消化系統(tǒng)臨床教學(xué)緒論課件

消化系統(tǒng)緒論

An

Overview

ofTheDigestiveSystem消化系統(tǒng)緒論

AnOverviewofTheDige學(xué)習(xí)目標(biāo)1001畫圖顯示消化系統(tǒng)的各器官及其毗鄰關(guān)系；1002列舉消化系統(tǒng)的主要功能；1003解釋為何消化道是體內(nèi)最大的內(nèi)分泌器官和最大的免疫器官；1004描述消化道血管和神經(jīng)支配的特點；解釋腸神經(jīng)系統(tǒng)以及腸-腦軸的概念與生理意義；1005列舉消化系統(tǒng)常見疾病的種類，討論消化系統(tǒng)疾病的臨床地位。學(xué)習(xí)目標(biāo)1001畫圖顯示消化系統(tǒng)的各器官及其毗鄰關(guān)系；OrgansthatconstitutethedigestivesystemOrgansthatmakeupthedigestivetract:MouthEsophagusStomachSmallIntestine(SI)

LargeIntestine(colon)RectumAnusOrgansthathelpwithdigestionbutarenotpartofthedigestivetract:TongueSalivaryglandsPancreasLiverGallbladder~15feet(4.6m)OrgansthatconstitutethedigDigestfoodstuffs;AbsorbnutrientmoleculesExcretenon-nutrientsEndocrineDefensePhysiologicalfunctionsofthedigestivesystemSurfaceareaSkin~1.8m2;GImucosae~400m2Digestfoodstuffs;PhysiologicaFoodingestionDigestfoodstuffs;AbsorbnutrientmoleculesExcretenon-nutrientsDefenseMainFunctionsMotilitySecretionDigestionAbsorptionImmunereactionsNeurohumoralresponsesMajorphysiologicalprocessesTheresponsestofoodingestionFoodingestionDigestfoodstuffNauseaandvomitinganddiarrheaarephysiologicalprotectiveresponsestotoxicandpathogenicchemicals/microorganisms,butformanycanbedevastatingexperiences.NauseaandvomitinganddiarrhSomeGIfactsNutrientsarebrokendownbythedigestivesystemandtransportedtoeverypartofthebodybythecirculatorysystem.Ittakesthemouth,esophagus,stomach,smallintestine,largeintestine,gallbladder,pancreasandliverjusttodigestaglassofmilk.Theaveragemalewilleatabout50tonsoffoodduringhislifetime.Withinthecolon,atypicalpersonharborsmorethan400distinctspeciesofbacteria(1~1.5kg,×1014);Afteryoueat,ittakesusuallybetween24and72hoursinhealthyadultsforthecompleteprocessofdigestiontooccur.Theliverperformsmorethan500functions.SomeGIfactsStructure&

Function

(grossanatomylevel)Structure&Function

(grossanPolysaccharidesdisaccharidesdisaccharidesmonosaccharidesLactaseSucraseMaltaseisomaltasepolypeptidesSmallPeptidechainsTripeptidesDipeptidesAminoacidsMonoglycerridesFreefattyacidsPolysaccharidesdisaccharidesmoStructure&Function

(microscopiclevel)Structure&Function

(microscoThesplanchniccirculationThreemajorarteriessupplyoxygen-richbloodtoabdominaldigestiveorgans;Inrest,~25%ofcardiacoutputflowthroughsplanchniccirculation;Portalveincarriesnutrient-richbloodtotheliver;Isareservoirthatcanbecompromisedeg,non-occlusiveischemicdiseaseofthegutThesplanchniccirculationThre消化系統(tǒng)臨床教學(xué)緒論課件InnervationTheextrinsicinnervationa.TheParasympatheticNb.TheSympatheticNInnervationTheextrinsicinner2)Theintrinsicinnervation

