(内科学教材）07-Peptic ulcer-2017-GJJ.pptxVIP

Peptic Ulcer Disease(PUD);Definition: Defects in the gastrointestinal mucosa extending through the muscularis mucosae into the submucosa or muscularis Why called peptic ulcers: Persist and are generally dependent on the acid-peptic activity of gastric juice. ;Histology of Stomach;;Anatomy;How is the prevalence： Estimated from endoscopic studies of adult volunteers About 10% in population over a lifetime 1-6% in Hp+ patients by at least one screening test A lifetime risk of 10-20% in patients with Hp infection Prevalence of Non-Hp and Non-NSAIDs is unknown but is probably very low.;Etiology of PUD ; Ulcers due to defined mechanisms;;Idiopathic peptic ulcer;Pathophysiology of PUD ;;Exogenous factors;When defense mechanisms are compromised by Hp and NSAID When repair and healing mechanisms fail;Why ulcers tend to recur locally;How important the blood flow is;1. H.Pylori;Barry J. Marshall ;J. Robin Warren ;Hp, Gastritis, and Peptic ulcers;Hypothesis-DU pathogenesis;2. NSAIDs and platelet-active agents;Topical effects of NSAIDs;Systemic effects of NSAIDs;Platelet-active agents;Risk factors for NSAID ulcers;3. Acid-pepsin;4. Non-Hp, non-NSAIDs ulcers;Hormonal- or mediator-induced ulcers associated with acid hypersecretion Gastrinoma Systemic mastocytosis: mast cell infiltration of many tissues Basophilia associated with myeloproliferative disorders: Antral G-cell hyperfunction Idiopathic hypersecretory (Hp-) duodenal ulcer Vascular insufficiency including crack cocaine use Mechanical: duodenal obstruction Other uncommon forms ;5. Risk factors for peptic ulcer ;6. Comorbid ulcers;Pathology of Peptic Ulcers;Erosion;Clinical presentation;(1) Acid dyspepsia: Epigastric pain or discomfort;Rhythmicity DU: hunger (2-3hours after meals): when acid is secreted in the absence of food buffer at night(11pm-2am)/nocturnal pain : when the circadian stimulation of acid secretion is maximal Relieved when intaking alkali, food, antisecretory agents GU: Less likely to be relieved b