最新：【医药健康】口腔粘膜溃疡类疾病文档资料.ppt

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1、Introduction,Behets disease,Traumatic Ulcer&Traumatic Bulla,Recurrent Aphthous Ulcer,Summary&Questions,BACK,Reiters Syndrome,I.Introduction,Ulcers are one of the most common types of lesions seen in oral mucosa.2.The difference between ulcer and erosion.,NEXT,ulcer,erosion,NEXT,BACK,Comparison,Recur

2、rent Aphthous Ulcer,1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU,NEXT,Typing Lehners classification minor aphthous ulcer（MiAU）major aphthous ulcer（MjAU）herpetiform ulcer（HU）Characteristic recidivity self-healing periodicity,NEXT,2.Etiology un

3、known immunity:cellular immunity,humoral immunity,complement,autoantibody heritage infection：HSV environment:psychology,NEXT,denutrition：iron,copper,zinc,folic acid,Vit B12 hyperoxide dismutase microcirculation disturbance：lip,nail,apex linguae systemic factor：ulceration of stomach、hepatitis、colonit

4、is、diarrhoea,NEXT,3.Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcer,NEXT,NEXT,Minor aphthous ulcers,NEXT,NEXT,NEXT,Major aphthous ulcers,NEXT,Periadenitis Mucosa Necrotica Recurrens,NEXT,Major aphthous ulcers,NEXT,3、饮食相关因素：肝癌的发生与生活习惯息息相关。长期进食霉变食物、含亚硝胺食物、微量元素硒缺乏也是促发肝癌的重要

5、因素。黄曲霉毒B1是目前已被证明有明确致癌作用的物质，主要存在于霉变的粮食中，如玉米、花生、大米等。另外当摄食大量的含有亚硝酸盐的食物，亚硝酸盐在体内蓄积不能及时排出，可以在体内转变成亚硝胺类物质，亚硝酸盐含量较高的食物以烟熏或盐腌的肉制品为著，具有明确的致癌作用。同时肝癌的发生也与遗传因素、寄生虫感染等因素相关。1 临床表现疾病症状肝癌的早期表现很不典型，往往容易被忽视。以下症状可供参考：1、食欲明显减退：腹部闷胀，消化不良，有时出现恶心、呕吐；2、右上腹隐痛：肝区可有持续性或间歇性疼痛，有时可因体位变动而加重；3、乏力、消瘦、不明原因的发热及水肿；4、黄疸、腹水、皮肤瘙痒；5、常常表现为鼻

6、出血、皮下出血等。肝癌的一些典型症状只有疾病进展到中晚期时才会发生，而那时往往已经丧失手术机会，因此平时的自我检查非常重要。当感觉疲惫乏力持续不能缓解时，很可能是肝病的预兆；心窝处沉闷感，或是腹部右上方感觉钝痛，有压迫感和不适感等，体重减轻，时有原因不明的发烧及出现黄疸，应尽早前往医院检查。1-2 诊断鉴别检查主要包括血清甲胎蛋白（AFP）和肝脏影像学检查。甲胎蛋白是目前常用的，也最简单实用。我国60%以上肝癌病例的血清AFP400 g/L，95%的肝癌患者具有乙肝病毒（HBV）感染的背景，10%有丙肝病毒（HCV）感染背景，还有部分患者HBV和HCV重叠感染，因此如果在病毒性肝病基础上合并A

7、FP 400 g/L应该高度怀疑肝癌可能，尽早完善影像学相关检查，做到早发现、早诊断、早治疗。现代医学影像学手段也为肝癌的诊断提供了很大的帮助，为肝癌的定位、定性、定量、定期和制定治疗方案提供了可靠的依据。1、最常用的是肝脏超声检查，超声检查为非侵入性检查，对人体组织无任何不良影响，其操作简单、直观准确、费用低廉、方便无创、广泛普及，可用于肝癌的普查和治疗后随访。2、CT已经成为肝癌诊断的重要常规手段。腹部CT增强扫描可清楚地显示肝癌的大小、数目、形态、部位、边界、肿瘤血供丰富程度，以及与肝内管道的关系，对于进一步明确诊断，与其他良性肝脏占位相鉴别，同时明确肝癌的分期分级，对于指导治疗及判断预

