消化性溃疡 中山大学 内科学ppt课件.ppt

Diseases of the Stomach and Duodenum;;“If there is no acid, peptic ulceration cannot occur.” In fact, peptic ulcers may occur anywhere where pepsin and acid occur together . They may occur in the esophagus, the duodenum, the stomach itself, the jejunum after surgical construction of a gastrojejunostomy, or in the Meckel’s diverticulum .;Peptic Ulcer Disease;DU and GU;PU is caused by an imbalance between secretion of acid and pepsin, and breakdown of mucosal defence. An acid environment and reduced mucosal defences provide ideal circumstances for pepsin to cause mucosal ulceration.;;Over-excitement of vagus nerve--DU Breakdown of mucosal defences--GU Helicobactor Pylori infection---Both;In general terms, the ulcerative process can lead to 4 types of disability: Pain: most common Bleeding Perforation Obstruction;Chief cell-pepsinogen;Crows-foot;Duodenal Ulcer;Occurrence; Men:Women = 3:1 DU : GU = 10 :1 (young)  = 1 :1 (old);Any age groupMost common in 20 -45 years old95% within 2cm from the pylorus5% post-bulbar ulcer;Physiological Abnormalities;Clinical Findings;Food, milk,or antacid ---- temporary relief;Laboratory Findings;Serum Gastrin;Barium meal (upper GI series) ;DU;DU;;DU;Essentials of Diagnosis;Surgical Treatment for DU;With improving medical management, intractability as an indication for surgical intervention has markedly diminished and now accounts for only less than 5% of patients who undergo all types of ulcer operations;Intractable ulcer;Operations for DU;Operations;1) Subtotal gastrectomy 2) Vagotomy drainage 3) Vagotomy antrectomy 4) Parietal cell vagotomy 5) Gastrojejunostomy;1. Subtotal Gastrectomy;1. Subtotal Gastrectomy;1. Subtotal Gastrectomy;;1. Subtotal Gastrectomy;Mechanism of gastrectomy;1) Subtotal gastrectomy 2) Vagotomy drainage 3) Vagotomy antrectomy 4) Parietal cell vagotomy 5) Gastrojejunostomy;2.Vagotomy and drainage;DU;2) Vagotomy drainage;DU;H