内科学课件：5-3消化性溃疡.ppt

Diagnosis—Hp infection is yes or no? virulence—need taking gastric mucosa (RUT): ammine Histological examination Cultivation PCR Non –virulent examination—not need taking gastric mucosa Breath test Serology Hp stool antigen Urase based test: RUT、UBT Diagnose-if have complication upper GI hemorrhage (UGIH) ??the most common complication ??the first symptom of hemorrhage by 10%-20% ulcer activity symptom before hemorrhage perforation ?? acute perforation ：acute diffuse peritonitis ?? penetrability perforation ： lesser bursa omentalis subacute perforation pyloric obstruction ：functionality/parenchymatous obstruction canceration ：warning sings and symptoms chronic patient history age45(GU) symptom has changed recently and curative effect badly the appearance of hemorrhage :stool OB (+), anemia emaciation Factitiousness intervention to speed up ulcer healing PU cure-purpose Eliminate cause of a disease、relieve symptom、heal ulcer、prevent recurrence、avoid complication Antacid ：counteract gastric acid obviously rebound Acid-reducing Drugs ：H2RA，PPI PU cure—degrade gastric acid Gastrin Histamine Ach H+ Cimetidine Famotidine Nizatidine Ranitidine Omeprazole Lansoprazole pantoprazole Rabeprazole PPI DU:4-6 Wk GU:6-8 Wk H2RA PU cure— Eradication Hp Program Trigeminy with the core of PPI PPI+(Clarithromycin/amoxicillin )+(furazlidone /metronidazole), Bid, 7-14d Trigeminy with the core of bismuth ?To object: blind medication ,single/ double medication Re-examination ? ?Eradication:after course of treatment to end for 4 weeks,HP Negative Generally do not request re-examination 0 100 Healing rate (%) H. pylori eradicated H. pylori persisted Duodenal ulcer ***95 76 **88 73 Gastric ulcer Treiber Lambert, Gastroenterol 1998; 93: 1080–4. **p0.01 ***