Between the duodenum between the stomach and the jejunum, duodenum adult length of 20 ~~ 25cm diameter 4 ~~ 5cm, close to the abdominal wall, small intestine length of the shortest, largest diameter, location of the deepest and most fixed segment of small intestine. Pancreatic duct and common bile duct opening in the duodenum. It accepted the gastric juice, pancreatic juice and bile injected into the duodenum digestive function is very important.
compositionobserve the specimens of duodenum (duodenum) transverse slices (HE staining)
naked eye mucosa stained purple out followed by the submucosa, muscularis and adventitia. mucosa and submucosa to form a ring within the lumen protruding folds.
low magnification and high magnification observation of duodenal wall from the inside out in 4 layer
mucosa① epithelium: simple columnar epithelium, mainly composed of columnar cells with a small number of cups like cells and endocrine cells. the free surface of a thin layer of dyed red the linear
structure of striated edge.
② The lamina propria: connective tissue, containing a large number of intestinal glands, capillaries, lymphatic capillaries, nerves, smooth muscle cells and lymphoid tissue scattered small intestine glands simple tubular gland, the opening in the adjacent between the villi, the glandular epithelium of the villus epithelial cells constitute the intestinal epithelial intestinal gland at the bottom of the groups the distribution of Paneth cells,
easy to see on the specimen.
③ muscularis mucosa: section of the smooth muscle, muscle cells how to arrange the small intestine villi: the lamina propria and epithelial convex foliation to the intestine, free in the intestinal lumen lumps is the center of the villus cross-section compared with the intestinal gland, villous features of fluff in place the structure, visible lumen larger, central milk extravagant constituted by a single layer of endothelial tube, that is, the lymphatic capillaries. tube surrounded by scattered smooth muscle bundles
submucosaloose connective tissue containing larger blood vessels, lymphatic vessels and submucosal plexus. duodenal glands of the duodenum with mucinous glandular epithelial cells of conical or columnar, the cytoplasm dyed blue or empty reticular nucleus flat circular near the base, small acinar cavity, irregular ducts pass through the mucosal muscle opening between the bottom or adjacent villi of the intestinal gland. 3) muscularis: within ring, two layers of the outer longitudinal smooth muscle, each cross section of what section between the two layers of muscle, connective tissue, the possibility to find the myenteric plexus. adventitial
constitutes a thin layer of loose connective tissue and mesothelium of the serous membrane.
small intestine of small intestine from the pylorus, then under the cecum in adult total length of 5 ~ 7m, three sub-duodenum, jejunum and ileum.
duodenum duodenum between the stomach and the jejunum between the adult length of 20 ~ 25cm diameter 4 ~~ 5cm, close to the abdominal wall is the shortest length of the small intestine, the largest diameter, the location of the deepest and most fixed segment of the small intestine. Pancreatic duct and common bile duct opening in the duodenum. It accepted the gastric juice, pancreatic juice and bile injected into the duodenum digestive function is very important. The duodenal The shape of "C" shaped package system the head of the pancreas can be divided into the bulb, descending portion, the horizontal part and ascending portion of four.
bulb (upper)duodenal Ministry (superior part) of about 5cm from the pylorus of the stomach, to the right rear. Sharp to become the descending portion of the posterior and inferior to the gallbladder neck, the turning point of the duodenum on the song. Duodenal pyloric segment about 2.5cm section of the bowel wall is thinner, the mucosal surface than light
slip, there is no or little ring fold, said that this section duodenal bulb duodenal bulb, the predilection site of duodenal ulcer, duodenal ulcer, in clinical statistics, not into cancer.
descending portion of descending partdescending duodenum is the first two of the duodenum, about 7-8cm from the duodenum on the song along the right kidney the inside edge of the drop to the third lumbar level, bend the left side, turning Department to the duodenum, the next song. Descending portion of the left side of the head of the pancreas close to the mucous membrane of this part there are many bad like fold, subsequent medial wall of the common bile duct downstream along the outside, resulting in mucous membranes were slightly convex bulge to the vertical line in the intestine, called the duodenum longitudinal fold. Vertical fold the bottom of the hump The said duodenal large nipple, is the common opening of the common bile duct and pancreatic duct. Common bile duct and pancreatic duct in here to form the ampulla of the liver and pancreas. Large duodenal papilla near the pot valve, you can close the common bile duct or pancreatic duct, causing a corresponding disease. Big nipple slightly above, sometimes visible duodenum, small nipple, Vice duct openings.