8、后有重要意义。通过影像分析软件还可以对肝脏内各管道进行重建，可以精确到各肝段血管的走行，肿瘤与血管的关系，模拟手术切除平面，测算预切除肿瘤的体积和剩余肝体积，极大的提高手术安全性。3、肝脏特异性MRI能够提高小肝癌检出率，同时对肝癌与肝脏局灶性增生结节、肝腺瘤等的鉴别有较大帮助，可以作为CT检查的重要补充。4、PET（正电子发射计算机断层扫描）-CT全身扫描可以了解整体状况和评估肿瘤转移情况，更能全面判断肿瘤分期及预后，但是价格较为昂贵，一般不作为首选检查。,医学健康系列精品课件,最好的专业文档，免费在线浏览，下载后可以修改编辑，欢迎下载收藏。,Herpetiform ulcers,NEXT,

9、disease-process,24h,10d-14d,outbreak,NEXT,intermission,healing,prodromal stage,ulcerative stage,5.Diagnosis,history clinical feature,NEXT,4.Pathology：nonspecific inflammation,6.Differential diagnosis,benign ulcer&malignant ulcerNecrotizing sialadenometaplasia,Behets disease,herpes simplex,hand-foot-

10、and-mouth disease,NEXT,Comparison,NEXT,7.Treatment,principle：symptomatic treatmentEvaluation of curative effect,NEXT,Topical application of a steroid ointment reduces discomfort and decreases the duration of the lesions.Topical anesthetics,antibiotics,mouthwashes,etc.,have been used.In severe cases,

11、intralesional steroid injection or systemic steroids in a low dose(10-20 mg prednisone)for 5-10 days reduce the pain dramatically.,BACK,III.Behets disease,1.Preface Hulusi Behet(1937)Behets disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.2.Etiology Unknown,N

12、EXT,3.Clinical features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:ulcer 3)skin lesions:erythema nodosum,epifolliculitis,pustule after needling 4)ocular lesions:conjunctivitis,recurrent iritis 5)others systems:joint,digestive,cardiovascular,nervous,respiratory,urinary,NEXT,Behets disease,NE

13、XT,4.Pathology：Histopathologic changes consist of a perivascular mononuclear cellular infiltrate,endothelial cell swelling or necrosis,partial luminal obliteration and occasional fibrinoid necrosis of the vessels.,NEXT,5.Diagnosis 1)recurrent oral ulceration 2)recurrent genital ulceration 3)eye lesi

14、ons 4)skin lesions 5)positive pathergy test To establish the diagnosis of Behets Disease,recurrent oral ulceration plus any two of the other four major clinical criteria must be present.,NEXT,6.Differential diagnosis,NEXT,RAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syndrome

15、,7.Treatment Symptomatic in mild cases.Systemic steroids,immunosuppressive drugs,colchicines,thalidomide,and dapsone are administered in severe cases.,BACK,IV.Traumatic Ulcer Traumatic Bulla,1.Preface,Because of the constant motion of the masticatory mucosa over the teeth and the introduction of har

16、d objects into the oral cavity,traumatic ulcers are frequent.,NEXT,2.Etiology,Mechanical factors:a sharp or broken tooth,rough fillings,clumsy use of cutting dental instruments,hard foodstuffs,sharp foreign bodies,biting of the mucosa,and denture irritation etc.Physical factors:thermal burnsChemical

17、 factors:strong acid,strong base,As2O3,Ag(NO)3,iodophenol,NEXT,3.Clinical feature,1)Decubital ulcer,mechanical irritating factors the ulcer conforms in area and linearity to the source of the irritating factors,NEXT,NEXT,traumatic ulcer,traumatic ulcer,NEXT,infants,hard palate improper feeding,NEXT,

18、2)Bednar ulcer,3)Rida-Fede ulcer,infants lingual frenum ulcer secondary to inferior deciduous incisor,NEXT,4)Factitious ulcer,mentally handicapped patients or those with serous emotional problems oral self-inflicted trauma by biting,fingernails,or by the use of a sharp object tongue,lower lip,gingiv

19、a slow to heal due to perpetuation of the injury by the patient local measures and psychiatric therapy,NEXT,5)Chemical burn,the type of chemical utilized,its concentration,and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damage healing within 1-2 weeks,NEXT,NEXT,chemical burn

20、,6)Thermal burn,very hot foods,liquid,or hot metal objects palate,lips,floor of the mouth,tongue painful,red,undergoing desquamation,leaving erosions supportive treatment;self-healing in about a week,NEXT,NEXT,thermal burn,7)Traumatic bulla&traumatic hematoma,caused by biting or prosthetic appliance

