（Digestive note） Gastroesophageal reflux disease 1. etiology and pathogenesis: 1.1 esophageal anti reflux barrier: 1.1.1LES and LES: hormones, drugs (calcium channel blockers, diazepam), food (fat, chocolate). Increased intra-abdominal pressure and pressure in the stomach 1.1.2 a LES relaxation 1.1.3 Kong Shan 1.2 esophageal acid clearance 1.3 esophageal mucosal defense 1.4 delayed gastric emptying 2. pathology 3. clinical manifestations 3.1 heartburn and acid regurgitation: often in an hour after the meal, supine bending or abdominal pressure can be increased 3.2 dysphagia and odynophagia 3.3 retrosternal pain: retrosternal or xiphoid, severe sharp tingling can radiate to the back, chest, shoulders, neck, ears 3.4 other things: reflux throat stimulation can cause sore throat, hoarseness. Inhalation of the trachea and lung can be repeated pneumonia, and even the emergence of pulmonary interstitial fibrosis 3.5 complications: upper gastrointestinal bleeding: esophageal mucosal inflammation, erosion and ulcer. Esophageal stenosis Barrett esophagus 4. laboratory and other examination 4.1 endoscopy 4.224 hour esophageal pH monitoring: normal esophageal pH 5.5~7.0, when pH4 is prepared by acid reflux 4.3 esophageal barium X-ray examination 4.4 esophageal acid perfusion test 4.5 esophageal manometry 5. diagnosis and differential diagnosis: The diagnosis should be based on: A has obvious reflux symptoms may have B endoscopic reflux esophagitis C excessive gastroesophageal reflux objective evidence 6. treatment 6.1 general treatment 6.2 drug treatment: H2 receptor antagonists, prokinetic drugs, proton pump inhibitors, antacids 6.3 anti reflux surgery 6.4 treatment of complications chronic gastritis Pathology: Intestinal metaplasia, gastric adenoid into intestinal pseudo pyloric metaplasia, gastric body gland into gastric antrum pyloric gland morphology Two etiology and pathogenesis: helicobacter pylori infection Autoimmune Duodenal juice reflux Three clinical classifi