内科学教学课件：胃、十二指肠疾病
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12 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素 4. 尿素酶
13 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素 4. 尿素酶 5. 空泡毒素(Vac A)
细胞毒素相关基因蛋白 (CageA) 诱导自身抗原
14 2020/11/6
Chapter 3 第三章
circulation, H+ ion contra-diffusion , PGE2↓
• Curling’s ulcer(burns); • Cushing’s ulcer(central nervous system)
19 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury • Drugs:NSAIDs(non-steroidal anti-inflammatory
Bacteria (helicobacter pylori, H.pylori) , virus, and their toxins
21 2020/11/6
Etiology
1. Stress 2. Chemical injury 3. Acute infection
22 2020/11/6
Pathology
18 2020/11/6
Etiology & mechanism
1. Stress • Severe disorders of other organs, great operation,
trauma, shock, serious burns, sepsis, multiple organ failure, et al. • Mesenteric Ischemia ,disturbance of mucosal
上皮 上皮后 血流
2020/11/6
pH
1
PGE
~
7
6
Nobel Prize 2005
Robin Warren and Barry Marshall. The team discovered the bacterium behind stomach inflammation and ulcers.
26 2020/11/6
Endoscopy
27 2020/11/6
Treatment
• Treating primary diseases • Control the causes • Prevention: for serious disease or
nausea; vomiting • Hemorrhage
small amount, or obvious bleeding Hematemesis (bloody vomitus )
Melena ( black stools ) self-limited
24 2020/11/6
Clinic manifestation
胃、十二指肠疾病
1 2020/11/6
必要的病理生理基础
1. 关于消化道粘膜保护机制 2. 关于幽门螺旋杆菌（helicobactor pylori,
Hp ）
2 2020/11/6
胃粘膜为什么可以抵御盐酸的腐蚀？
3 2020/11/6
4 2020/11/6
5 2020/11/6
上皮前
粘液 HCO-3
Gastritis
胃炎
15 2020/11/6
definition
• 损伤damage • 粘膜炎症 inflammation • 上皮细胞再生regeneration • 胃病 gastropathy
• 胃炎（gastritis）
16 2020/11/6
第一节 急性胃炎
1. Acute gastritis
• Neutrophil infiltration • Erosion • Hemorrhage • Shallow Ulcer
23 2020/11/6
Clinic manifestation
1. Symptom most of the patients has no symptom.
but can has obvious symptom • epigastric pain ; distention; Dyspepsia;
2. Physic Sign • epigastric tenderness
25 2020/11/6
Diagnosis
• Etiology • Emergent endoscopy
within 12~48 hours after bleeding Multiple erosions, difused bleeding spots, mucosal edema
Conception: acute inflammation of mucosa。
Acute: definite etiologic cause
Obvious pathologic change of endoscopy
Temwenku.baidu.comorarily or self-healing
同义词： “急性糜烂出血性胃炎”
Acute erosive &hemorrhagic gastritis “急性胃粘膜病变” “急性胃粘膜损害” “应激性溃疡” “急性糜烂出血性胃病”
gastric
17 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury 3. Acute infection
drugs), some antiboitics, Ferreous drugs, KCl, anti-
tumor drugs • Alcohol;
20 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury 3. Acute infection:
7 2020/11/6
幽门螺旋杆菌(helicobactor pylori HP)感染 ---胃粘膜损伤主要病因
8 2020/11/6
胃 酸
血流
9 2020/11/6
1. 鞭毛
致病因素
10 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶
11 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素 4. 尿素酶
13 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素 4. 尿素酶 5. 空泡毒素(Vac A)
细胞毒素相关基因蛋白 (CageA) 诱导自身抗原
14 2020/11/6
Chapter 3 第三章
circulation, H+ ion contra-diffusion , PGE2↓
• Curling’s ulcer(burns); • Cushing’s ulcer(central nervous system)
19 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury • Drugs:NSAIDs(non-steroidal anti-inflammatory
Bacteria (helicobacter pylori, H.pylori) , virus, and their toxins
21 2020/11/6
Etiology
1. Stress 2. Chemical injury 3. Acute infection
22 2020/11/6
Pathology
18 2020/11/6
Etiology & mechanism
1. Stress • Severe disorders of other organs, great operation,
trauma, shock, serious burns, sepsis, multiple organ failure, et al. • Mesenteric Ischemia ,disturbance of mucosal
上皮 上皮后 血流
2020/11/6
pH
1
PGE
~
7
6
Nobel Prize 2005
Robin Warren and Barry Marshall. The team discovered the bacterium behind stomach inflammation and ulcers.
26 2020/11/6
Endoscopy
27 2020/11/6
Treatment
• Treating primary diseases • Control the causes • Prevention: for serious disease or
nausea; vomiting • Hemorrhage
small amount, or obvious bleeding Hematemesis (bloody vomitus )
Melena ( black stools ) self-limited
24 2020/11/6
Clinic manifestation
胃、十二指肠疾病
1 2020/11/6
必要的病理生理基础
1. 关于消化道粘膜保护机制 2. 关于幽门螺旋杆菌（helicobactor pylori,
Hp ）
2 2020/11/6
胃粘膜为什么可以抵御盐酸的腐蚀？
3 2020/11/6
4 2020/11/6
5 2020/11/6
上皮前
粘液 HCO-3
Gastritis
胃炎
15 2020/11/6
definition
• 损伤damage • 粘膜炎症 inflammation • 上皮细胞再生regeneration • 胃病 gastropathy
• 胃炎（gastritis）
16 2020/11/6
第一节 急性胃炎
1. Acute gastritis
• Neutrophil infiltration • Erosion • Hemorrhage • Shallow Ulcer
23 2020/11/6
Clinic manifestation
1. Symptom most of the patients has no symptom.
but can has obvious symptom • epigastric pain ; distention; Dyspepsia;
2. Physic Sign • epigastric tenderness
25 2020/11/6
Diagnosis
• Etiology • Emergent endoscopy
within 12~48 hours after bleeding Multiple erosions, difused bleeding spots, mucosal edema
Conception: acute inflammation of mucosa。
Acute: definite etiologic cause
Obvious pathologic change of endoscopy
Temwenku.baidu.comorarily or self-healing
同义词： “急性糜烂出血性胃炎”
Acute erosive &hemorrhagic gastritis “急性胃粘膜病变” “急性胃粘膜损害” “应激性溃疡” “急性糜烂出血性胃病”
gastric
17 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury 3. Acute infection
drugs), some antiboitics, Ferreous drugs, KCl, anti-
tumor drugs • Alcohol;
20 2020/11/6
Etiology & mechanism
1. Stress 2. Chemical injury 3. Acute infection:
7 2020/11/6
幽门螺旋杆菌(helicobactor pylori HP)感染 ---胃粘膜损伤主要病因
8 2020/11/6
胃 酸
血流
9 2020/11/6
1. 鞭毛
致病因素
10 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶
11 2020/11/6
致病因素：
1. 鞭毛 2. 粘液酶 3. 粘附素