1、n 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. n Whats the most likely diagnosis ？ n Which exa
2、mination should be done for this patient？ And how to treat? Case Review Chapter 5 Peptic ulcer 消化性溃疡 Department of Gastroenterology Third Xiangya Hospital Xiaoyan Wang, MD, PhD. Contents of classes n Overview n Etiology and pathogenesis n Pathology n Clinical presentation n Special types of PU n Lab
3、oratory examination n Diagnosis and Differential diagnosis n Complication n Treatment Overview n Definition Gastric ulcer Duodenal ulcer jejunum ulcer after gastric resection Epidemiology Overview M:F slightly more DU:GU 3:1 Age of DU young people Age of GU middle age and elder Etiology GU 2cm giant
4、 ulcer) Complication Pathology Clinical presentation 临床表现 Chronicity Rhythmicity Features of PU Periodicity and recurrence abdominal pain- typical symptom Location Quality Rhythmicity Other symptoms epigstric burning sensation（ useful) bloating dyspepsia epigastric malaise (not special,not diagnosti
5、c) belch, acid reflux asymptomatic case Physical sign n Without complication: just mild epigastric tenderness n With complication: present corresponding physical sign(rebound tenderness,gastric form,splashing sound) Special types of PU n Compound ulcer(复合溃疡） n Pyloric channel ulcer（幽门管溃疡） n Postbulb
6、ar ulcer（球后溃疡） n Giant ulcer（巨大溃疡） n The aged peptic ulcer（老年人消化性溃疡） n Asymptomatic ulcer（无症状溃疡） Laboratory examination 实验室检查 n Endoscopy（胃镜） n Testing of HP（ HP检测） n Barium Radiography（钡餐） n Gastric juice analysis（胃液分析） n Testing of serous gastrin(血清胃泌素） Laboratory examination Endoscopy is the sens
7、itive ,specific and precise method for diagnosing peptic ulcer,allowing direct inspection and biopsy. Endoscopy Endoscope Endoscopy -normal imaging Gastric fundus Gastric bodyGastric angleGastric antrum duodenal bulb Endoscopy- pyloric channel ulcer Endoscopy-Bulbar ulcer Invasive assessment Rapid u
8、rease 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） 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 nEndos
9、copy (内镜） nBarium radiography （钡餐） Diagnosis Present history Initial diagnosis Final diagnosis Differential diagnosis 鉴别诊断 n Gastric carcinoma （胃癌） n Zollinger-Ellision syndrome （卓艾综合症） Differential diagnosis GU GC Complication Hemorrhage(出血） Perforation（穿孔） Gastric outlet obstruction（梗阻） Canceratio
10、n （癌变） Treatment 治 疗 Remove the inducement Drug therapy Surgical therapy Antacids Therapy Mucosal protection Treatment Hp eradication Remove the inducement Living and Diet regularly Mental status well Avoiding bad habit n Proton pump inhibitors (PPIs) are the most potent Antacid agents. omaprazole(2
11、0mg) lansoprazole(30mg) pantoprazole(40mg) rebaprazole(10mg) n H2-receptor antagonist cimetidine(200mg) ranitidine(150mg) famotidine(20mg) nizatidine Drug therapy-Antacids Therapy Lithium and Magnesium Carbonate Prostaglandin Drug therapy-Mucosal protective therapy Drug therapy - Hp eradication n PP
12、I+Clarithromycin0.5+Amoxicillin1.0 n PPI+Furazolidone 0.1+Amoxicillin1.0 n PPI+Amoxicillin1.0+Metronidazole0.4 n PPI+Clarithromycin0.5+Metronidazole0.4 Bid X 7 days Drug therapy-Hp eradication Bismuth agent(480mg/d） + two types of antibiotics(Clarithromycin、 Furazolidone Amoxicillin 、 Metronidazole
13、） Failure of HP eradication n Alter another two antibiotics n PPI+Bismuth + other two antibiotics Surgical therapy Indication ： n massive hemorrhage n Acute perforation n Obstruction caused by scar n Suspected canceration n Refractory ulcer n Male， 30 years old， complain of recurrent epigastric pain
14、 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. n Whats the most likely diagnosis ？ n Which examination should be done for this patient？ And how to treat? Case Review Question nWhat is the mechanism of Hp causing DU? nTypical symptom of peptic ulcer? Summary nClinical presentation nLaboratory examination nDiagnosis and Differential diagnosis nTreatment Thank you!Thank you !
