【正文】 Motility Urease induction of hypochlorhydria Adherence P Type ATPase(NH4+/H+exchange)B. Induce Tissue injury Lipopolysaccharide (LPS)Leukocyte recruitmemt and activating factors Cag A and Vac A proteins Heat shock protein⑶ Relationship of Hp and PU Leaking roof hypothesis 6 facts hypothesis Acid/pepsin Gastric metaplasia Duodenitis infected Gastrin bicarbonateacid and pepsin Acid is the basic factor of PU , it plays an key role in the development of PU. （no acid, no ulcer）⑴ Proof of a causal role for Acid① Acid output is higher in DU patients②Antiacid therapy could lead to the healing of PU③ The recurrence of PU increased with stop of antiacid therapy⑵ Mechanisms of acid hypersecretion5 / 24① Increased of parietal cell mass(PCM)；② Increased of sensitivity of parietal cell to stimulation；③ Impaired acid inhibitory mechanisms。查體：上腹劍突下輕壓痛，肝脾未觸及。 intrinsic factor antibody, IFA?autoimmune disease: acpaniment Hashimoto thyroiditis。1 / 24Disorders of Digestive SystemBasic structure of digestive system?Gastrointestinal tract?Histologic anization anatomy and physiology of STOMACHzonation of stomach? cardia? fundus? body? antrum?Receptor of parietal cell Acetylcholine?Receptors of hypersecretion Gastrin HistamineProstaglandins?Receptors of hyposecretion Somatostatin?Histologic anization of the GI tractepithelium mucosa lamina propria muscularis mucosaewall of the GI submucosa muscularis inner circular layer outer longitudinal layer serosa?Digestive glands?liver : plex function ?pancreas : endocrine:insulin two functions trypsin exocrine: amylopsin steapsin?biliary systemeLIVER Double blood supply Portal vein 75% Hepatic artery 25% lobules of liver fundamental unit of the liverOther associated ans?peritoneum?mesentery?omentumFunction of the Digestive System?Digestion?Absorption?Metabolism?Excretion?Endocrine?Digestion: digestion refers to the conversion of ingested food molecules into smaller capable of being absorbed into the blood and lymph. glucosecarbohydrate: frtdigestiv enzyme (lpsin) maltoseproteins:aino acidsdigestion (trysi)fat: faty cids(stepsin) glerolmovent ?Absorption: Absorption refers to the process of absorbable molecules entering the blood or lymph. active transportationabsorptive mechanisms simple diffusion facilitated diffusion endocytosislongchain fatty acid →lymphmonoglyceridesother nutrients ───→blood?Metabolism of liver biochemical processes absorbed nutrients are primarily managed toxins are detoxicated hormones are inactiveted ?Excretion:bilirubin, cholesterine and some drugs are excreted by the liver.?Endocrin:endocrine cells in the stomach, intestine, and pancreas. They can secret a lot of hormones. ?Till now, morn than twenty hormones have been found in the digestive system. ?The number of hormone produced by the digestive system is increasing. ?The hormones produced by GI tract not only modulate the activity of digestive system but also play an important role in the regulation of a lot of other physiological functions. ?In recent years, it is found that GI tract can produce a number of peptide hormones. ?This peptide hormones previously found to be produced by the brain. ?These peptides are named as`braingut peptides `Diagnostic measures?History and symptoms?Physical examination(sign)?Laboratorysymptoms and mon diseases?History:History taking can provide very important information. For some digestive diseases only by these means can be established accurate diagnoses . Acute gastritis Acute appendicitis esophagus History and symptoms chest pain dysphagia heart burn acid reflux Common disease esophagitis 、GERD 、esophageal carcinoma、achalasia of cardiastomach and duodenum History and symptoms epigastric pain anorexia nausea 、vomiting belch、acid regurgitation Common disease acute and chronic gastritis 、peptic ulcer、gastric carcinoma、functional dyspepsiaintestine History and symptoms abdominal pain diarrhea malnutrition Common disease chordapsus 、intestinal tuberculosis 、Crohn disease colon and rectum History and symptomsabdominal pain diarrhea、constipationrectal tenesmus Common disease Dysentery 、ulcerative colitis 、irritable bowel syndrome、carcinoma of large intestineliverHistory and symptoms plaint or pain of hepatic region hepatauxe tenderness of hepatic region portal hypertension jaundice hepatic encephalopathy nutrition dysmetabolism Common disease viral hepatitis、cirrhosis、primary hepatic carcinoma。 increase the secretion of gastric mucus.? Since endogenous PGs play an important role in the maintenance of the mucosal integrity, decrease of endogenous PGs can cause mucosal damage.?Stress may cause reduction of mucosal blood supply or damage of other defensive mechanisms. Some stress factors may also cause gastric acid oversecretion.?Bile salts and pancreatic enzymes depose mucus and break biological membrane. These mechanism can all result in mucosal injury and erosion.3 / 24Drugs,ethanol stresblod flow acid outptmucs