消化性溃疡5年制第七版.ppt

Male，30 years old，complain of recurrent epigastric pain for 2 years. The pain become worse 2-3 hours after meal and can be relieved by food and ranitidine ，usually accompanied with bloating. In the other hospital B ultrasound showed cholecystitis. What’s the most likely diagnosis ？ Which examination should be done for this patient？And how to treat? Contents of classes Overview Etiology and pathogenesis Pathology Clinical presentation Special types of PU Laboratory examination Diagnosis and Differential diagnosis Complication Treatment Overview Definition Overview Epidemiology Hp infection G cells function ,D cells function ,Gastrin acid-pepsin Decreased duodenal bicarbonate secretion Gastric epithelium metaplasia in duodenum Direct cytotoxicity (Local effect) COX inhibitor (systematic effect) Gastric acid and Pepsin (三） The formation of peptic ulcer eventually result from invading of acid-pepsin (direct factor) BAO↑ MAO ↑ (Leaking roof hypothesis) Features of PU abdominal pain-- typical symptom Other symptoms Physical sign Without complication: just mild epigastric tenderness With complication: present corresponding physical sign(rebound tenderness,gastric form,splashing sound) Special types of PU Compound ulcer(复合溃疡） Pyloric channel ulcer（幽门管溃疡） Postbulbar ulcer（球后溃疡） Giant ulcer（巨大溃疡） The aged peptic ulcer（老年人消化性溃疡） Asymptomatic ulcer（无症状溃疡）  Endoscopy（胃镜） Testing of HP（ HP检测） Barium Radiography（钡餐） Gastric juice analysis（胃液分析） Testing of serous gastrin(血清胃泌素） Endoscopy Endoscopy is the sensitive ,specific and precise method for diagnosing peptic ulcer,allowing direct inspection and biopsy. Endoscopy --normal imaging Testing of HP Invasive assessment Rapid urease test （快速尿素酶法） Histological examination（组织学） HP culture（HP培养） PCR Testing for HP （二）  Endoscopy (内镜） Barium radiography （钡餐） Differential diagnosis