胃结石_教材教学课件.pptVIP

Gastric bezoar胃结石 延安医院消化科 陈思瑾 A case of gastric bezoar 刘XX F/47y 因“反复右上腹痛1年，再发加重2周”住我院普外科，考虑慢性胆囊炎急性发作，患者要求保守治疗后转入我科后，行胃镜检查发现胃角溃疡（A1）以及胃体部一褐色胃石（约5.0×6.0） 追问病史，2周前曾进食柿饼。 Questions about gastric bezoar What Why How INTRODUCTION Gastric bezoar is a mass found trapped in the gastrointestinal system (usually the stomach) Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome(急腹症）. When located in small bowel, they frequently cause small bowel obstruction (SBO). INTRODUCTION Since 1 000 BC, bezoars (BZ) in digestive tracts have been detected in some animals and humans. The first report of human trichobezoar was credited to Baudamant in 1779.In 1896 Stelzner reported the first preoperatively diagnosed trichobezoar (TBZ). The reported incidence was 0.4% Bezoars are rare, being found in less than 1 percent of patients undergoing upper gastrointestinal endoscopy TYPES OF BEZOARS Bezoars are classified according to their composition The major types are phytobezoars（植物性胃石）, trichobezoars（动物性胃石）, and pharmacobezoars（药物性胃石）. 此外还有继发性胃石及混合性胃石 Emily F/7y voiced no complaints her pediatrician noted a nontender palpable mass in the child’s stomach 患病前父母离异 Pharmacobezoars Pharmacobezoars?—?Pharmacobezoars, composed of ingested medications, have become increasing recognized. Examples include extended release nifedipine（硝苯地平缓释片）, theophylline（茶碱）, enteric-coated aspirin（肠溶型阿司匹林）, sodium alginate（海藻酸钠）, and sucralfate（硫糖铝） epidemiology Region Season Gender Age Diet habit Clinical features 胃结石临床表现多种多样, 病程在6 个月以内的称为急性, 超过6 个月的称为慢性 症状：早期不明显、与结石大小及病程相关 体征： 合并症：梗阻、出血、穿孔、胃食管反流 Diagnose and assistant examination Diagnose Assistant examination therapy and treatment 内科治疗 外科治疗 内镜治疗 * *