????? Peptic ulcar

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????? Peptic ulcar ????Summary
?????? Duodenal ulcer,Du ???
Gastric ulcer,Gu
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??1 ?,24?,5???????3-4??????????,???????,?????,???
????,?????????????????????????4?????,??????,??????
????????,?????????????????,??(-),?????,??,?????,?
?????(),????,???3?/??
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????? Clinical manifestation (?)
???? Chronic phase (?)????? periodic onset
(?)????????Rhythmic pain inepigastrium 1.
????? Character of pain 2. ????? Site of
pain 3. ?????? Rhythmicity of pain
(?) ???? Other Symptoms (?)??Signs

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(?) ?????????? peptic ulcer of
special type 1. ???? postbulbar ulcer
2. ????? pyloric channel ulcer
3.????? penetrating ulcer 4. ????????
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????? Compl ication (?)???????
upper gastrointestinal hemorrhage
??????????? Mallory-Weiss Syndrome
(?) ?? perforation 1.????
Acute perforation- Diffuse peritonitis
2.???? Chronic perforation-penetratin
g ulcer 3. ????? Subacute
perforation-localized peritonstis
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(?)????pyloric obstruction
(?)??Canceration ?????????
Diagnosis and Differential Diagnosis
(?)??Diagnosis 1.????
2.X?????X-ray barium meal examination

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3. ???????? endoscope and biopsy
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4.????????detection of H.pyior
5.?????Occult blood in stool (?)????Differential
diagnosis 1.????cancerous ulcer

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2.????Gastrinoma ??????
Zollinger-Ellison Syndrome3.?????????4.???????F
unctional dyspepsia
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?????????Cause and mechanism
???? ??-???? Hp?? ?? ?? ????
???? ???? ??HCO3- ?? ???? ???? ???? ??????
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(?)??????lncrease of damage Cause. 1. H .
pylori????????????? 1)?????

?? Hp?? ???
???
???? 2)?????
??
?????? ??
Hp?? ?? ??????
????? ????? ??????

????

HCO3-

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2. ????????? Gastric acidpepsin
effect (1)pcM??
???
??H2??
?????
??????
??
???
????
????
??????
G??
??? (Hp???Du)
??
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(2) ???????? (3)???? 3.
???? (?)???????
Decrease of protective factors
1.?????????
Muci-mucosa barrier damage 2.??????
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????Treatment (?)????General
treatment (?)????pharmacotherapy
1.????????? Drug of
decrease damage cause
1)??Hpylori???
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??Hpylori?????

• ?????????
• 1.??????????0.5???0.4 2?/d2?
• 2.?????????0.5???0.4 2?/d2?
• 3.??????????0.25???0.4 2?/d2?
• ????????(PPI)?????
• 1.PPI????????0.5????1.0 2?/d1?
• 2.PPI????????1.0???0.4 2?/d1?
• 3. PPI????????0.25???0.4 2?/d1?
• ??????
• 1.????????(RBC)0.4?????????PPI
• 2.H2-RA?PPI?????,??????
• ?????
• 1.??????0.4g?????0.5g???
• 2. Hp??????????,??????????Hp??
• ?,Hp???????,??????0.1g??????
• 3.PPI???????????????????????

• ?????????
• 1.??????????0.5???0.4 2?/d2?
• 2.?????????0.5???0.4 2?/d2?
• 3.??????????0.25???0.4 2?/d2?
• ????????(PPI)?????
• 1.PPI????????0.5????1.0 2?/d1?
• 2.PPI????????1.0???0.4 2?/d1?
• 3. PPI????????0.25???0.4 2?/d1?
• ??????
• 1.????????(RBC)0.4?????????PPI
• 2.H2-RA?PPI?????,??????
• ?????

• ?????????
• 1.??????????0.5???0.4 2?/d2?
• 2.?????????0.5???0.4 2?/d2?
• 3.??????????0.25???0.4 2?/d2?
• ????????(PPI)?????
• 1.PPI????????0.5????1.0 2?/d1?
• 2.PPI????????1.0???0.4 2?/d1?
• 3. PPI????????0.25???0.4 2?/d1?
• ??????
• 1.????????(RBC)0.4?????????PPI
• 2.H2-RA?PPI?????,??????
• ?????

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2)????????????
??? HCl
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?????????????
?? ?? ? ? ???? ??? ? ?
? ? ? ? ? ? H2????? ????Cimetidine ????Ranitidine ????famotidine ????nicatidine ????Roxatidine ???????H2????,???????????? ????,ALT? CR?, ??,?? ???? ????, ??,?? ??,?? DU??4-6?,GU6-8?
? ? ? ? ? ? ?????? ????omeprazole (???Losec) ????Ransoprazole ????Pantoprazole ????rabeprazole 1.?????H/KATP?,???????????? 2.??H.pylori. DU4-6? GU6-8?-12?
? ? ? ? ??? ??????10-15ml tid dPC 10-15ml QN ???? ????,??????????? ?-?? ???-?? 6-8W
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2.?????????Drug of increase protective factors
? ? ???? ??? ??
??????? ?????De-nol CBS?? ??? 1.?????????????? 2.?????HCO3-?? 3.??PGE?? 4.???????????????? 5.??Hp ??, ?? lt8?,??GU,DU
??? Sucralfate lg Qid A.C. 1.???????????????? 2.??PGE?? 3.?????????? ?? ??GU,DU
????E ?????misoprostol 200µg,Qid ?????enprostil 35 µg,Bid 1.??????DNA?? 2.?????HCO3-?? 3.?????? 4.???????????CAMP,?????? ??, ??, ???? DU
???????S?? ???
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3.Pu????? (?)Pu?????Strategy of
pu (?)??????Treatment of complication
1.?????????Treatment of upper

gastroitestinal hemorrhage
2.???????Treatment of pyloric obstruction
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??2 ???,?,29?,??. ??????6?,???????,????????
3??,???????,??????????,??????,????????????????????
?,???,??,????????,??????,????????,???????,????,???
?,????5-6?,??????????????????,????,?????
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??Bp 110/70mmHg,??????,?????,?????,?????????,??94
?/?,??,???,?(-),????,????,???(),?????,?????,????(
-),??????
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??3 ?,60?,9????????1?????????,??,??,???,????????
,????10???,????(??)?????2?????,?????????,????,????
???,??,??,????6Kg,????,??30g,???,??????
?,???????,?????????
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??P80?/?,??????,???,?????,???,???????????,???,???
??,????,?????,?????,???5?/?,????(-)?
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??5 ?,32?,3???????? ?????,??????,??????,?????,?
???3????,?????X?????,?????????????,?????,??????,??
????,? ??????? ???????,??(),?????,???,??
???,????(-),??????(),????,?????(-),Murphys(-),??
?4?/?,????(-)?
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??6 ???,?,28?. ??????2?,?????
????????????????2????????????2???????????????,???
?????,????????????,??????,??????,????????????,????
,?????,??????,?????
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?????????. ??T 36.5?,P 120?/?,Bp
85/65mmHg,??,????,?????,???????????????,????,???,?
???????,???,???????,?????????????,???13?/?,???????
,?????,??????
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