21、s buccal mucosa,soft palate,lips,tongue self-healing in 4-6 days,NEXT,traumatic bulla,NEXT,4.Diagnosis,historyclinical features,NEXT,carcinoma,syphilis,tubercular ulcer,major aphthous ulcerthrombocytopenia,thrombastheniapemphigus,cicatricial pemphigoid,5.Differential diagnosis,malignant ulcer,NEXT,5

22、.Differential diagnosis,BACK,6.Treatment,Removal of the traumatic factorsTopical measures,NEXT,V.Reiters Syndrome,1.Preface,Reiters syndrome is a disease of unknown cause that predominantly affects young men,20-30 years of age.,NEXT,2.Etiology,unknown,3.Clinical feature,Major symptoms:nongonococcal

23、urethritis,conjunctivitis,arthritis Other symptoms:oral ulcer,circinate balanitis,keratoderma blennorrhagicum,NEXT,NEXT,oral lesion,4.Diagnosis,history clinical criteria,NEXT,5.Differential diagnosis,The differential diagnosis the oral lesions includes erythema multiforme,Stevens-Johnson syndrome,ps

24、oriasis,Behets Disease,geographic tongue,and stomatitis.,NEXT,6.Treatment,It is nonspecific and symptomatic.Non-steroidal anti-inflammatory drugs,salicylates,and tetracyclines may be helpful,cyclosporin,azathioprine,methotrexate,and systemic steroid in severe case.,BACK,Summary,To compare the charac

25、teristics of major Aphthous ulcer,traumatic ulcer,carcinoma and tuberculous ulcer.(etiology,pathology,clinical feature,treatment,prognosis).To master the treatment principle of ulcerative diseases by taking RAU for example.,NEXT,To master the effect,usage,contraindication and side-effect of corticos

26、teroid in treating ulcerative diseases.To establish the conception of oral mucosal syndrome by means of learning Behets disease.,NEXT,Questions,Which is the most common form of Recurrent Aphthous Ulcer?Whats the characteristic of its lesion?Whats the effect of corticosteroid in treating oral ulcerat

27、ive diseases?Whats the primary treatment to traumatic ulcer?,NEXT,Taking major Aphthous ulcer and carcinoma for example,try to tell the difference between benign ulcer and malignant ulcer.What are the oral lesions of Behets Disease and Reiters Syndrome?What are their clinical systemic features?,BACK

28、,肝癌是指发生于肝脏的恶性肿瘤，包括原发性肝癌和转移性肝癌两种，人们日常说的肝癌指的多是原发性肝癌。原发性肝癌是临床上最常见的恶性肿瘤之一，根据最新统计，全世界每年新发肝癌患者约六十万，居恶性肿瘤的第五位。原发性肝癌按细胞分型可分为肝细胞型肝癌、胆管细胞型肝癌及混合型肝癌。按肿瘤的形态可分为结节型、巨块型和弥漫型。原发性肝癌在我国属于高发病，一般男性多于女性。中国是乙肝大国，我国的肝癌多在乙肝肝硬化的基础上发展而来，丙肝病人也在逐渐增加，乙肝后也会发展为肝癌。目前我国发病人数约占全球的半数以上，占全球肝癌病人的55%，已经成为严重威胁我国人民健康和生命的一大杀手，其危险性不容小视。1 发病原因

29、总的来说，原发性肝癌的病因至今未能完全阐明，但已证明与以下因素密切相关：1、病毒性肝炎：流行病学统计表明，乙肝流行的地区也是肝癌的高发地区，患过乙肝的人比没有患过乙肝的人患肝癌的机会要高10倍之多。长期的临床观察中发现，肝炎、肝硬化、肝癌是不断迁移演变的三部曲。近来研究表明，与肝癌有关的病毒性肝炎主要包括乙型肝炎（HBV）、丙型肝炎（BCV），而其中又以乙型肝炎最为常见。2、酒精：俗话说“饮酒伤肝”，饮酒并不是肝癌的直接病因，但它的作用类似于催化剂，能够促进肝癌的发生和进展。有长期酗酒嗜好者容易诱发肝癌。这是因为酒精进入人体后，主要在肝脏进行分解代谢，酒精对肝细胞的毒性使肝细胞对脂肪酸的分解和代谢发生障碍，引起肝内脂肪沉积而造成脂肪肝。饮酒越多，脂肪肝也就越严重，进而引起肝纤维化、肝硬化、肝癌的发生。,医学健康系列精品课件,最好的专业文档，免费在线浏览，下载后可以修改编辑，欢迎下载收藏。,