消化系统七制课件.ppt

Adenocarcinoma of the stomach, linitis plastica. Barium double contrast study. There is a. irregular lining and rigid aspect with retraction of greater curvature of the stomach, and b. loss of normal musocal pattern and wall irregularity of the antrum due to infiltrative tumour extension. CT following oral tap water and intravenous contrast medium, demonstrating a polypoid tumour originating on the posterior wall of the stomach. No invasion of pancreatic tail is noted as evident from the preserved fat plane between the stomach and the pancreas (arrow). Carcinoma of the fundus of the stomach, linitis plastica. CT following oral water and intravenous contrast medium. There is an infiltrating squamous carcinoma of the fundus characterized by circumferential thickening of the gastric wall up to 1.5 cm (arrows) with loss of the normal rugal pattern. 鉴别诊断： 溃疡型胃癌与良性胃溃疡的X线鉴别诊断 胃窦良恶性狭窄鉴别诊断 溃疡型胃癌与良性胃溃疡的X线鉴别诊断 胃窦良、恶性狭窄鉴别要点 十二指肠憩室(duodenal diverticulum) 比较常见，多发生于十二指肠降部内后壁 发病机理： 肠壁生长发育过程中的薄弱点 肠内压力增加或肠肌收缩不协调 炎症时可见憩室内壁粘膜充血、水肿、糜烂或溃疡形成 胃溃疡 胃溃疡 直接征象：龛影 急性期：粘膜水肿带(粘膜线、项圈征、狭颈征) 慢性期：肉芽纤维组织(粘膜纠集) 间接征象 功能性改变 疤痕变形 间接征象(代表溃疡造成的功能和疤痕改变)： 功能性改变： 痉挛切迹 胃分泌增加 蠕动增加或减弱 龛影处有不同程度压痛 疤痕性改变： 胃小弯缩短 幽门狭窄梗阻 痉挛切迹 Barium fleck 间接征象 (代表溃疡造成的功能和疤痕改变)： 功能性改变： 痉挛切迹 胃分泌增加 蠕动增加或减弱 龛影处有不同程度压痛 疤痕性改变： 胃小弯缩短 幽门狭窄梗阻 Chronic peptic ulcer disease of the stomach localized to the lesser curvature has led to shrinkage and foreshortening of the lower curvature (arrows).  预后： 溃疡愈合 溃疡恶变 Benign ulcers A smooth ulcer mound with tapering edges An edematous ulcer collar with overhanging mucosal edges An ulcer projecting beyond the expected lumen Radiating folds extending to the crater Depth of ulcer greater than width Sharply marginated contour Hampton’s line (a thin, sharp, lucent line that traverses the orifice of the ulcer) Attention please: The size, depth, location and the contour of the ulcer are of no diagnostic value in differentiating benign from malignant ulcers. Malignant ulcers An ulcer within the lumen