内科学DisordersofDigestiveSys

内科学aspirin/2006-1-DisordersofDigestiveSystemBasicstructureofdigestivesystemGastrointestinaltractHistologicorganizationanatomyandphysiologyofSTOMACHzonationofstomach•cardia•fundus•body•antrumReceptorofparietalcellAcetylcholineReceptorsofhypersecretionGastrinHistamineProstaglandinsReceptorsofhyposecretionSomatostatinHistologicorganizationoftheGItractepitheliummucosalaminapropriamuscularismucosaewalloftheGIsubmucosamuscularisinnercircularlayerouterlongitudinallayerserosaDigestiveglands•liver:complexfunction•pancreas:endocrine:insulintwofunctionstrypsinexocrine:amylopsinsteapsin•biliarysystemeLIVERDoublebloodsupplyPortalvein75%Hepaticartery25%lobulesofliverfundamentalunitoftheliverOtherassociatedorgans•peritoneum•mesentery•omentumFunctionoftheDigestiveSystemDigestionAbsorptionMetabolismExcretionEndocrineDigestion:digestionreferstotheconversionofingestedfoodmoleculesintosmallercapableofbeingabsorbedintothebloodandlymph.glucosecarbohydrate:fructosedigestiveenzyme(amylopsin)maltoseproteins:aminoacidsdigestion(trypsin)fats:fattyacids(steapsin)glycerolmovementAbsorption:Absorptionreferstotheprocessofabsorbablemoleculesenteringthebloodorlymph.activetransportationabsorptivemechanismssimplediffusionfacilitateddiffusionendocytosislong-chainfattyacid→lymphmonoglyceridesothernutrients───→bloodMetabolismofliverbiochemicalprocessesabsorbednutrientsareprimarilymanagedtoxinsaredetoxicatedhormonesareinactivetedExcretion:bilirubin,cholesterineandsomedrugsareexcretedbytheliver.Endocrin:endocrinecellsinthestomach,intestine,andpancreas.Theycansecretalotofhormones.•Tillnow,mornthantwentyhormoneshavebeenfoundinthedigestivesystem.•Thenumberofhormoneproducedbythedigestivesystemisincreasing.•ThehormonesproducedbyGItractnotonlymodulatetheactivityofdigestivesystembutalsoplayanimportantroleintheregulationofalotofotherphysiologicalfunctions.•Inrecentyears,itisfoundthatGItractcanproduceanumberofpeptidehormones.•Thispeptidehormonespreviouslyfoundtobeproducedbythebrain.•Thesepeptidesarenamedas`brain-gutpeptides`DiagnosticmeasuresHistoryandsymptomsPhysicalexamination(sign)LaboratorysymptomsandcommondiseasesHistory:Historytakingcanprovideveryimportantinformation.Forsomedigestivediseasesonlybythesemeanscanbeestablishedaccuratediagnoses.AcutegastritisAcuteappendicitis1、esophagusHistoryandsymptomschestpaindysphagiaheartburnacidrefluxCommondiseaseesophagitis、GERD、esophagealcarcinoma、achalasiaofcardia2、stomachandduodenumHistoryandsymptomsepigastricpainanorexianausea、vomitingbelch、acidregurgitationCommondiseaseacuteandchronicgastritis、pepticulcer、gastriccarcinoma、functionaldyspepsia3、intestineHistoryandsymptomsabdominalpaindiarrheamalnutritionCommondiseasechordapsus、intestinaltuberculosis、Crohndisease4、colonandrectumHistoryandsymptomsabdominalpaindiarrhea、constipationrectaltenesmusCommondiseaseDysentery、ulcerativecolitis、irritablebowelsyndrome、carcinomaoflargeintestine5、liverHistoryandsymptomscomplaintorpainofhepaticregionhepatauxetendernessofhepaticregionportalhypertensionjaundicehepaticencephalopathynutritiondysmetabolismCommondiseaseviralhepatitis、cirrhosis、primaryhepaticcarcinoma。6、billductHistoryandsymptomsabdominalpainjaundicemurphy’ssignCommondiseasecholelithiasis、cholecystitis、biliarytractroundworm、biliarytracttumor7、pancreas内科学aspirin/2006-2-Historyandsymptomsepigastricpainsecretiondisorderofpancreasexternalsecretion：Intestinalmalabsorptioninternalsecretion：metabolicdisorderCommondiseaseacute、chronicpancreatitispancreaticcarcinoma8、peritoneum、mesenteryHistoryandsymptomsabdominalpainabdominaltenderness、reboundtenderness、abdominalguarding（triad）ascitesCommondiseaseperitonitis,mesentericlymphadenitis,tuberculosis,metastaticcarcinomaofabdominalmembraneCommonsymptoms•anorexia•nausea•vomiting•acidregurgitation•belching•heart-burn•dysphagia•Abdominaldistention•diarrhea•abdominalpain•constipation•hematemesis•melena•hematocheziaPhysicalexaminationcommonsigns•abdominalshape•peristalticrushes•abdominalvaricesandthedirectionofbloodflow•abdominaltendernessandthelocation•reboundtenderness•abdominalguarding•shiftingdullness•Bowelsounds•abdominalmass•jaundice•hepatomegaly•splenomegalyLaboratorytests•stooltests•acidsecretiontest•hepaticfunctiontestsImagingprocedures•plainfilm•bariummealandbariumenema•ultrasonagraphy•computedtomography,CT•endoscopicretrogradecholangiopancreatogyaphy,ERCP•magneticresonanceimaging,MRIEndoscopy•gastroscopy•colonoscopy•laparoscopyothersbiopsymotionfunctionlaparotomyPreventionandTreatmentofdigestivediseasesProphylaxissystemictreatmentpsychologicaltreatmentcomprehensivemeasuremedicationsurgerytraditionalchinesemedicinegeneraltreatment⒈resting⒉noruishment(drinkandfood)⒊Supportivetreatmentpharmacotherapy⒈treatmentforcausesandpathogenesis⒉symptomatictreatmentsurgicalorinterventionaltreatmentindicationspointsforattentioncontraindicationssideeffectsAdvancesandForecast1.medicationofpepticulcer2.diagnoseandtreatmentofdigestivemalignancy3.managementofportalhypertension4.diagnoseandtreatmentofalimentarytracthe