内科学课件-胃炎

1 Gastritis 2 Definition Gastritisistheinflammationofvariousfactorsstimulatethegastricmucosa CategoriesAcutegastritisChronicgastritisSpecialtypeofgastritis 3 SectionIAcuteGastritis 4 Summarizeacutegastritisalsocallederosivegastritis hemorrhagicgastritis acutegastricmucosalesion Gastroscopeexamination gastricmucosaerosion bleedingHistology acuteinflammationofthegastricmucosa 5 etiologyandpathogenesis 1 StressInthestressstate itcancausegastricmucosalerosionandbleeding suchasseveretrauma majorsurgery largeareaburnandintracraniallesion shock sepsisandmultipleorganfailure MOF 6 mechanism gastricmucosamicrocirculationdysfunction hypoxia mucussecretiondecreased locallackofprostaglandinsynthesis barrierfunctionisdamaged gastricacidsecreteincreased 7 etiologyandpathogenesis 2 Drugnon steroidanti inflammatorydrug NSAID suchasaspirin acetaminophen 对乙酰氨基酚 etc Someanti tumormedicine potassiumchlorideliquid chalybeate etc NSAIDblocksprostaglandinsynthesisbyinhibitingthecyclooxygenase COX COX 1helptoepithelialcellstorepair COX 2promotesinflammationmedium 8 etiologyandpathogenesis 3 AlcoholAlcoholwithlipotropyandfatsoluble candestroythebarrierofgastricmucosadirectly 4 Traumaandphysicalfactorsplacedstomachtube vomiting stomacheyewinker 异物 polyp 息肉 excisionundergastroscope etc 9 5 DuodenogastricrefluxAbnormalgastricdynamics Pyloricsphincterdysfunction billroth operation6 Gastricmucosabloodcirculationobstacleportalhypertensivegastropathy PHG 10 clinicalfeatureMostpatientsisasymptomatic Afewpatientshaveepigastricdiscomfort nauseaandvomiting Itcanoccursuddenlyhematemesisand ormelaena evenmassivehemorrhageoftheupperalimentarytract whichaccountsforabout10 25 casesofuppergastrointestinalbleeding sign slight 11 DiagnosisDiagnosisdependsonthehistoryandclinicalfeature andconfirmeddiagnosisdependsonendoscopicexamination 12 Askingmedicalhistorytodeterminethecause Manystressescausedbythestresshistory whichisthemainperformanceofuppergastrointestinalbleeding Endoscopicexaminationshowedmultipleerosions acutesuperficialulcer hemorrhageandmucosaledema etc 13 14 AcuteGastricMucosalLesions 15 Differentialdiagnosis pepticulceresophogealvaricesgastriccarcinoma 16 Treatment1 Removethecause2 Drugsinhibitinggastricacidsecretion protonpumpinhibitors PPI orH2receptorantagonist 3 Gastricmucosaprotectiveagent sucralfate misoprostol bismuthagent etc 17 Prognosis Mostofthegastricmucosalerosionandbleedingcanhealitself andafewdevelopintoulcers 18 Prevention 1 stoppingNSAID2 Ifunderthestressstateorneedlong termtakingaspirinorclopidogrel ithadbettertogivePPI H2RApreventively 3 Theuseofselectivecox 2inhibitors suchascelecoxibtoreducetheinhibitionofcox 1 19 Itischronicinflammationofgastricmucosathatcausedbyavarietyofcauses Endoscopy mucosalunevencolor granularproliferation 增生 abnormalplica Histology inflammatorycellinfiltration epitheliosis 上皮增殖 gastricglandatrophy SectionIIChronicGastritis 20 etiologyandpathogenesis 1 H pyloriinfectionItisthemaincauseofchronicactivegastritis A Amongthechronicactivegastritispatients Hpdetectionrateishigh B H pylori sdistributioninthestomachandthestomachinflammationdistributionisconsistent C AftertheeradicationofHp gastricmucosalinflammationisgone D Infectionmodelcanbeclonedinpersonoranimals 21 The2005NobelPrizewinnerinmedicineJ RobinWarren older BarryJ Marshall Helicobacterpylori silverstaining 22 etiologyandpathogenesisH pylori spathogenicfactors flagella adhesin ureaenzymes theemptycelltoxin cytotoxinassociatedproteinandH pylorithallus etc 23 etiologyandathogenesis2 duodenogastricreflux3 autoimmunityPositivereactionofparietalcellantibody PCA andintrinsicfactorantibody IFA canreduceparietalcells 24 25 etiologyandpathogenesis 4 Ageandgastricmucosalackofnutritionalfactorsagedness gastricarteriolehyalinechange mucosalmalnutrition nutritiondeficiency abnormalgastricmucosaepithelialproliferationandgastricglandatrophy 26 Gastroscope chronicnon atrophicgastritis mucousmembraneredandwhite plica 皱襞 swellingandenlargement chronicatrophicgastritis colourispale plicaflatten mucusreduce mucousmembranethinning submucosalstriavasculariscanbeseen 27 Classification1 antralgastritis causedbyHpinfection2 bodygastritis relatedtoautoimmunity3 allgastritis causedbyHpinfectionextension 28 Pathology1 InflammationThemainchronicinflammatorycellsarelymphocyteandplasmocyte superficiallayermucousmembrane superficialgastritis diseasedevelopment spreadtothewholelayerInflammatoryactivity neutrophilappear 29 2 Metaplasia 化生 Long termchronicinflammationcanmakegastricmucosasurfaceepitheliumandglandularepitheliumbereplacedbygobletcellandpyloricglandcell intestinalmetaplasiaIntestinalglandwhichwithgobletcellreplacesinherentgastricglands pseudopyloricmetaplasiaThehyperplasiaofmucousneckcellsofoxyntic 泌酸 gland formpseudopyloricgland 30 3 atrophy 萎缩 Inflammationextendstothedeepoftheglands glanddamage depletioninnumbers mucousmembranethinningnon metaplasiaatrophymetaplasiaatrophy 31 4 Dysplasia 异型增生 Cellsarehyperplasiaanddifferentiation 分化 ontheregenerativeprocess s