horizontal part of the horizontal partduodenum horizontal part, also known as the lower part of about 10cm, the song from the duodenum under the start, left rampant to the first three lumbar the left side continued in the ascenders. The superior mesenteric artery and superior mesenteric vein close to the front of this part downstream. The superior mesenteric artery clamping part of the pancreatic tissue, known as the uncinate process. Here if the disease, symptoms of early mid-term is not obvious, the late obstructive jaundice, life-threatening. Superior mesenteric artery can oppress the horizontal part, caused by intestinal obstruction.
ascenders ascending partduodenum l Minister of about 2-3cm, Sharp downward and forward, up the left side of the third lumbar to reach the first two lumbar left side of the formation of the duodenum and jejunum song duodenojejunal flexure, and shift behavior jejunum. The duodenum, the duodenum and jejunum song hanging muscle attached to the diaphragm right foot. Even this muscle the upper part of the diaphragm feet striated muscle, attached to the lower part of the duodenum and jejunum song part smooth muscle and connective tissue intervention. Duodenum suspended muscle (also known as the Treitz ligament) is an important symbol of the surgery to determine the starting point of the jejunum.
TCM Foot anatomy(1) Location: duodenum in the right upper quadrant, is the initial part of the small intestine, the total length of about 25-30 cm, the pylorus of the stomach, the next the empty
intestine, was surrounded by C-shaped head of the pancreas.
(2) physiological functions: to digest and absorb nutrients.
(3) reflex zones location:
in the feet soles of the first metatarsal cuneiform joint front (direction) to toes, the rear of the pancreas reflex zones (to heel direction). Techniques: hand-held to a foot, a single index finger button boxing, massage three to four times from toe to heel direction. Indications: stomach and duodenum disorders such as bloating, indigestion, ulcer, loss of appetite, food poisoning.
duodenal ulcer is an extremely common disease, has long been clinically confirmed, but its etiology and pathogenesis has not yet been fully elucidated. A long time, gastric ulcer required conditions have been acceptable to us, "no acid no ulcer" theory, has been dominant in the pathogenesis of the ulcer. Since Helicobacter pylori (of Helicobacter pylori, Hp) isolated from human gastric mucosa, the dominant position of the gastric acid in the pathogenesis of duodenal ulcer disease is a challenge. Digestive disease specialists without Hp, there is no ulcer "argument. Clinical data and literature, to discuss our views.
"advocates without Hp, there is no ulcer" basis: Hp infection in duodenal ulcer disease detection rate as high as 95% to 100% and Hp eradication can prevent ulcer recurrence. Hp in the pathogenesis of duodenal ulcer, occupy a certain position, which is now generally accepted, but its importance in the end achieved what extent? Need to study and explore.
clinical data the h2> 1991 in 1995, our department in-patients, duodenal ulcer disease 88 cases of Hp infected with 82 cases (
92.1%), Hp infection, 6 cases (7.9%), duodenal ulcer disease at home and abroad reported Hp infection rate from 86.5% to 100% similar to such a high positive rates of Hp shows Hp indeed with duodenal the occurrence of ulcers have a certain relationship, however, the hospital since the end of 1991-7 to 1994-12, gastroscopy in our hospital because of upper abdominal symptoms, a total of 4,589 people, including Hp infection of 1,932 (42.1 %); Hp infection, only 348 (17.4%) patients suffering from duodenal ulcer, similar to Gu Boqi reported. This shows that most do not occur duodenal ulcer Hp infection does not close contact between the specific means of Hp exists, the necessary conditions for duodenal ulcer is not occurring. Abroad, one reported that 345 cases of the Hp settle without ulcer dyspepsia, in the three years of endoscopic and clinical follow-up, only two cases of duodenal ulcer. Our 86 cases of Hp settlers, in the same follow-up of 2 years, only 1 case of duodenal ulcer. This also shows that the the Hp settlers, the occurrence of duodenal ulcer incidence rate is lower than the expected value of the general population. duodenal adenocarcinomas of
Introduction1% of gastrointestinal cancer incidence of duodenal adenocarcinoma of the total of foreign literature, the low% of duodenal malignancy of 80%. Domestic reports of this disease accounted for 0.3% of digestive tract tumors, accounting for 25% to 45% of the small intestine malignancies accounted for about 65% of malignant tumors of the duodenum. Occurs in 50 to 70 years, men slightly more than the women of Central South University Xiangya Second Hospital medical records of the past 10 years found only 18 cases of duodenal adenocarcinoma, accounting for 70% of duodenal malignant tumors over the same period.