AlsocalledtheEntericNervousSystem(ENS),consistingthesubmucosalplexus(粘膜下神經(jīng)叢)&themyentericplexus(肌間神經(jīng)叢),isacomplexneuronalnetworkofsensory(afferent)neurons,interneurons&motor(efferent)neurons.2)Theintrinsicinnervation3)Dualafferent(sensory)innervationVagal:lowthreshold;Spinal:widedynamicrange&highthresholdInteroceptors(內(nèi)感受器)Gutfeeling3)Dualafferent(sensory)innEntero-endocrinefunctions

(guthormones)StomachGastrin,Somatostatin,histamine,GhrelinDuodenumorjejunumSecretin,Cholecystokinin(CCK),Motilin,Somatostatin,Gastricinhibitorypeptide,serotoninPancreaticisletsInsulin,Glucagon,Pancreaticpolypeptide,SomatostatinIleumorcolonEnteroglucagon,PeptideYY,Neurotensin,Somatostatin,serotonin(5-HT)Entero-endocrinefunctions

(gWalkerAK,RiveraPD,WangQ,ChuangJC,TranS,Osborne-LawrenceS,EstillSJ,StarwaltR,HuntingtonP,MorlockL,NaidooJ,WilliamsNS,ReadyJM,EischAJ,PieperAA,ZigmanJM.TheP7C3classofneuroprotectivecompoundsexertsantidepressantefficacyinmicebyincreasinghippocampalneurogenesis.MolPsychiatry.2014Apr22.doi:10.1038/mp.2014.34.Grhelin(胃饑餓素)具有抗抑郁作用WalkerAK,RiveraPD,WangQ,Intestinalflora,pathogens&mucosalimmunityGITharbors500~1000speciesofmicrobes;GITislinedbyathinlayerofepithelium;GITisthe1stlineofdefenseandthelargestimmuneorganofthebody.Intestinalflora,pathogens&Immunity.2014Sep18;41(3):478-92.Immunity.2014Sep18;41(3):47Clostridiumdifficile艱難梭狀芽胞桿菌Clostridiumdifficile艱難梭狀芽胞桿菌消化系統(tǒng)臨床教學(xué)緒論課件22

Sensoryinput

VagalSpinal

Guthormones

5-HTLeptinCCKGLP-1………..ImmunemodulationMicrobialproducts

AutonomicNervousSys.

Sympatheticn.Parasympatheticn.Entericnervouss.

HPAaxisDescendingfacilitationorinhibitionofGIsensationRegulategutimmunityRegulatebloodflowBottom-upsignalsComponentsoftheGut-BrainAxisTopdownsignals22SensoryinputAutonomicNerThedigestivesystem,whichdigestsfoodstuffandabsorbnutrients,alsoconstitutethelargestendocrineorgan&thelargestimmuneorganinthebody.TheGItractisequippedwithanautonomousnervoussystem,ie,theentericnervoussystem,whichplaysmajorroleinGIfunction.Digestionandabsorptionisanorderlyprocesscarriedoutbythegastrointestinaltractwhichisregulated(coordinated)byneuralandhormonal(neurohumoral)factors.Thedigestivesystem,whichThingscan&oftengowrong…..Diseasesofthedigestivesystemaccountformorehospitaladmissionsthananyothercategoryofdiseases(USA,howaboutinChina?);Mostofushavehadatleastanepisodicexperiencewiththeunpleasantness,seriousinconvenienceanddiscomfortofaGIdisorder;GIdysfunctionisoftenassociatedwithgreatemotionaldistressanddisability;ManyGIdiseasescanbeextremelysevere&lethal.Ourunderstanding,diagnosis&managementofGIdiseasesiseverevolving.Thingscan&oftengowrong…..DiseasesoftheDigestiveSystemDiseasesoftheGastrointestinalTract—FunctionalGastrointestinalTractDiseases(FGIDs)

