《医药健康口腔粘膜溃疡类疾病课件》由会员分享，可在线阅读，更多相关《医药健康口腔粘膜溃疡类疾病课件（61页珍藏版）》请在金锄头文库上搜索。
1、NEXT,口腔粘膜溃疡类疾病 Oral Ulcerative diseases,BACK TO INDEX,Introduction,Behets disease,Traumatic Ulcer & Traumatic Bulla,Recurrent Aphthous Ulcer,Summary & Questions,BACK,Reiters Syndrome,I. Introduction,Ulcers are one of the most common types of lesions seen in oral mucosa.2. The difference between ulce
2、r and erosion.,NEXT,ulcer,erosion,NEXT,BACK,Comparison,Recurrent Aphthous Ulcer,1.Preface Namerecurrent aphthous ulcer RAUrecurrent aphthous stomatitis RASrecurrent oral ulcer ROU,NEXT, Typing Lehners classification minor aphthous ulcer （MiAU）major aphthous ulcer （MjAU）herpetiform ulcer （HU） Charact
3、eristicrecidivityself-healingperiodicity,NEXT,2. Etiology unknown immunity : cellular immunity, humoral immunity, complement, autoantibody heritage infection ：HSV environment: psychology,NEXT, denutrition ：iron, copper, zinc, folic acid, Vit B12 hyperoxide dismutase microcirculation disturbance ：lip
4、, nail, apex linguae systemic factor ：ulceration of stomach、hepatitis、colonitis、diarrhoea,NEXT,3. Clinical featuresminor aphthous ulcermajor aphthous ulcerherpetiform ulcer,NEXT,NEXT,Minor aphthous ulcers,NEXT,NEXT,NEXT,Major aphthous ulcers,NEXT,Periadenitis Mucosa Necrotica Recurrens,NEXT,Major ap
5、hthous ulcers,NEXT,3、饮食相关因素：肝癌的发生与生活习惯息息相关。长期进食霉变食物、含亚硝胺食物、微量元素硒缺乏也是促发肝癌的重要因素。黄曲霉毒B1是目前已被证明有明确致癌作用的物质，主要存在于霉变的粮食中，如玉米、花生、大米等。另外当摄食大量的含有亚硝酸盐的食物，亚硝酸盐在体内蓄积不能及时排出，可以在体内转变成亚硝胺类物质，亚硝酸盐含量较高的食物以烟熏或盐腌的肉制品为著，具有明确的致癌作用。同时肝癌的发生也与遗传因素、寄生虫感染等因素相关。1 临床表现 疾病症状肝癌的早期表现很不典型，往往容易被忽视。以下症状可供参考： 1、食欲明显减退：腹部闷胀，消化不良，有时出现恶心、
6、呕吐； 2、右上腹隐痛：肝区可有持续性或间歇性疼痛，有时可因体位变动而加重； 3、乏力、消瘦、不明原因的发热及水肿； 4、黄疸、腹水、皮肤瘙痒； 5、常常表现为鼻出血、皮下出血等。 肝癌的一些典型症状只有疾病进展到中晚期时才会发生，而那时往往已经丧失手术机会，因此平时的自我检查非常重要。当感觉疲惫乏力持续不能缓解时，很可能是肝病的预兆；心窝处沉闷感，或是腹部右上方感觉钝痛，有压迫感和不适感等，体重减轻，时有原因不明的发烧及出现黄疸，应尽早前往医院检查。1-2 诊断鉴别检查主要包括血清甲胎蛋白（AFP）和肝脏影像学检查。甲胎蛋白是目前常用的，也最简单实用。我国60%以上肝癌病例的血清AFP400
7、 g/L，95%的肝癌患者具有乙肝病毒（HBV）感染的背景，10%有丙肝病毒（HCV）感染背景，还有部分患者HBV和HCV重叠感染，因此如果在病毒性肝病基础上合并AFP 400 g/L应该高度怀疑肝癌可能，尽早完善影像学相关检查，做到早发现、早诊断、早治疗。 现代医学影像学手段也为肝癌的诊断提供了很大的帮助，为肝癌的定位、定性、定量、定期和制定治疗方案提供了可靠的依据。 1、最常用的是肝脏超声检查，超声检查为非侵入性检查，对人体组织无任何不良影响，其操作简单、直观准确、费用低廉、方便无创、广泛普及，可用于肝癌的普查和治疗后随访。 2、CT已经成为肝癌诊断的重要常规手段。腹部CT增强扫描可清楚地
8、显示肝癌的大小、数目、形态、部位、边界、肿瘤血供丰富程度，以及与肝内管道的关系，对于进一步明确诊断，与其他良性肝脏占位相鉴别，同时明确肝癌的分期分级，对于指导治疗及判断预后有重要意义。通过影像分析软件还可以对肝脏内各管道进行重建，可以精确到各肝段血管的走行，肿瘤与血管的关系，模拟手术切除平面，测算预切除肿瘤的体积和剩余肝体积，极大的提高手术安全性。 3、肝脏特异性MRI能够提高小肝癌检出率，同时对肝癌与肝脏局灶性增生结节、肝腺瘤等的鉴别有较大帮助，可以作为CT检查的重要补充。 4、PET（正电子发射计算机断层扫描）-CT全身扫描可以了解整体状况和评估肿瘤转移情况，更能全面判断肿瘤分期及预后，但