etiologyunclear the cause of duodenal adenocarcinoma of bile and pancreatic secretion of certain substances, such as lithocholic acid and other secondary bile acids may be carcinogenic role in promoting tumor formation from the original. Familial adenomatous polyposis, Gardner and Turcot syndrome, von Reeklinghausen syndrome, Lynch syndrome, benign epithelial tumors such as villous adenoma, and other diseases, may with duodenal adenocarcinoma was also reported duodenal ulcer or diverticulum malignant and genetic factors with duodenal adenocarcinoma has a certain relationship
pathogenesis1. Predilection sites of duodenal adenocarcinoma occurred in the descending part around the nipple, about 60%, followed by the ampulla under the bulbar rare.
(1) Gross morphology: duodenal adenocarcinoma gross morphology can be divided into polyps, ulcer type, ring ulcer type and diffuse infiltrative in which polypoid the most common accounting for 60% of the ulcer type, followed by
(2) organizational forms: Microscopically, the duodenal adenocarcinoma in the case of papillary adenocarcinoma, tubular adenocarcinoma, located in the vicinity of the duodenal polypoid papillary adenocarcinoma of the majority of other parts of the multi-tubular adenocarcinoma, was type of ulcer type or ring ulcer, ulcer lesions lateral expansion can lead to the duodenum ring the narrow
clinical performance1. Signs of obvious clinical symptoms and signs of early symptoms of general or only upper abdominal discomfort, pain, inability to anemia their symptoms and the course of the disease sooner or later and the tumor literature statistics now common symptoms, signs are as follows:
(1) pain: many similar ulcer disease manifested as epigastric discomfort or dull pain does not ease the pain after eating, sometimes pain can be to the back radiation
(2) anorexia, nausea and vomiting: non-specific symptoms such digestive tract in the duodenal adenocarcinoma incidence of 30% to 40%, such as vomiting, frequent vomiting the contents of more than most of the tumor gradually increased blockage intestine caused the duodenum partial or complete obstruction due to. Vomiting the contents containing bile can distinguish the site of obstructionanemia bleeding
(3): The most common symptoms of bleeding mainly to chronic blood loss, such as fecal occult blood, melena; massive blood loss may be vomiting
(4) jaundice: Department of the tumor blocking ampulla caused such tumors cause jaundice often fall off leaving jaundice due to tumor necrosis fluctuations, common in the fecal occult blood was positive after the jaundice lessens; another jaundice often accompanied by abdominal pain. 2:00 is different from pancreatic cancer is a common chronic progressive painless jaundice
(5) weight loss: such symptoms than common, but progressive weight loss often indicative of poor treatment
(6) Abdominal mass: tumor growth or tissue invasion, in some cases, palpable, and right upper quadrant mass
2. Clinical stages of domestic duodenal adenocarcinoma has not been detailed staging, staging and more along the argument developed by the U.S. Joint Committee on Cancer staging France
(1) clinical stage: The first stage Ⅰ tumor confined to the duodenal wall; the first stage Ⅱ tumors penetrate the duodenal wall; the first Phase Ⅲ tumors have regional lymph node metastasis; Stage Ⅳ tumors far at transfer
(2) TNM staging as follows:
T: primary tumor
To: no evidence of primary tumor
Tis,: carcinoma in situ.
T1: tumor invasion of the lamina propria or submucosa
T2: tumor violation of the myometrium.
T3: tumor perforation myometrial invasion serosal or through the peritoneal covering of the muscle Department (such as mesangial or retroperitoneal Office) and outside infiltration ≤ 2cm.
T4: tumor invasion of adjacent organs and structures, including the pancreas.
N: regional lymph nodes
N0: No regional lymph node metastasis.
N1: regional lymph node metastasis.
M: distant metastasis.
Mo: no distant metastasis.