Functionaldyspepsia(FD)，Irritablebowelsyndrome(IBS),Gastroesophagealrefluxdisease(GERD),non-cardiacchestpain,etcInfection&Inflammationgastritis,enteritis,Crohn’sdisease(CD),ulcerativecolitis(UC),etcUlcerTumorsesophagealcarcinoma,gastriccarcinoma,colorectalcarcinomaDiseasesofthedigestiveglandsInflammationHepatitisPancreatitisCirrhosisLivercirrhosis(肝硬化)TumorsHepatocellularcarcinoma,cholangiocarcinomaPancreaticCarcinomaDiseasesoftheDigestiveSystcarcinomaSalmonellacolitis.

carcinomaSalmonellacolitis.Generalcourseobjectives

在掌握消化系統(tǒng)正常結(jié)構(gòu)與功能的基礎(chǔ)上，理解和掌握消化道癥狀和疾病的病理表現(xiàn)和病理生理機(jī)制、診斷學(xué)方法、處理原則和藥物作用原理?！癥ouarewhatyoueat!”Generalcourseobjectives“You2,080Pages3173pagesAnatomy,Histology&embryology,Physiology,Biochemistry,Pathology,Pathophysiology,Pharmacology,Diagnosis&Management312pages2,080Pages3173pagesAnatomy,Canweachievethecourseobjectives&yourexpectations:missionimpossible?

Thecoreprinciples(核心原理)1.消化系統(tǒng)各部分的正常組織結(jié)構(gòu)與功能的關(guān)系；

2.消化、吸收和排泄的基本生理過程、機(jī)制及神經(jīng)體液調(diào)控原理；

3.消化道常見疾?。ㄑ装Y性和功能性疾病及腫瘤等）的癥狀與體征、發(fā)生機(jī)制、病理表現(xiàn)與病理生理過程、診斷學(xué)方法以及臨床處理原則；

4.肝功能檢查的原理、基本方法以及肝臟疾病時肝臟生化指標(biāo)的改變；

5.治療消化道常見疾病（消化性潰瘍、腹痛、腹瀉與便秘及腫瘤）藥物的作用原理以及藥物對胃腸道的副作用CanweachievethecourseobjeHowcanweachievethecourseobjectives&yourexpectations?Weasteachers

-Helpyoutolearn!lectures(37hrs)——Thecoreprinciplesnavigation(Demo&PBL)-Evaluation——means,notpurposeYouasstudents-Areresponsibleforthelearningprocess!Activelearning:reflection(thinking),question&research(internet,textbooks,etc)Meaningfullearning:linkwhatyoulearntophysiological&clinicalscenariosHowcanweachievethecourseKeymessagesThedigestivesystemisanimportantsystembothinhealthandinclinicalsettings;PhysiologicalfunctionsarecarriedoutinGIsysteminorderlymannersregulatedbyneurohumoralandimmunefactors;Whenthingsgowrong(whichisverycommon),manifestationscanbelocalorsystematic&oftendevastating;Theobjectivesofthiscourseareforyoutolearnthe“coreprinciples”orthefoundationsofclinicalgastroenterologythroughactiveandmeaningfullearning.KeymessagesThedigestivesystRecommendedreadingRecommendedreading消化系統(tǒng)緒論

An

Overview

ofTheDigestiveSystem消化系統(tǒng)緒論

AnOverviewofTheDige學(xué)習(xí)目標(biāo)1001畫圖顯示消化系統(tǒng)的各器官及其毗鄰關(guān)系；1002列舉消化系統(tǒng)的主要功能；1003解釋為何消化道是體內(nèi)最大的內(nèi)分泌器官和最大的免疫器官；1004描述消化道血管和神經(jīng)支配的特點；解釋腸神經(jīng)系統(tǒng)以及腸-腦軸的概念與生理意義；1005列舉消化系統(tǒng)常見疾病的種類，討論消化系統(tǒng)疾病的臨床地位。學(xué)習(xí)目標(biāo)1001畫圖顯示消化系統(tǒng)的各器官及其毗鄰關(guān)系；OrgansthatconstitutethedigestivesystemOrgansthatmakeupthedigestivetract:MouthEsophagusStomachSmallIntestine(SI)

