胃十二指腸疾病英文課件

Gastro-duodenaldiseasesAnatomyBloodsupplytothestomachandduodenumwithanatomicalrelationshipstothespleenandpancreas.ThestomachisreflectedcephaladLymphaticdrainage:PhysiologyStomach:-secretion-motilityThecentralroleoftheenterochromaffin-like(ECL)cellinregulationofacidsecretionbytheparietalcellisshown.PhysiologyDuodenum:SegmentsanditsadjacentorgansItsbloodvesselsPEPTICULCERDISEASEEpidemiology-annualincidenceofactiveulcer(gastriculcerandduodenalulcer)inUS≈1.8%roughly500,000newcasesperyear≈4millionulcerrecurrencesyearly

statisticsby2002Majoretiology:-Helicobacterpyloriinfection-consumptionofNSAIDsAcidClinicalManifestationsDuodenalulcer:Abdominalpain:

mid-epigastric,tolerable,relievedbyfoodPerforation:

→chemicalperitonitisBleeding:

penetrationgastroduodenalarteryObstruction:

acuteinflammation→mechanicalobstructionGastriculcer:RecurrentepisodesofquiescenceandrelapsePain,bleeding,obstructionandperforationDifficulttodifferentiatebetweengastriccarcinomaandbenignulcersDiagnosisHISTORYHelicobacterpyloriTestingSEROLOGYUREABREATHTESTRAPIDUREASEASSAYHISTOLOGYCULTURESupplementaryexamsUpperGastrointestinalRadiographyFiberopticEndoscopyTreatmentMedicalmanagement:ANTACIDSH2-RECEPTORANTAGONISTSPROTON-PUMPINHIBITORSSUCRALFATE-TREATMENTOFHELICOBACTERPYLORIINFECTION:Astandard2-weekbismuth-basedtherapycomprisedPepto-Bismol(2tabletsfourtimesdaily)incombinationwithmetronidazole(500mgfourtimesdaily)andtetracycline(500mgfourtimesdaily).SurgicalProceduresforPepticUlcerDisease

4classicindicationsforsurgeryIntractabilityHemorrhagePerforationObstructionTRUNCALVAGOTOMYTheclassictruncalvagotomyincombinationwithaHeineke-MikuliczpyloroplastyHIGHLYSELECTIVEVAGOTOMY)

TRUNCALVAGOTOMYANDANTRECTOMYBillrothILAPAROSCOPICPROCEDURESparietalcellvagotomyposteriortruncalvagotomyanteriorseromyotomy(Taylorprocedure)PostoperativesyndromeDUMPINGSYNDROMEMETABOLICDISTURBANCESAFFERENTLOOPSYNDROMEEFFERENTLOOPOBSTRUCTIONRETAINED-ANTRUMSYNDROMEALKALINEREFLUXGASTRITISPOSTVAGOTOMYDIARRHEAPOSTVAGOTOMYGASTRICATONYINCOMPLETEVAGALTRANSECTIONGastricneoplasiaMalignantTumorsAdenocarcinomaBenignTumor：GastricPolypsEctopicPancreasAdenocarcinomaEpidemiology:-3rdmalignanttumorsinChina-PrevalenceinChina:male——37.1/100,000female——17.4/100,000Factorsassociatedwithincreasedriskofdevelopingstomachcancer

NutritionalLowfatorproteinconsumptionSaltedmeatorfishHighnitrateconsumptionHighcomplex-carbohydrateconsumptionEnvironmentalPoorfoodpreparation(smoked,salted)LackofrefrigerationPoordrinkingwater(wellwater)SmokingSocialLowsocialclassMedicalPriorgastricsurgeryHelicobacterpyloriinfectionGastricatrophyandgastritisAdenomatouspolypsMalegenderSubtypesofEarlyGastricCancerBorrmann’sclassificationⅠⅡaⅡcⅡcⅢⅡc+ⅢⅡa+ⅡcⅡcI型II型III型Ⅳ型T–primar一tumor

Txprimarytumorcan’tbeassessedT0noevidenceofprimarytumorTiscarcinomainsituT1TumorinvadeslaminapropriaorsubmucosaT2TumorinvadesmuscularispropriaorsubserosaT3Tumorpenetratesserosa(visceralperitoneum)withoutinvasionofadjacentstructures）

T4Tumorinvadesadjacentstructures

N-RegionalLymphNodesNxRegionallymphnode(s)cannotbeassessedN0NoregionallymphnodemetastasisN1Metastasisin1to6regionallymphnodesN2Metastasisin7to15regionallymphnodesN3Metastasisinmorethan15regionallymphnodes

M-DistantMetastasisMxDistantmetastasiscannotbeassessedM0NodistantmetastasisM1DistantmetastasisTNMStagingofGCTNMclassification N0 N1 N2 N3T1 IA IB IIT2 IB II IIIAT3 II IIIAIIIB T4 IIIA M1H1P1CY1 IVDiagnosisNospecificsymptomsPhysicalExamsSupplementaryexams:-TumormarksEndoscopyC