消化性溃疡 中山大学 内科学课件.ppt

DU and GU Etiology 1.gastric acid Nerval and humoral secretion 2.gastric mucosal defences mucosal barrier prevent antidromic diffuse 3.Helicobactor Pylori infection impair mucosal defences Duodenal Ulcer Occurrence A common disease 10% of the adult population in USA Incidence ↓ since 1955 Complications remain high Men:Women = 3:1 DU : GU = 10 :1 (young)  = 1 :1 (old) Physiological Abnormalities ↑numbers of parietal and chief cell ↑parietal cell sensitivity to gastrin ↑gastrin response to meal ↑gastric emptying ↓inhibition of gastrin release to acid Clinical Findings Laboratory Findings Serum Gastrin Performed if ZES suspected Readily available Normal basal levels: 50-100 pg/ml (Conventional PU) Abnormal 200 pg/ml 1) ZES 2) Retained antrum after BII op. Indications 1.Major underlying medical illness 2.Perforation lasting more than 12 hours 3.Severe peritoneal inflammation and stomach swelling Upper Gastrointestinal Hemorrhage Occur with erosion of the submucosal vessles Intensity Slow,chronic blood loss Massive life-threatening acute hemorrhage Upper gastrointestinal endoscopy Diagnosis Identification of patients at risk for re-bleeding Selected use of hemostatic measures electrocoagulation and laser coagulation Treatment Conservative for slow chronic blood loss Surgery for massive bleeding Indications for surgery Massive blood loss with shock No improvement after 600cc infusion during 6-8h Recurrent bleeding during medical therapy Repeated hospitalization for bleeding Elder patients with arteriosclerosis Accompanied with perforation and obstruction Complications of Gastrectomy for PU  Early complications1. Postoperative haemorhage2.Breakage/leakage of duodenal stump3.Stomal fistula4.Postoperative obstruction Postoperative haemorhage 1.Intraperitoneal bleed