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右上黏膜与左边的已腐蚀了黏膜层的溃疡融合。如果不治疗,随着时间的发展溃疡将继续破坏深部组织,导致疼痛。如果穿透肌层和外膜层,即发生溃疡穿孔,导致急腹症。腹部X线见穿孔所致的腹腔气体。

The mucosa at the upper right merges into the ulcer at the left which is eroding through the mucosa. Ulcers will penetrate over time if they do not heal. Penetration leads to pain. If the ulcer penetrates through the muscularis and through adventitia, then the ulcer is said to "perforate" and leads to an acute abdomen. An abdominal radiograph may demonstrate free air with a perforation.

右侧的溃疡正穿透肌层,接近一动脉。溃疡侵蚀动脉将导致另一个主要的并发症-出血,出血可威胁生命,而慢性失血将导致缺铁性贫血。

The ulcer at the right is penetrating through the muscularis and approaching an artery. Erosion of the ulcer into the artery will lead to another major complication of ulcers--hemorrhage. This hemorrhage can be life threatening. Chronic blood loss may lead to an iron deficiency anemia.

胃炎常伴有幽门螺旋杆菌的感染。在大多数急性胃炎病人的黏膜上皮可见小弯曲螺旋状杆菌。图为亚甲基兰染色见杆状菌。

Gastritis is often accompanied by infection with Helicobacter pylori. This small curved to spiral rod-shaped bacterium is found in the surface epithelial mucus of most patients with active gastritis. The rods are seen here with a methylene blue stain.

幽门螺旋杆菌与十二指肠溃疡密切相关,85%以上的十二指肠溃疡都有幽门螺杆菌感染。图示刚超过幽门部的十二指肠的急性溃疡。

The strongest association with Helicobacter pylori is with duodenal peptic ulceration--over 85% of duodenal ulcers. Seen here is a penetrating acute ulceration in the duodenum just beyond the pylorus.

见急性十二指肠溃疡的两张胃镜图。

An acute duodenal ulcer is seen in two views on upper endoscopy.

恶性贫血是胃炎的另一症状。慢性萎缩性胃炎与自身抗体作用有关。图示自身抗体-抗壁细胞抗体,胃黏膜的壁细胞可见亮绿色免疫荧光物质。

Another association with gastritis is pernicious anemia. Chronic atrophic gastritis is associated with autoantibodies that block or bind intrinsic factor. Another type of autoantibody demonstrated here is anti-parietal cell antibody. The bright green immunofluorescence is seen in the paritetal cells of the gastric mucosa.

胃肿瘤不常见,图示胃腺癌。在美国,大多数胃癌发现时已是晚期,此时肿瘤已经浸润和(或)转移。所有的胃溃疡和胃部肿块必须检,因为仅从外观上不可能判断良恶性。相反,实际上所有的十二指肠溃疡都是良性的。

Gastric neoplasia is not uncommon. Here is a gastric adenocarcinoma. In the U.S., most gastric cancers are discovered at a late stage when the neoplasm has invaded and/or metastasized. ALL gastric ulcers and ALL gastric masses must be biopsied, because it is not possible to tell from gross appearance alone which are benign and which are malignant. In contrast, virtually all duodenal peptic ulcers are benign.

图中央见胃溃疡,较浅和直径约2-4厘米,溃疡活检证明是恶性。图示胃癌切除标本。

Here is a gastric ulcer in the center of the picture. It is shallow and is about 2 to 4 cm in size. This ulcer on biopsy proved to be malignant, so the stomach was resected as shown here.

革囊胃,弥漫性浸润性胃腺癌使胃缩小呈“皮革样”外观,有广泛的黏膜浸润和明显胃壁变厚,预后较差。

This is an example of linitis plastica, a diffuse infiltrative gastric adenocarcinoma which gives the stomach a shrunken "leather bottle" appearance with extensive mucosal erosion and a markedly thickened gastric wall. This type of carcinoma has a very poor prognosis.

图示革囊胃胃镜图,有广泛的黏膜侵蚀。

The endoscopic view of this lesion is shown, with extensive mucosal erosion.


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