Endocrine-System內(nèi)分泌系統(tǒng)Diabetes糖尿病英文課件

EndocrineSystemEndocrineSystem1Whatisglands?

HormoneEndocrinecells

Duct

SweatglandExocrineglandsreleasetheirsecretionsintoaductthatcarriesthemtotheoutsidethebodyReleasetheirhormonesdirectlyintothebloodsream

EndocrineglandsWhatisglands?Ho2

EndocrineGlandsEndocrineGlands3ThyroidGland?Thyroidhormones(甲狀腺激素)–Regulatingmetabolism（調(diào)節(jié)代謝）Disordersofthyroidgland–Hyperthyroidism甲亢–Hypothyroidism甲減–Cretinism呆小癥ThyroidGland?Thyroidhormones4AdrenalGlandAdrenalgland

腎上腺–sittingatop頂上thekidneys–Secretingcatecholamines兒茶酚胺,mineralocorticoids鹽皮質(zhì)激素,glucocorticoids糖皮質(zhì)激素andsexhormonesAdrenalGlandAdrenalgland腎上5ParathyroidHormone（PTH）?Parathyroidhormones甲狀旁腺激素?Calciumbalance鈣平衡ParathyroidHormone（PTH）?Parat6Pancreas?Pancreas胰腺–Exocrinegland?secretingdigestivejuice分泌消化液–Endocrinegland?releasinghormones釋放激素–insulin胰島素?localizedintheislet胰島cellsPancreas?Pancreas胰腺7

TheRootandWordBuildingTheRootandWordBu8Endocrine-System內(nèi)分泌系統(tǒng)Diabetes糖尿病英文課件9Theendocrinesystemisoneofthemostimportantaccommodationsystemofthebody.Itconsistoftheendocrineglandsandtheendocrinetissuesfromdifferentpartsofthebody.Foralongtime,ithasbeenrecognizedthatthissystemofductlessglandsexertsprofoundinfluenceonthebody.Itincludinggrowthanddevelopment,breedingactivitiesandmetabolicprocesses.Thefunctionorpowerofthissystemisexpressedbythesubstance------TheHormone.

BackgroundoftheEndocrineSystemTheendocrinesystemisone10

AboutHormones

Theseendocrineorgansortissuescansecretesomesubstanceswhichiscalledhormones,whichgetintothebloodcirculationandregulatetheactivitiesoftheorgansinthebody.

AboutHormones11

ClassificationofHormone

Proteinandpolypeptide(多肽)hormones

(hormonessecretedbypituitary（垂體）hypothalamus（下丘腦）andparathyroid（甲狀旁腺）;insulin,glucagon（胰高血糖素）etc.)Aminoacid（氨基酸）hormones

（T3T4etc.）Amine（胺）hormones

(NE,,DA,5-HT,melatonin褪黑素)Steroid（類固醇）hormones

(adrenalcortexhormones;T,DHT,estrogen,VitD3etc.)ClassificationofHorm12SomeHormones

Calcitonin降鈣素Corticosteriod皮質(zhì)內(nèi)固醇激素Glucocorticoid糖皮質(zhì)激素Cortisol可的松Mineralocorticoid鹽皮質(zhì)激素Aldosterone醛固酮Epinephrine腎上腺素Norepinephrine去甲腎上腺素MoradrenalineEstradiol雌二醇Progesterone孕激素Malatonin褪黑激素SomeHormonesCalcitonin降鈣素13

MechanismofHormones

signalmolecule（信號分子）actthroughextracellularsurfacereceptor（細胞表面受體）orintracellularreceptor（細胞內(nèi)受體）toregulatebodyfunctions.MechanismofH14FeedbackControlofHormonesSecretion負反饋正反饋下丘腦垂體前葉FeedbackControlofHormonesS15

PathologyHyperfunctionofglandsendocrinetumors\ectopicendocrinesyndrome(異位內(nèi)分泌綜合征)\autoimmunity（自身免疫）Hypofunctionofglands(endocrinedisrupting（內(nèi)分泌腺破壞）\Endocrineglandhormonesynthesisdefect（內(nèi)分泌腺激素合成缺陷）)ThereceptorlacksensitivitytohormonesHyper-高于，超過，上Hypo-在下，次，次于缺乏激素敏感性PathologyHyper16