ML: distant metastasis
discussionseen from the treatment of the majority of reports, either H2 blockers or proton pump blockers. four weeks of duodenal ulcer healing rate. 70.8% to 100%. However, reports of Hp clearance rate is inconsistent, ranitidine and Losec of Hp clearance rate of 3% to 88.23%, and even some reports that Losec is no effect of Hp, even if there is a role, but four weeks of ulcer healing rate compared with significant differences, not to mention the disease group Hp invalid. This suggests that the Hp on the occurrence of ulcers, is not a major risk factor for gastric acid plays a major role. In the present case no Hp caused by the direct evidence of duodenal ulcer disease, premature certainly Hp is the pathogen of the disease, and even draw the conclusions of the disease is a contagious disease, is questionable. Duodenal ulcer recurrence in the treatment of important issues, despite the recurrence involves many factors, but the Hp not eradicated, there are indeed a very important role in ulcer recurrence. Any single acid suppression therapy, the recurrence rate of ulcers 1a up to 85% eradication of Hp antimicrobial agents or bismuth, ulcer healing rate was not as antacids, ulcer recurrence rate is greatly reduced.
In summary, we believe that Hp in duodenal ulcer occurrence, risk factors, but not duodenal ulcer pathogens, the occurrence of ulcers, gastric acid than Hp is more important; but the recurrence of ulcers, Hp does have a very important role.
duodenal ulcerduodenal ulcer is a common disease of the digestive tract, generally considered to be due to the cerebral cortex is the outside negative stimulus, causing the blood vessels and muscles of the stomach and duodenal wall spasm, so that the cells of the gastrointestinal wall nutrition disorders and reduce the resistance of the gastrointestinal mucosa, resulting in the gastrointestinal mucosa is susceptible to gastric digestion and the formation of ulcers, the current was considered to be due to the gastric Campylobacter infection, ulcers often single personality, but there are a number of ulcers, stomach and duodenal ulcer, while there , said the complex ulcer.
ulcer disease and pain is the main symptom, the pain more than a cycle of attack, the onset of the season in the fall and spring, may be the weather is cold or improper diet, and after the meal induced gastric lesser curvature ulcer pain more than 0.5 of 1 hour, duodenal ulcer or pyloric ulcers, mainly in the postprandial 3 to 4 hours, sometimes in the middle of the night, but the location of the pain of the elderly often also a lack of time laws.
duodenal ulcer diseases easily confused
typical history of ulcers, the occurrence of hematemesis or tarry stools, diagnosis is generally not difficult. Accompanied by abdominal pain, the patient should consider whether associated with ulcer perforation, and no history of ulcers, the diagnosis of the bleeding site. Lesions and bleeding site is often more able to determine by barium meal examination, endoscopy and selective arteriography. Ulcer disease, bleeding, and a variety of gastrointestinal bleeding diseases, such as portal hypertension complicated by bleeding, acute biliary tract hemorrhage, gastric hemorrhage phase identification.
clinical symptoms: chronic ulcer history, recent may have aggravated; ulcer tenderness (+).
· special examination: X-ray barium meal or gastroscopy, can be found in ulcers.
and bleeding characteristics: multi-black-based mixed with gastric juice within small blood clots, vomiting blood, few, mostly small or the amount of bleeding.
portal hypertension, esophageal or gastric variceal bleeding
· clinical symptoms: schistosomiasis or a history of exposure, history of chronic hepatitis, hepatosplenomegaly, history; abdominal venous engorgement, spider skin, yellow sclera.
· special examination: whole blood, especially platelets and white blood cell count decreased, barium meal examination showed esophageal varices.
bleeding characteristics: multi-vomiting-based, often a large amount of fresh whole blood or blood clots, blood in the stool and more after the vomiting.
gastric cancer bleeding
· clinical symptoms: history of stomach, weight loss, anemia, stomach pain and more pain, or tingling, a small number of upper abdominal palpable mass.
special examinations: barium meal examination or gastroscopy, can be found in gastric cancer.
Hemorrhage: vomiting mostly dark brown or black and red gastric juice, and more for a small amount of bleeding.
· clinical symptoms: biliary tract infection, the biliary Guo worm history, chills, fever, periodic bleeding, bleeding may be associated with biliary colic. Or jaundice, followed by a cold sweat, palpitation, after melena mainly vomiting few, or no.
