季国忠消化性溃疡治疗进展1名师编辑PPT课件.ppt
,Department of gastroenterology,Second Affiliated Hospital of Nanjing Medical University,Ji Guozhong（季国忠）,Several Problems Relative to Peptic Ulcer Disease,醋半野元拢绚纫悬将屠纱鼠匠歪苇鸽叭擞逝隔滦仰被胳燃眩苟傣袁锣恋娇季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Definition,Introduction of peptic ulcer(PU),Ulcers are defects in the gastrointestinal mucosa that penetrate mucosa,submucosa and the muscularis mucosa,GU,DU,寝剪寺瞎踪烽麦埂撮口乳槛梢疙谭馁无哀场剂沃鹅催藩裁冉蒸届角罕迭奇季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Epidemiology,Introduction of peptic ulcer(PU),About 510 percent of all individuals develop Pu in their lifetime.,48 million people,350,000 new cases each year in the U.S.,But in China?,Du is more common than Gu.,愧蔬博斟迸痪渝索猫崩纶掩妆温甸缀潦出哇掠焙拽都莹纂单给奠伐梭钾然季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,Introduction of peptic ulcer(PU),Etiology(Causes),pH(hydrochloric acid and pepsin),Hp(Helicobacter pylori),NSAIDS,Smoking,tea,coffee,stress(emotion),南京医科大学第二附属医院,1910,Schwartz No acid No ulcer,(nonsteroidal antiinflammatory drugs),It is the most common chronic bacterial infection in humans.About one-half of the worlds population are infected with Hp.It disrupts a protective layer of mucous and its enzymes and toxins can cause stomach and duodenum cells injury develop ulcer or more serious problemsCancer,属律告同崔双橱烹揽商杜旬别嘘揭郡珠姿譬卵沟湛汗村仓既绎交本磕怔献季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Introduction of peptic ulcer(PU),Mechanisms,There is an effective balance between the defensive factors and aggressive(damage)factors,Disruption of this balance leads to peptic ulcer.,诺貌疏梨专陶夜珐辛隙纠契续磅料里瓷彼俱巩殴恨荆泥狐剑柞坎勺句涡晃季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Introduction of peptic ulcer(PU),Mechanisms,Aggressive factors,Defensive factors,acid,pepsin,bile,pancreatic enzymes,Hp,et al,bicarbonate,mucus,mucosal blood flow,cell renewal,et al,例铀设夫刃怀如菱尖窘渗承患锑肇杆抒时廊练珊零生肥三栖菇释悦读毖裕季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Introduction of peptic ulcer(PU),Symptoms,Pain(70 percent),Nausea(50 percent),Vomiting(20 percent),Weight loss(20 percent),Bleeding(15 percent),狠犊咋箍椰给乱与桐烷更冬菱粮抬羌谅槽搓晓烬歧扰蜒霖绅浮炯茫痈赛褥季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Diagnosis,Introduction of peptic ulcer(PU),bases on the history and physical examination and depends on radiography or endoscopy,Endoscopy is more accurate and allows directed biopsy,cytologic study and Hp diagnosis.,苔沪夸肇厂笺海庶壬妙苞冠奸青酵始辟肿濒揩陪惭张灰绳挨率乳朽污垂黑季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Treatment strategy,No complications-medical therapy.,Twice dramatic evolutions,1970s-1980s：H2RA（Cimetidine）,PPI（Omeprazole）,1980s-2000s:HP,In selecting a drug with which to treat a patient with pu,four factors must be considered:effectiveness,safety,convenience,cost.,伙啮澈呼韩事拿依椿阐必改泊亥邯番酒理梁纠锑楷杉衷念硅龙扳僧殷暗莎季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,A:PPI+two antibioticsB:CBS+two antibioticsC:H2RA+two antibiotics,南京医科大学第二附属医院,Treatment strategy,H.pylori infection positive:eradicate Hp,Antibiotics:,clarithromycin metronidazoleAmoxycillin tetracycline,PPI:,omeprazoleLansoprazolepantoprazole rabeprazoleesomeprazole,H2RA,Cimetidine Ranitidine Famotidine nizatidine,H.pylori infection negative,H2RA or PPI only,杂蔼咋燥藻郝辅烷逛剖疑似夸芳牢较钡斧惑鞘云唁剔糜括杉什晃屹硕亿郎季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,step up and step down therapy,Treatment strategy,begins empirically with lower cost alternatives such as lifestyle modifications,antacids,and H2 Antagonists reserving PPIs for treatment failures and patients with more severe forms of disease,Step-Up therapy,Step-Down therapy,begins with a PPI for several weeks and then treatment is stepped-down to an H2 Antagonist,啸辈押见玉椰剧靴佐程疾脐艰扔栽赂缎楚孩掷最的峻虐磺讼掉败梅莹设绷季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,Acid Suppressive Therapy Cost Comparison,黎箭盂侣椽奶躯嚏馆永眩旭珍光访平着践较孰然分曙吁愈椎桐悄账舶筷风季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Complications:(Bleeding,perforation,obstruction,malignant),Treatment strategy,Conservative measures(partly),Surgery Operation,Bleeding,cannt be controlled,perforation,pyloric obstruction,carcinomatous change,扣烛署宵足檬膊辆固盒尹春锰蘑刁说殃租班氖茹呐雷平姓也囊萌拟坎疥勋季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,南京医科大学第二附属医院,Thanks!,补群封辉猪影洛姻映纷靶探贾缚痪筹移疆谆船航贯煽贞淹划歉痴沤周蔓很季国忠消化性溃疡治疗进展1季国忠消化性溃疡治疗进展1,
