【2011苗圃执考笔记】消化系统第四讲（The 4th lecture of the digestive system）.doc

【2011苗圃执考笔记】消化系统第四讲（The 4th lecture of the digestive system） Practice physician exam BBS Peptic ulcer (below) Vii. Diagnosis and differential diagnosis. Chronic pathogenesis, recurrent episodes and rhythmic pain are important clues to diagnosing peptic ulcers. The diagnosis relies on gastroscopy. Identification of benign ulcer and malignant ulcer: A benign ulcerative ulcer Middle age is more likely to be middle-aged or older The history is shorter The clinical manifestations of the abdominal pain are obvious, and there is no upper abdominal mass, and the whole body shows light, and the acid medicine can relieve the pain, and the internal medicine treatment is good. Progressive development, can have upper abdominal package block, systemic expression (such as emaciation) obvious, make acid general effect is poor, internal medicine treatment is ineffective or only temporarily effective. Fecal occult blood can temporarily positive positive Gastric juice analysis was normal or low, but there were not many acid deficient X line barium meal check the diameter of the shadow of the shadow 25mm and the wall is smooth. Located outside the contour of the stomach cavity, the surrounding stomach wall is soft and can be shaped by a star. The shadow is often 25mm. The edge is not whole, located in the contour of the stomach cavity. The surrounding area of the shadow has a nodular wall, which is a nodular pattern, where the folds of the ulcer are fused Endoscopic examination of ulcer rounded or oval-shaped, smooth, smooth, white or gray, with soft mucous membranes around ulcers, and visible corrugated wall toward ulcer concentration. Ulcer shape is irregular, the bottom concave and convex, the marginal nodules rise, the defilement mossy, the area of the ulcer because the cancer sex infiltrates thickening, rigid, the texture is crispy, have nodules, erosion, easy bleed. Other points to note: The gastric and duodenal complex ulcer, which means the stomach ulcer and the duodenal ulce