Peptic Ulcer Disease
消化性溃疡病
上海第二医科大学仁济医学院
薛惠平
Question,What’s the meaning
of,Peptic Ulcer Disease”?
Definition
Peptic Ulcer Disease is defined as an
ulcer occurring in a region that touches
gastric acid(胃酸 ) and pepsin(胃蛋白酶 )
and usually refers to gastric ulcer(胃溃疡 )
or duodenal ulcer(十二指肠溃疡 ),
Typical endoscopic appearance of a benign gastric
ulcer,The ulcer is on the angularis,the most
common location for a gastric ulcer,and is well
circumscribed without any associated mass effect,
The surrounding mucosa is mildly erythematous红
斑的 and without nodularity结节,
Typical radiographic features of a benign
gastric ulcer,A large well-circumscribed
ulcer is seen on the angularis,
a posterior duodenal ulcer
Typical radiographic features of duodenal
ulcer,This duodenal bulb ulcer is associated
with marked edema,resulting in the
appearance of radiating folds to the ulcer
crater,The bulb is also distored secondary
to previously existing ulceration,
Questions,
What does ulcer 溃疡 mean?
How can we differentiate between ulcer
and erosion 糜烂?
Erosions in the duodenal bulb and
a posterior duodenal ulcer
Erosion糜烂, a superficial lesion caused
by denudation of the surface epithelium
（上皮细胞）
ulcer 溃疡, a mucosal defect extending
into the muscularis mucosa(粘膜肌层 )
Mucosa can be divided into,
Epithelium 上皮
Lamina propria 固有层
Muscularis mucosae 粘膜肌层
Clinical manifestations of
Peptic Ulcer Diseases
消化性溃疡病的临床表现
symptoms
症状
abdominal pain
腹痛
located in the epigastric(上腹 ) area;
burning in quality(烧灼样 );
occurred on an empty stomach 2 to 4 hours after
meals and/or at night (nocturnal pain夜间疼痛 );
relieved by antacids(抗酸剂 ) and/or meals(进餐 );
tend to wax and wane(加重与缓解 ) over months
,acid dyspepsia酸消化不良,
the majority of patients (approximately
70%) with epigastric distress
(“dyspepsia”) do not have evidence of
active ulcer disease;
conversely up to 40% of patients with
an active ulcer crater deny abdominal
pain;
patients can present with an ulcer-
related complication,particularly
hemorrhage,without antecedent
symptoms
despite being both insensitive
and non-specific,the symptom
of epigastric abdominal pain,
particularly burning after meals
and at night and relieved with
food or antacid,suggests the
possibility of ulcer disease,
Other symptoms
gastroesophageal reflux 胃食管反流
(including upright 直立位 and supine仰
卧位 reflux and non-cardiac chest pain
非心源性胸痛 );
symptoms of indigestion 消化不良
occurring with or shortly after eating
and characterized by epigastric fullness
and discomfort(上腹饱胀与不适 ),
belching(打嗝 ),bloating(胀气 ),
nausea(恶心 ),early satiety(早饱 ),and
specific food intolerances);
signs
体征
Physical examination is of limited value
in patients with uncomplicated ulcer,
For epigastric tenderness 压痛 on deep
palpation深部触诊,the sensitivity and
specificity are all approximately 50% or
less,
Furthermore,many patients with non-
ulcer diseases 非溃疡性消化不良 also have
epigastric tenderness on physical
examination,
In patients with free perforation穿孔 or
ulcer penetration穿透 into the
pancreas,findings of peritonitis腹膜炎
are usually present,
In patients with gastric retention 胃潴