DiagnosisandExaminations

Completethefunctionof

endocrine

systemdiseasesdiagnosis

shouldincludethreeaspects:

Functionaldiagnosis

功能診斷

Pathologicaldiagnosis

病理診斷

Etiologicaldiagnosis

病因診斷DiagnosisandExamina17

Functionaldiagnosis

1.ClinicalManifestationTypicalsignsandsymptomshasimportantreferencevaluetothediagnosisofendocrinedisease.Forexample：amenorrhea,Oligomenorrhea,sexualityandsexualfunctionchange,Hairchange,growthdisorderorexcessive,Weightlossorincrease,headache,decreasedvisualacuity,thespiritofexcitementordepression,weakness,skinpigmentchanges，purplelines,anemia,gastrointestinalsymptoms(lossofappetite,vomiting,abdominalpain,constipation,diarrhea),etc.閉經(jīng)月經(jīng)過少參考價值皮膚色素改變食欲嘔吐便秘腹瀉Functionaldiagnosis1.182.Laboratorytestsanddataanalysis（1）Evidenceofmetabolicdisorder：measurethebasicconditionofthebloodglucose,bloodlipidspectrum,serumsodium,potassium（鉀）,calcium，ect.（2）Hormonesecretion：Generally,todeterminehormonelevelsofbasicconditionofpituitaryandtargetgland,canhelptounderstanditsfunctionandpathogenicsite.(3)Determinationofdynamiccapabilities：includeInhibitiontestandExcitationtest,actuallyevaluatinghormonelevels,weshouldconsiderofage,gender,nutritionalstatus,whetherinastressstateandtakebloodtimeandsoon,andcombinewiththeclinicalstatusinordertomakeeveryefforttocorrect.2.Laboratorytestsanddata19

PathologicalDiagnosis

1.ImageologicalexaminationtheX-rayplainfilm、CT、MRI、type-Bultrasonic，whichbelongstothenoninvasiveendocrineglandtest,canidentifythehypothalamus-pituitary,thyroid,gonaddisease,adrenaltumors,isletcelltumor(胰島細胞),etc.2.Radionuclideexaminationthyroid

scintiscan(123I),Adrenalcorticalscanningwith131I-cholesterol,131I-MIBGscanningforthediagnosisofpheochromocytoma（嗜鉻細胞瘤）.3.CytologicalexaminationPathologicalbiopsyneedlepuncturecells（針吸活檢）,immunecellsinchemicaltechnology,semen,hormonereceptortesting.4.VeincatheterizationSelectivedeterminationofvenouscatheter（靜脈導管）inthedifferentpartstakebloodhormoneinordertomakeclearpituitary,thyroid,adrenal,isletlesionsite.Phe/o微暗的，褐Chrom/o色素，顏色Cyt/o細胞PathologicalDiagnosis120

EtiologicalDiagnosis1.AutoantibodiesdetectionThyroglobulinantibody,thyroidperoxidaseantibodiesandtestingforthyroid-stimulatinghormonereceptorantibodyandinsulin,isletcellantibodies,antibodyofadrenalgland,Determinationofantibodiescanhelptoclearthenatureofendocrinediseaseandthepathogenesisofautoimmunediseases,andevencanbeusedasthebasisforearlydiagnosisandlong-termfollow-up.2.WhitebloodcellschromosomeexaminationWithorwithoutdistortion,missing,increasing.3.IdentificationofHLA.人類白細胞抗原EtiologicalDiagnos21

