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1、Male，30 years old，complain of recurrent epigastric pain for 2 years. The pain become worse 2-3 hours after meal and can be relieved by food and ranitidine ，usually accompanied with bloating. In the other hospital B ultrasound showed cholecystitis. Whats the most likely diagnosis ？ Which examination
2、should be done for this patient？And how to treat?,Case Review,Contents of classes,Overview Etiology and pathogenesis Pathology Clinical presentation Special types of PU Laboratory examination Diagnosis and Differential diagnosis Complication Treatment,Overview,Definition,Gastric ulcer,Duodenal ulcer
3、,jejunum ulcer after gastric resection,Epidemiology,Overview,Age of GU middle age and elder,Etiology & Pathogenesis 病因和发病机制,Injury factor,Defensive factor,Normal,Peptic ulcer,Defensive factors(防御因素）,Mucus and bicarbonate(黏液和碳酸氢盐） Mucosa barrier （粘膜屏障） The riched mucosal blood flow（丰富的血流） Other facto
4、rs: PGE1,EGF etc.,Other risk factors drinking, diet, viral infection, stress, genetic factor,Injury factors（损伤因素）,Hp infection（幽门螺杆菌）,NSAID（非甾体抗炎药） Non-steroidal anti-inflammatory drug,Gastric acid and Pepsin（胃酸和胃蛋白酶）,Hp infection,G cells function ,D cells function ,Gastrin acid-pepsin Decreased duo
5、denal bicarbonate secretion Gastric epithelium metaplasia in duodenum,Direct cytotoxicity (Local effect) COX inhibitor (systematic effect),COX1,COX2,Pathogenesis of NSAID (二）,胃肠道,炎症,Gastric acid and Pepsin (三）,The formation of peptic ulcer eventually result from invading of acid-pepsin (direct facto
6、r) BAO MAO (Leaking roof hypothesis),Pathology 病 理,Location: The peptic ulcer usually located in antrum and duodenal anterior wall . Number: one or more Size:generally DU 2cm giant ulcer) Complication,Pathology,Clinical presentation 临床表现,Chronicity,Rhythmicity,Features of PU,Periodicity and recurren
7、ce,abdominal pain- typical symptom,Location Quality Rhythmicity,Other symptoms,epigstric burning sensation（useful) bloating dyspepsia epigastric malaise (not special,not diagnostic) belch, acid reflux asymptomatic case,Physical sign,Without complication: just mild epigastric tenderness With complica
8、tion: present corresponding physical sign(rebound tenderness,gastric form,splashing sound),Special types of PU,Compound ulcer(复合溃疡） Pyloric channel ulcer（幽门管溃疡） Postbulbar ulcer（球后溃疡） Giant ulcer（巨大溃疡） The aged peptic ulcer（老年人消化性溃疡） Asymptomatic ulcer（无症状溃疡）,Laboratory examination 实验室检查,Endoscopy（胃
9、镜） Testing of HP（ HP检测） Barium Radiography（钡餐） Gastric juice analysis（胃液分析） Testing of serous gastrin(血清胃泌素）,Laboratory examination,Endoscopy is the sensitive ,specific and precise method for diagnosing peptic ulcer,allowing direct inspection and biopsy.,Endoscopy,Endoscope,Endoscopy -normal imaging
10、,Gastric fundus,Gastric body,Gastric angle,Gastric antrum,duodenal bulb,Endoscopy- pyloric channel ulcer,Endoscopy-Bulbar ulcer,Invasive assessment Rapid urease test （快速尿素酶法） Histological examination（组织学） HP culture（HP培养） PCR,Testing of HP,rapid urease test,histological examination,Testing for HP （二
11、）,Noninvasive assessment Urea breath testing(呼气试验） Fecal antigen assay（粪便抗原分析） Serologic antibody testing（血清学分析）,13C-urea breath test,Diagnosis 诊 断,Endoscopy (内镜） Barium radiography （钡餐）,Diagnosis,Present history,Initial diagnosis,Final diagnosis,Differential diagnosis,鉴别诊断,Gastric carcinoma （胃癌） Zo
12、llinger-Ellision syndrome （卓艾综合症）,Differential diagnosis,GU,GC,Complication,Hemorrhage(出血） Perforation（穿孔） Gastric outlet obstruction（梗阻） Canceration （癌变）,Treatment 治 疗,Remove the inducement,Drug therapy,Surgical therapy,Antacids Therapy,Mucosal protection,Treatment,Hp eradication,Remove the inducem
13、ent,Living and Diet regularly,Mental status well,Avoiding bad habit,Proton pump inhibitors (PPIs) are the most potent Antacid agents. omaprazole(20mg) lansoprazole(30mg) pantoprazole(40mg) rebaprazole(10mg) H2-receptor antagonist cimetidine(200mg) ranitidine(150mg) famotidine(20mg) nizatidine,Drug t
14、herapy-Antacids Therapy,Lithium and Magnesium Carbonate Prostaglandin,Drug therapy-Mucosal protective therapy,Drug therapy - Hp eradication,PPI+Clarithromycin0.5+Amoxicillin1.0 PPI+Furazolidone 0.1+Amoxicillin1.0 PPI+Amoxicillin1.0+Metronidazole0.4 PPI+Clarithromycin0.5+Metronidazole0.4 Bid X 7 days
15、,Drug therapy-Hp eradication,Bismuth agent(480mg/d）+ two types of antibiotics(Clarithromycin、Furazolidone Amoxicillin 、 Metronidazole ）,Failure of HP eradication,Alter another two antibiotics PPI+Bismuth + other two antibiotics,Surgical therapy,Indication ： massive hemorrhage Acute perforation Obstr
16、uction caused by scar Suspected canceration Refractory ulcer,Male，30 years old，complain of recurrent epigastric pain for 2 years. The pain become worse 2-3 hours after meal and can be relieved by food and ranitidine ，usually accompanied with bloating. In the other hospital B ultrasound showed cholec
17、ystitis. Whats the most likely diagnosis ？ Which examination should be done for this patient？And how to treat?,Case Review,Question,What is the mechanism of Hp causing DU? Typical symptom of peptic ulcer?,Summary,Clinical presentation Laboratory examination Diagnosis and Differential diagnosis Treatment,Thank you!,Thank you !,