· special examination: The liver is often enlarged, the gallbladder may touch too, often right upper quadrant tenderness; B-mode ultrasound showed gallbladder enlargement; bleeding of duodenal endoscopy, may have positive findings.
Hemorrhage: of melena mainly vomiting also black blood or black blood clots more common and more able to self-only, the cyclical nature of a cycle of about 10 to 20 days.
imaging findings1. Kanying: Kanying for the diagnosis of 12-the fat ball direct signs of ulcers, more common in the bulbar partial base. Anteroposterior, Kanying were round or oval, and the pressure when surrounded by a neat circular translucent band called "halo sign". Tangential Kanying prominent papillary shadow ball inside wall contours.
2. "Irritation" sign: barium can not remain in the bulb, quickly emptying, known as "bowel sign.
3. Duodenal deformity: common signs of duodenal ulcer. Performance refers to the side of the ball-shaped notch, which is not constant, with peristalsis shallow, disappeared, ball shape mountain-shaped, petal-type and small spherical deformity.
4. False diverticula: their shape and size can be changed, is still visible mucosal folds into the diverticulum, while Kanying change in form.
5. Mucosal folds change; mucosal fold thickening, smooth or fuzzy, and can radiate gathered Kanying edge.
6. Often accompanied by gastric inflammation.
7. Ulcers after the ball: the ball after the ulcer is more common, sizes, and more at the the inside of the intestine, the lateral wall of the often spastic contraction or scar formation, stenosis, mostly eccentric. Where the descending duodenum upper spasm, should consider the possibility of ulcers after the ball.
TCM believes that the disease is not simply a local disease, but systemic disease, and liver is closely related to common clinical disharmony of liver, spleen and stomach, and license the virtual liver depression embolism type, the diet is a very major measures.
1. Gastroduodenal ulcer of the stomach, the duodenal mucosa (inner wall) rupture. the the duodenum image of
2. nervous, daily life, eating disorders, unsanitary food, as well as neurological dysfunction can lead to stomach, duodenum lowered immunity, coupled with stomach secretion gastric acid and digestive enzymes excessive erosion of the surface of the stomach, duodenum, causing ulcers. The pain of ulcers, the gastric mucosal surface ulceration caused by the stimulating effect.
3. Heavy smoking and gastric acid secretion of too many people are particularly susceptible to disease.
4. Typical of gastric and duodenal ulcers and more long-term, chronic, cyclical, rhythmic abdominal pain, and closely related to diet. Duodenal ulcer more than hunger, pain and pain at night, eating can be alleviated; pain, gastric ulcer, compared with eating. Site of gastric ulcer pain located in the epigastric the middle and left upper quadrant, duodenal ulcer is located in the right upper quadrant, when the ulcer is located in the posterior wall, can be manifested as back pain, upper gastrointestinal bleeding (hematemesis, melena), and gastric perforation of its merger syndrome.
5. The main symptoms of duodenal ulcer usually develop recurrent pain in the upper abdomen of a small central area. Sometimes when the ulcer in the duodenum wall, will feel the pain is coming from behind. Pain at bedtime and midnight now, called "night pain". Such like "hunger disease" as opposed to the typical duodenal ulcer pain after meals.
prevention and control points1. The meal should be the law, a few times, and avoid the rough, too cold, overheating and irritating diet such as spicy foods, strong tea, coffee and so on.
2. Quit alcohol limit.
3. Alleviate stress.
4. Necessary to use drugs to promote ulcer healing accelerated. Some drugs can reduce gastric acid secretion, some drugs will give ulcers before putting the protective film of a layer such as aluminum or protein; should be disabled can damage gastric mucosa of drugs such as aspirin, indomethacin, phenylbutazone.
stomach, duodenal ulcer is a common disease. Often due to mood swings, excessive fatigue,
eating disorders, smoking, alcoholism, induced by the adverse effects of certain drugs. Its typical manifestations
hunger, discomfort, fullness, belching, heartburn, or postprandial timing of chronic epigastric pain, Yan
weight when you have black stools and vomiting. Usually treated by medication, the symptoms ease or disappear. As
invalid, should be further X-ray barium meal and gastroscopy to exclude perforation, obstruction, or evil
the possibility of change.
prescription 1. Acute exacerbation of attention to rest, and rest, avoid stress and
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