留 who have been fasting禁食 for a few
hours,a succussion splash 振水声
(produced by auscultating 听诊 the
abdomen while rocking the patient
back and forth)
suggests retained gastric contents,
Complications
并发症
Hemorrhage 出血
the most common complication of ulcer
disease (in approximately 15% of patients)
Perforation穿孔 and Penetration
穿透
(in approximately 7% of patients )
Duodenal ulcers,perforate anteriorly
Gastric ulcers,perforate along the
anterior wall of the lesser curvature of
the stomach
Perforated peptic ulcer,Air is present
under the right hemidiaphragm in a
patient with acute severe abdominal
pain,
Penetration is similar pathologically to
perforation,except that the ulcer crater
壁龛 burrows打洞 through the entire
wall of the intestine,and instead of
leaking digestive contents into the
peritoneal cavity腹腔,the crater bores
钻孔 into an adjacent organ附近脏器,
Gastric ulcers most commonly
penetrate into the left lobe of the liver,
while duodenal ulcers penetrate
posteriorly into the adjacent pancreas胰
腺,sometimes leading to pancreatitis胰
腺炎, Rarely,gastric ulcers may
penetrate into the colon结肠,resulting
in a gastrocolic fistula胃结肠瘘,
Gastric outlet obstruction 梗阻 (gastric
retention or pyloric stenosis胃潴留或 幽门狭窄 )
functional impairment of antral motility 胃
窦动力功能不良 due to the effects of acute
inflammation and edema;
mechanical obstruction 机械性梗阻 due to
scarring near the gastroduodenal junction;
manifest as gastroesophageal reflux,early
satiety,weight loss,abdominal pain,and
vomiting;
As the degree of retention increases,the
quantity of vomitus呕吐物 also increases,
often containing food ingested 12 or more
hours previously,
Barium upper gastrointestinal study
demonstrates the size of the
stomach,
Endoscopy demonstrates the pyloric
obstruction with an active ulcer crater
seen in the pyloric channel,
Canceration癌变
(Gastric ulcer )
Questions for summary,
(1) What does Peptic Ulcer Disease refer
to?
(2) What are the symptoms and signs you
can find in the patients with peptic ulcer
disease?
(3) Which kind of complication most
frequently occur?
THANK YOU!
消化性溃疡病
上海第二医科大学仁济医学院
薛惠平
Question,What’s the meaning
of,Peptic Ulcer Disease”?
Definition
Peptic Ulcer Disease is defined as an
ulcer occurring in a region that touches
gastric acid(胃酸 ) and pepsin(胃蛋白酶 )
and usually refers to gastric ulcer(胃溃疡 )
or duodenal ulcer(十二指肠溃疡 ),
Typical endoscopic appearance of a benign gastric
ulcer,The ulcer is on the angularis,the most
common location for a gastric ulcer,and is well
circumscribed without any associated mass effect,
The surrounding mucosa is mildly erythematous红
斑的 and without nodularity结节,
Typical radiographic features of a benign
gastric ulcer,A large well-circumscribed
ulcer is seen on the angularis,
a posterior duodenal ulcer
Typical radiographic features of duodenal
ulcer,This duodenal bulb ulcer is associated
with marked edema,resulting in the
appearance of radiating folds to the ulcer
crater,The bulb is also distored secondary
to previously existing ulceration,
Questions,
What does ulcer 溃疡 mean?
How can we differentiate between ulcer
and erosion 糜烂?