LargeIntestine(colon)RectumAnusOrgansthathelpwithdigestionbutarenotpartofthedigestivetract:TongueSalivaryglandsPancreasLiverGallbladder~15feet(4.6m)OrgansthatconstitutethedigDigestfoodstuffs;AbsorbnutrientmoleculesExcretenon-nutrientsEndocrineDefensePhysiologicalfunctionsofthedigestivesystemSurfaceareaSkin~1.8m2;GImucosae~400m2Digestfoodstuffs;PhysiologicaFoodingestionDigestfoodstuffs;AbsorbnutrientmoleculesExcretenon-nutrientsDefenseMainFunctionsMotilitySecretionDigestionAbsorptionImmunereactionsNeurohumoralresponsesMajorphysiologicalprocessesTheresponsestofoodingestionFoodingestionDigestfoodstuffNauseaandvomitinganddiarrheaarephysiologicalprotectiveresponsestotoxicandpathogenicchemicals/microorganisms,butformanycanbedevastatingexperiences.NauseaandvomitinganddiarrhSomeGIfactsNutrientsarebrokendownbythedigestivesystemandtransportedtoeverypartofthebodybythecirculatorysystem.Ittakesthemouth,esophagus,stomach,smallintestine,largeintestine,gallbladder,pancreasandliverjusttodigestaglassofmilk.Theaveragemalewilleatabout50tonsoffoodduringhislifetime.Withinthecolon,atypicalpersonharborsmorethan400distinctspeciesofbacteria(1~1.5kg,×1014);Afteryoueat,ittakesusuallybetween24and72hoursinhealthyadultsforthecompleteprocessofdigestiontooccur.Theliverperformsmorethan500functions.SomeGIfactsStructure&

Function

(grossanatomylevel)Structure&Function

(grossanPolysaccharidesdisaccharidesdisaccharidesmonosaccharidesLactaseSucraseMaltaseisomaltasepolypeptidesSmallPeptidechainsTripeptidesDipeptidesAminoacidsMonoglycerridesFreefattyacidsPolysaccharidesdisaccharidesmoStructure&Function

(microscopiclevel)Structure&Function

(microscoThesplanchniccirculationThreemajorarteriessupplyoxygen-richbloodtoabdominaldigestiveorgans;Inrest,~25%ofcardiacoutputflowthroughsplanchniccirculation;Portalveincarriesnutrient-richbloodtotheliver;Isareservoirthatcanbecompromisedeg,non-occlusiveischemicdiseaseofthegutThesplanchniccirculationThre消化系統(tǒng)臨床教學(xué)緒論課件InnervationTheextrinsicinnervationa.TheParasympatheticNb.TheSympatheticNInnervationTheextrinsicinner2)Theintrinsicinnervation

AlsocalledtheEntericNervousSystem(ENS),consistingthesubmucosalplexus(粘膜下神經(jīng)叢)&themyentericplexus(肌間神經(jīng)叢),isacomplexneuronalnetworkofsensory(afferent)neurons,interneurons&motor(efferent)neurons.2)Theintrinsicinnervation3)Dualafferent(sensory)innervationVagal:lowthreshold;Spinal:widedynamicrange&highthresholdInteroceptors(內(nèi)感受器)Gutfeeling3)Dualafferent(sensory)innEntero-endocrinefunctions

(guthormones)StomachGastrin,Somatostatin,histamine,GhrelinDuodenumorjejunumSecretin,Cholecystokinin(CCK),Motilin,Somatostatin,Gastricinhibitorypeptide,serotoninPancreaticisletsInsulin,Glucagon,Pancreaticpolypeptide,SomatostatinIleumorcolonEnteroglucagon,PeptideYY,Neurotensin,Somatostatin,serotonin(5-HT)Entero-endocrinefunctions