9、是价格较为昂贵，一般不作为首选检查。,医学健康系列精品课件,最好的专业文档，免费在线浏览，下载后可以修改编辑，欢迎下载收藏。,Herpetiform ulcers,NEXT,disease-process,24h,10d-14d,outbreak,NEXT,intermission,healing,prodromal stage,ulcerative stage,5. Diagnosis,historyclinical feature,NEXT,4. Pathology ：nonspecific inflammation,6. Differential diagnosis,benign ulc
10、er & malignant ulcer Necrotizing sialadenometaplasia, Behets disease, herpes simplex, hand-foot-and-mouth disease,NEXT,Comparison,NEXT,7. Treatment,principle：symptomatic treatment Evaluation of curative effect,NEXT,Topical application of a steroid ointment reduces discomfort and decreases the durati
11、on of the lesions. Topical anesthetics, antibiotics, mouthwashes, etc., have been used. In severe cases, intralesional steroid injection or systemic steroids in a low dose (10-20 mg prednisone) for 5-10 days reduce the pain dramatically.,BACK,III. Behets disease,1. PrefaceHulusi Behet (1937)Behets d
12、isease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis. 2. EtiologyUnknown,NEXT,3. Clinical features1) oral mucosa: minor aphthous ulcer2) genital lesion: ulcer3) skin lesions: erythema nodosum, epifolliculitis, pustule after needling4) ocular lesions: conjunctiviti
13、s, recurrent iritis 5) others systems: joint, digestive, cardiovascular, nervous, respiratory, urinary,NEXT,Behets disease,NEXT,4. Pathology ：Histopathologic changes consist of a perivascular mononuclear cellular infiltrate, endothelial cell swelling or necrosis, partial luminal obliteration and occ
14、asional fibrinoid necrosis of the vessels.,NEXT,5. Diagnosis1) recurrent oral ulceration2) recurrent genital ulceration3) eye lesions4) skin lesions 5) positive pathergy test To establish the diagnosis of Behets Disease, recurrent oral ulceration plus any two of the other four major clinical criteri
15、a must be present.,NEXT,6. Differential diagnosis,NEXT,RAU Herpetic atomatitis Crohns disease Reiters syndrome Stevens-Johnson syndrome,7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases.,BACK,IV.
16、 Traumatic Ulcer Traumatic Bulla,1. Preface,Because of the constant motion of the masticatory mucosa over the teeth and the introduction of hard objects into the oral cavity, traumatic ulcers are frequent.,NEXT,2. Etiology,Mechanical factors: a sharp or broken tooth, rough fillings, clumsy use of cutting dental instruments, hard foodstuffs, sharp foreign bodies, biting of the mucosa, and denture irritation etc. Physical factors: thermal burns Chemical factors: strong acid, strong base, As2O3, Ag(NO)3, iodophenol,
