消化系统疾病(2014-12-4).pptVIP

* * five-year survival rate in early gastric cancer (90 to 95%) five-year survival rate in advanced gastric cancer (below 15%) * * * The larvae enter through the skin, migrate via the blood vessels, and mature in the lungs. From there they travel to the veins of the upper or lower intestine or bladder and reproduce. Some eggs pass out in the feces. Others are carried into the liver, where form hundreds of tiny ball-like granulomas that eventually impair the livers ability to function. It is believed that the flukes settle in blood vessels that have a particular human immune substance, tumor necrosis factor, that they require in order to reproduce. * CD: 40%---- small intestine alone; 30% ---- both small intestine and colon; 30% ---- colon alone * fistula formation to other loops of bowel, the urinary bladder, vagina, or perianal skin * * * nm=nanometer Complete Dane particle Electron dense core: 28 nm, containing HBcAg and HBeAg The coat and the 22 nm free particles contain HBsAg X-protein: causation of hepatic Ca following its integration into the host genome * * * * * * * * * 胆道炎 胆囊炎(cholecystitis) 胆管炎(cholecyitis) 胆道炎症及胆石症 病因 胆汁淤滞 细菌感染： 大肠杆菌、副大肠杆菌、葡萄球菌 病变 急性炎： 卡他：充血水肿、分泌亢进 化脓：坏死、溃疡、中性粒细胞 坏疽：穿孔 积脓 慢性炎 粘膜萎缩 纤维组织增生 慢性炎细胞浸润 Rokitansky-Aschoff 窦 : 腺体增生进入肌层 合并症 胆石症 穿孔,腹膜炎 癌变 胆石症 cholelithiasis 胆管结石 胆囊结石 Cholelithiasis 胆囊管 肝总管 胆总管 主胰管 原因及机理 胆汁理化性质改变：游离胆色素浓度增高，胆固醇过饱和 胆汁淤积 感染：坏死脱落细胞或寄生虫等可作为结石的核心 胆汁的某些成分(胆色素、胆固醇、粘液、钙)析出，凝集 Cholelithiasis Cholelithiasis 胰腺炎 pancreatitis 胰蛋白酶自身消化作用 病变 急性水肿性胰腺炎：3/4 胰腺肿大变硬 间质充血水肿 中性粒细胞浸润 Panccreatitis 急性出血性胰腺炎 肉眼：胰腺肿大、质硬、结构不清， 小灶状脂肪坏死灶 镜下：凝固性坏死 血管壁坏死 中性及单核细胞浸润 Panccreatitis 病因 十二指肠壶腹部阻塞： 胆石、狭窄、肿瘤、水肿、痉挛 胰液分泌亢进： 暴饮暴食 酗酒 Panccreatitis 发病机制 胰液外溢、胆汁返流 肠激酶 激活 胰蛋白酶原--胰蛋白酶--硬蛋白酶：溶解弹性组织 (无活性) (有活性) 脱氧胆酸 CM 磷脂酶A---磷脂酶A--甘油磷脂 (无活性) (有活性) | 转变 溶血卵磷脂：溶解脂蛋白 Panccreatitis 合并症和结局 休克：剧烈疼痛、出血、水电解质紊乱、中毒 急性腹膜炎 血(尿)淀粉酶、