消化性溃疡英文病历Word下载.docx

消化性溃疡英文病历Word下载.docx

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foods.Hispastmedicaihistoryandreviewofsystemswereotherwiseunremarkable,andotherthantheantacids,hetakesnomedications.Hisphysicalexamwasnormal,includingstoolguaiacthatwasnegativeforoccultblood.YouadvisedachangeindietandstartedhimonanH:

-bloeker.Hissymptomsresolvedcompletelywiththedietchangesanddailyuseofthemedication.Labtestsdoneathisfirstvisitshowsnoanemia,buthisserumHelicobacterpyloriantibodytestwaspositive.

+Whatisyourdiagnosis?

+Whatisyourneststep?

ANSWERS:

PepticUlcerDisease

Summary:

A37-year-oidmanpresentscomplainingofchronicandrecurrentupperabdominalpainwithcharacteristicssuggestiveofduodenalulcer:

thepainisburninginquality,occurswhenthestomachisempty,andisrelievedwithinminutesbyfoodorantacids.Hedoesnothaveevidenceofgastrointestinalbleedingoranemia.Hedoesnottakenonsteroida!

antiinflammatorydrugs,whichmightcauseulcerformation,buthedoeshaveserologicalevidenceofH.pyloriinfection.

♦Mostlikelydiagnosis:

Pepticulcerdisease.

♦Nextstep;

AntibiotictherapyforKpyloriinfection.

Analysis

Objectives

1.Knowhowtodifferentiatecommoncausesofabdominalpainbyhis

toricalclues.

2.Recognizeclinicalfeaturesofduodenalulcer,gastriculcer,andfea

turesthatincreaseconcernforgastriccancer.

3.UnderstandtheroleofHelicobacterpyloriinfectionanduseof

NSAIDsintheetiologyofpepticulcerdisease.

4.UnderstandtheuseandinterpretationoftestsforH.pylori.

Considerations

Inthispatient,thesymptomsaresuggestiveofduodenalulcer.Hedoesnothave"

alarmsymptoms"

suchasweightloss,bleedingoranemia,andhisyoungageandchronicityofsymptomsmakesgastricmalignancyanunlikelycauseforhissymptoms.H.pyloricommonlyisassociatedwithpepticulcerdiseaseandrequirestreatmentforcureoftheulcerandpreventionofrecurrence.Thispatient'

ssymptomsarealsoconsistentwiththatofnonulcerdyspepsia.

APPROACHTOPEPTICULCERDISEASE

Definitions

Dyspepsia:

Painordiscomfortcenteredintheupperabdomen（mainlyinoraroundthemidline）,whichcanbeassociatedwithfullness,earlysatiety,bloating,ornausea.Dyspepsiacanbeintermittentorcontinuous,andmayormaynotberelatedtomeals.

Functional（nonukerdyspepsia）:

Symptomsasdescribedabove,persistingatleast12weeks,butwithoutevidenceofulceronendoscopy.

Helicobacterpylori:

AGram-negativemicroaerophilicbacillusthatresideswithinthemucuslayerofthegastricmucosa,andcausespersistentgastricinfectionandchronicinflammation.Itproducesaureaseenzyme,whichsplitsurea,raisinglocalpHandallowingittosurviveintheacidicenvironment.

Pepticulcerdisease（PUD）:

Thepresenceofgastricorduodenalulcersasdemonstratedbyendoscopyorbyuppergastrointestinalbariumstudy.

ClinicalApproach

Upperabdominalpainisoneofthemostcommoncomplaintsencounteredinprimarycarepractice.Manypatientshavebenignfunctionaldisorders（i.e.,nospecificpathologycanbeidentifiedafterdiagnostictesting）,butothershavepotentiallymoreseriousconditionssuchaspepticulcerdiseaseorgastriccancer.Historicalclues,knowledgeoftheepidemiologyofdiseases,andsomesimplelaboratoryassessmentscanhelptoseparatebenignfromseriouscausesofpain.However,endoscopyisoftennecessarytoconfirmthediagnosis.

Dyspepsiareferstoupperabdominalpainordiscomfortthatcanbecausedbypepticulcerdisease,butcanalsobeproducedbyanumberofothergastrointestinaldisorders.Gastroesophagealrefluxtypicallyproduces"

heartburn,"

orburningepigastricormid-chestpain,usuallyaftermealsandworsewithrecumbency.Biliarycoliccausedbygallstonestypicallyhasanacuteonsetofseverepainlocatedintherightupperquadrantorepigastrium,isusuallyprecipitatedbymeals,especiallyfattyfoods,lasts30-60minuteswithspontaneousresolution,andismorecommoninwomen.Irritablebowelsyndromeisadiagnosisofexclusion,butissuggestedbychronicdysmon'

litysymptoms,thatis,bloating,crampingthatisoftenrelievedwithdefecation,withoutweightlossorbleeding.Ifoneexcludesthesecausesbyhistoryorotherin