消化性溃疡(双语).ppt

内容 一、 General Considerations(概述) 二、 Etiology (病因和发病机制) 三、 Clinical Findings (临床表现) 四、 Laboratory Findings and Diagnosis (实验室检查及诊断) 五、 Differential Diagnosis(鉴别诊断) 六、 Complications(并发症) 七、 Medical Treatment (治疗) 一、 General Considerations Peptic Ulcer Ulcers are defined as a break in the mucosal surface, with depth to the submucosa. The ulcer located in the stomach is known as gastric ulcer(GU)and that located in the duodenum is called a deudenal ulcer(DU). Peptic Ulcer Ulcer: extending through the muscularis mucosa into the submucosa or deeper Erosion :loss of superficial mucosa Peptic Ulcer PUD is very common. The lifetime prevalence of PUD is about 10%. GUs tend to occur later in life than DUs(十年). DUs is more common than GU(1.5~5.6:1) Ulcers occur slightly more commonly in men than in woman(DU 4.4~6.8:1;GU 3.6~4.7:1) The incidence of DUD has been declining dramatically for the past 30 years. Resulting from an imbalance between mucosal defensive/repairing factors and aggressive factors 消化性溃疡的发生是由于对胃十二指肠粘膜有损害作用的侵袭因素与自身防御-修复因素之间失去平衡的结果 （一）Aggressive factors (侵袭因素 ) 侵袭因素 一、 Helicobacter pylori (H. pylori) “Hp时代” 1） H pylori appears to be a necessary cofactor for the majority of duodenal and gastric ulcers.(消化性溃疡患者中H. pylori感染率高) DU感染率90%-100%，GU 80%-90% 2）根除Hp可以促进溃疡愈合，降低溃疡复发率 The natural history of PUD is well-defined.After standard therapies, 50-70% of patients will have an endoscopially documented recurrence with 1 year(常规抑酸治疗后，溃疡年复发率:50%-70%).Successful eradication of H. pylori was reported to decrease the ulcer recurrence rate to less than 5% per year(根除Hp后，溃疡复发率5%) 侵袭因素 3）Hp改变了粘膜侵袭因素与防御因素之间的平衡 Many H. pylori-infected patients have inceased gastric acid secretion(增强侵袭能力). H. pylori is able to facilitate gastric residence,induce mucosal injury,induce the inflammatory response and avoid host defense(损害局部粘膜的防御/修复能力). How Does H. Pylori Cause a Peptic Ulcer? “漏屋顶” 假说(Hypothesis of leaking roof). H. pylori weakens the protectiv