消化系统-常见疾病诊治规范.ppt

图. 乙型肝炎病毒颗粒图解 含有3种类型 HBsAg的外层 囊膜包绕着僵 硬的核衣壳。 核衣壳内含有 HBV基因组 DNA和病毒 DNA聚合酶 乙型肝炎病毒 世界HBV感染分布示意图 图2. HBV携带者发展进程 HBV感染的转归 乙醇及其中间代谢产物乙醛的毒性作用 引起脂肪肝 酒精性肝炎 肝硬化 长期--5年以上 大量--﹥80g/d（中国标准为﹥40g/d ）* 病因—酒精中毒 *中华医学会肝脏病学分会：酒精性肝病诊断标准（草案） 中华肝脏病杂志，2001；9（5）：264 持续肝内胆汁淤滞 持续肝外胆管阻塞 原发性和继发性胆汁性肝硬化 病因—胆汁淤积 长期服用损肝药物 长期接触化学毒物 中毒性肝炎 肝硬化 病因—药物或毒物 自身免疫性肝炎 肝硬化 病因—免疫紊乱 * * definition * Peptic ulcers are caused by increased damaging and/or decreased protective defence factors. Acid and pepsin appear to be the most important factors in PU. Helicobacter pylori colonisation and/or non-steroidal anti-inflammatory drug (NSAID) use are also present in almost all PU patients. The most important defence factors have not been completely defined. Decreased duodenal bicarbonate and/or mucus production may contribute to the pathogenesis of PU. Moreover, it appears that locally produced growth factors are critical in the ulcer healing process. Soll AH. Pathogenesis of peptic ulcer and implications for therapy. N Engl J Med 1990; 322: 909–16. * 6. Anatomical location of ulcerative colitis Ulcerative colitis usually extends proximally from the rectum in a continuous fashion. The extent of proximal spread varies, but ulcerative colitis is always confined to the colon with the exception of occasional mild inflammation of the most distal part of the terminal ileum (backwash ileitis Pettit & Irving 1992; Podolsky 1991; Shanahan & Targan 1989) * Erythema nodosum (10%) Tender, red subcutaneous nodules Extensor surfaces of arms & legs Correlates with disease activity Often responds to therapy for IBD Prednisone may also be used Pyoderma Gangrenosum (5%) Lesions exhibit pathergy Begin as single or multiple pustules Evolve to sterile necrotic ulceration with violaceous edges Dorsum of feet and lower legs Parallels IBD activity in 50% Spontaneous healing rarely occurs Most respond to high dose steroids Primary Sclerosing Cholangitis (5%) 75% of patients with PSC will have IBD Predil