Erosions in the duodenal bulb and
a posterior duodenal ulcer
Erosion糜烂, a superficial lesion caused
by denudation of the surface epithelium
（上皮细胞）
ulcer 溃疡, a mucosal defect extending
into the muscularis mucosa(粘膜肌层 )
Mucosa can be divided into,
Epithelium 上皮
Lamina propria 固有层
Muscularis mucosae 粘膜肌层
Clinical manifestations of
Peptic Ulcer Diseases
消化性溃疡病的临床表现
symptoms
症状
abdominal pain
腹痛
located in the epigastric(上腹 ) area;
burning in quality(烧灼样 );
occurred on an empty stomach 2 to 4 hours after
meals and/or at night (nocturnal pain夜间疼痛 );
relieved by antacids(抗酸剂 ) and/or meals(进餐 );
tend to wax and wane(加重与缓解 ) over months
,acid dyspepsia酸消化不良,
the majority of patients (approximately
70%) with epigastric distress
(“dyspepsia”) do not have evidence of
active ulcer disease;
conversely up to 40% of patients with
an active ulcer crater deny abdominal
pain;
patients can present with an ulcer-
related complication,particularly
hemorrhage,without antecedent
symptoms
despite being both insensitive
and non-specific,the symptom
of epigastric abdominal pain,
particularly burning after meals
and at night and relieved with
food or antacid,suggests the
possibility of ulcer disease,
Other symptoms
gastroesophageal reflux 胃食管反流
(including upright 直立位 and supine仰
卧位 reflux and non-cardiac chest pain
非心源性胸痛 );
symptoms of indigestion 消化不良
occurring with or shortly after eating
and characterized by epigastric fullness
and discomfort(上腹饱胀与不适 ),
belching(打嗝 ),bloating(胀气 ),
nausea(恶心 ),early satiety(早饱 ),and
specific food intolerances);
signs
体征
Physical examination is of limited value
in patients with uncomplicated ulcer,
For epigastric tenderness 压痛 on deep
palpation深部触诊,the sensitivity and
specificity are all approximately 50% or
less,
Furthermore,many patients with non-
ulcer diseases 非溃疡性消化不良 also have
epigastric tenderness on physical
examination,
In patients with free perforation穿孔 or
ulcer penetration穿透 into the
pancreas,findings of peritonitis腹膜炎
are usually present,
In patients with gastric retention 胃潴
留 who have been fasting禁食 for a few
hours,a succussion splash 振水声
(produced by auscultating 听诊 the
abdomen while rocking the patient
back and forth)
suggests retained gastric contents,
Complications
并发症
Hemorrhage 出血
the most common complication of ulcer
disease (in approximately 15% of patients)
Perforation穿孔 and Penetration
穿透
(in approximately 7% of patients )
Duodenal ulcers,perforate anteriorly
Gastric ulcers,perforate along the
anterior wall of the lesser curvature of
the stomach
Perforated peptic ulcer,Air is present
under the right hemidiaphragm in a
patient with acute severe abdominal
pain,
Penetration is similar pathologically to
perforation,except that the ulcer crater
壁龛 burrows打洞 through the entire
wall of the intestine,and instead of
leaking digestive contents into the
peritoneal cavity腹腔,the crater bores
钻孔 into an adjacent organ附近脏器,
Gastric ulcers most commonly
penetrate into the left lobe of the liver,
while duodenal ulcers penetrate
posteriorly into the adjacent pancreas胰
腺,sometimes leading to pancreatitis胰
腺炎, Rarely,gastric ulcers may
penetrate into the colon结肠,resulting
in a gastrocolic fistula胃结肠瘘,
Gastric outlet obstruction 梗阻 (gastric
retention or pyloric stenosis胃潴留或 幽门狭窄 )
functional impairment of antral motility 胃
窦动力功能不良 due to the effects of acute
inflammation and edema;
mechanical obstruction 机械性梗阻 due to
scarring near the gastroduodenal junction;
manifest as gastroesophageal reflux,early
satiety,weight loss,abdominal pain,and
vomiting;
As the degree of retention increases,the
quantity of vomitus呕吐物 also increases,
often containing food ingested 12 or more
hours previously,
Barium upper gastrointestinal study
demonstrates the size of the
stomach,
Endoscopy demonstrates the pyloric
obstruction with an active ulcer crater
seen in the pyloric channel,
Canceration癌变
(Gastric ulcer )
Questions for summary,
(1) What does Peptic Ulcer Disease refer
to?
(2) What are the symptoms and signs you
can find in the patients with peptic ulcer
disease?
(3) Which kind of complication most
frequently occur?
THANK YOU!
