消化性溃疡 （Peptic Ulcer Disease:PUD),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,糜烂：粘膜破损不超过粘膜肌层,溃疡：粘膜缺损超过粘膜肌层,Peptic Ulcer,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(1.55.6:1),Ulcers occur slightly more commonly in men than in woman(DU 4.46.8:1;GU 3.64.7:1)The incidence of DUD has been declining dramatically for the past 30 years.,二、Etiology and pathogenesis,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 ),Three major causes of PUD are now recognized:Chronic H pylori infection, NSAIDs ,and gastric acid and pepsin,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15mmol/h、MAO 60mmol/h,BAO/MAO60%,提示胃泌素瘤 可能 3）血清胃泌素测定：胃泌素瘤时可做,Diagnosis :Endoscopy and Biopsies,不论选用纤维胃镜或电子胃镜，均作为确诊消化性溃疡的主要方法。 在内镜直视下，消化性溃疡通常呈圆形、椭圆形或线形，边缘锐利，基本光滑，为灰白色或灰黄色苔膜所覆盖，周围粘膜充血、水肿，略隆起.,胃角溃疡,胃窦溃疡,十二指肠球部溃疡,龛影。在正面观，龛影呈圆形或椭圆形，边缘整齐。因溃疡周围的炎性水肿而形成环形透亮区。 龛影是溃疡存在的直接征象。 由于溃疡周围组织的炎症和局部痉挛等，X线钡餐检查时可发现局部压痛与激惹现象。溃疡愈合和瘢痕收缩，可使局部发生变形，尤多见于十二指肠球部溃疡，后者可呈三叶草形、花瓣样等变形。,Diagnosis :Barium,胃体小弯溃疡。钡餐造影切面观示胃体小弯龛影，口部光整，并出现项圈征。,