(gWalkerAK,RiveraPD,WangQ,ChuangJC,TranS,Osborne-LawrenceS,EstillSJ,StarwaltR,HuntingtonP,MorlockL,NaidooJ,WilliamsNS,ReadyJM,EischAJ,PieperAA,ZigmanJM.TheP7C3classofneuroprotectivecompoundsexertsantidepressantefficacyinmicebyincreasinghippocampalneurogenesis.MolPsychiatry.2014Apr22.doi:10.1038/mp.2014.34.Grhelin(胃饑餓素)具有抗抑郁作用WalkerAK,RiveraPD,WangQ,Intestinalflora,pathogens&mucosalimmunityGITharbors500~1000speciesofmicrobes;GITislinedbyathinlayerofepithelium;GITisthe1stlineofdefenseandthelargestimmuneorganofthebody.Intestinalflora,pathogens&Immunity.2014Sep18;41(3):478-92.Immunity.2014Sep18;41(3):47Clostridiumdifficile艱難梭狀芽胞桿菌Clostridiumdifficile艱難梭狀芽胞桿菌消化系統(tǒng)臨床教學(xué)緒論課件54

Sensoryinput

VagalSpinal

Guthormones

5-HTLeptinCCKGLP-1………..ImmunemodulationMicrobialproducts

AutonomicNervousSys.

Sympatheticn.Parasympatheticn.Entericnervouss.

HPAaxisDescendingfacilitationorinhibitionofGIsensationRegulategutimmunityRegulatebloodflowBottom-upsignalsComponentsoftheGut-BrainAxisTopdownsignals22SensoryinputAutonomicNerThedigestivesystem,whichdigestsfoodstuffandabsorbnutrients,alsoconstitutethelargestendocrineorgan&thelargestimmuneorganinthebody.TheGItractisequippedwithanautonomousnervoussystem,ie,theentericnervoussystem,whichplaysmajorroleinGIfunction.Digestionandabsorptionisanorderlyprocesscarriedoutbythegastrointestinaltractwhichisregulated(coordinated)byneuralandhormonal(neurohumoral)factors.Thedigestivesystem,whichThingscan&oftengowrong…..Diseasesofthedigestivesystemaccountformorehospitaladmissionsthananyothercategoryofdiseases(USA,howaboutinChina?);Mostofushavehadatleastanepisodicexperiencewiththeunpleasantness,seriousinconvenienceanddiscomfortofaGIdisorder;GIdysfunctionisoftenassociatedwithgreatemotionaldistressanddisability;ManyGIdiseasescanbeextremelysevere&lethal.Ourunderstanding,diagnosis&managementofGIdiseasesiseverevolving.Thingscan&oftengowrong…..DiseasesoftheDigestiveSystemDiseasesoftheGastrointestinalTract—FunctionalGastrointestinalTractDiseases(FGIDs)

Functionaldyspepsia(FD)，Irritablebowelsyndrome(IBS),Gastroesophagealrefluxdisease(GERD),non-cardiacchestpain,etcInfection&Inflammationgastritis,enteritis,Crohn’sdisease(CD),ulcerativecolitis(UC),etcUlcerTumorsesophagealcarcinoma,gastriccarcinoma,colorectalcarcinomaDiseasesofthedigestiveglandsInflammationHepatitisPancreatitisCirrhosisLivercirrhosis(肝硬化)TumorsHepatocellularcarcinoma,cholangiocarcinomaPancreaticCarcinomaDiseasesoftheDigestiveSystcarcinomaSalmonellacolitis.

carcinomaSalmonellacolitis.Generalcourseobjectives

在掌握消化系統(tǒng)正常結(jié)構(gòu)與功能的基礎(chǔ)上，理解和掌握消化道癥狀和疾病的病理表現(xiàn)和病理生理機(jī)制、診斷學(xué)方法、處理原則和藥物作用原