PrincipleofTreatmentUsingthefollowingtreatmentsforoveractive:1.Surgerytoremovethehyperplasiatissueandtumorwhichleadtooveractive2.Radiationtherapydestroytumororhyperplasiatissue,reducingthesecretionofhormones.3.Drugtreatmentcontrolhormonesynthesisandrelease.Thethreetreatmentscancooperatewitheachotherinordertoimprovecurativeeffect.Usingthefollowingtreatmentsforhypothyroid:1.Wecanuseanotherhormonewiththesameeffecttoreplacethehormonedeficiencyorsupplementthedeficienthormone.2.Endocrineglandtissuetransplants.PrincipleofTreatm222.Laboratorytestsanddataanalysis（1）Evidenceofmetabolicdisorder：measurethebasicconditionofthebloodglucose,bloodlipidspectrum,serumsodium,potassium（鉀）,calcium，ect.（2）Hormonesecretion：Generally,todeterminehormonelevelsofbasicconditionofpituitaryandtargetgland,canhelptounderstanditsfunctionandpathogenicsite.(3)Determinationofdynamiccapabilities：includeInhibitiontestandExcitationtest,actuallyevaluatinghormonelevels,weshouldconsiderofage,gender,nutritionalstatus,whetherinastressstateandtakebloodtimeandsoon,andcombinewiththeclinicalstatusinordertomakeeveryefforttocorrect.2.Laboratorytestsanddata23CommonclinicalendocrinesystemdiseasesDiabetesMellitusHyperthyroidismHypothyroidismThyroiditisCushing'ssyndromeDiabetesinsipidus（尿崩癥）Primaryaldosteronism（原醛）Chronicadrenocorticalhypofunction(Addison)Dyslipidemia（血脂異常）ObesityHyperuricemiaandgout（高尿酸及痛風）Osteoporosis（骨質(zhì)疏松）Gigantism（巨人癥）

Acromegaly（肢端肥大癥）................Syndrome綜合征Acute&Chronic急性慢性Dys-不良，壞Lipid/o脂質(zhì)，油脂-oporosis疏松的Commonclinicalendocrinesyst24Whatisthemostcommomdiseaseinendocrinesysterm?DiabetesMellitusWhatisthemostcommomdiseas25Estimatednumberofadultswithdiabetesindevelopedanddevelopingcountriesbyagegroupin2000and2030Estimatednumberofadultswit26

DiabetesMellitusdiabetesmellitus,orsimplydiabetes,isagroupofmetabolicdiseasesinwhichapersonhashighbloodsugar,eitherbecausethepancreasdoesnotproduceenoughinsulin,orbecausecellsdonotrespondtotheinsulinthatisproducedthereare3maintypesofDMType1DMType2DMGestationaldiabetesDiabetesMellitusdiab27Themostcommonformofdiabetes----Type2DMNearly95%belongstotype2DM,itoftenassociatedwitholderage,obesity,familyhistoryofdiabetese.t.c.Intype2diabetes,thepancreasisusuallyproducingenoughinsulin,butforunknownreasonsthebodycannotusetheinsulineffectively,aconditioncalledinsulinresistance.Afterseveralyears,insulinproductiondecreases.Sothusglucosebuildsupinthebloodandthebodycannotmakeefficientuseofitsmainsourceoffuel.胰島素抵抗/耐受Themostcommonformofdiabet28ClassicalmanifestationsofdiabetesPolyuria（多尿）

–increasedurinationPolydispia（多飲）

–increasedthirst,whichoccursasaresultofexcesslossoffluidassociatedwithosmoticdiuresis.Polyphagia（多食）

–increasedappetitewhichresultsfromthecatabolicstateinducedbyinsulindeficiencyLoseweight（體重下降）Ifthediabetesmellituscannotbecontrolledwell,itcancausecomplications,anditcannotbecured.Classicalmanifestationsofdi29

RiskfactorsfordiabetesObesity/overweightFamilyhistoryofdiabetesHavinghighbloodpressureOccupationalphysicalactivityToomuchsweetfoodintakeOverstressInfectionHyperlipemiaAndsoonRiskfactorsfordiabetes30TheMajorComplicationsofDiabetesRetin/o視網(wǎng)膜

糖尿病足Nephr/oRena-腎的TheMajorComplicationsofDi31TheMeasurementofPlasmaGlucoseFastingplasmaglucose(FPG):measurementafteran8-12hfast.Oralglucosetolerancetesting(OGTT):2hafteringestionofaconcentratedglucosesolution.OGTTismoresensitiveforDxDMandimpairedtolerancebutismoreexpansiveandlessconvenientandreproduciblethanFPG.Itisrarelyusedroutinely,exceptforDxofgestationalDM.HbA1c:testingforglycosylatedhemoglobin.HbA1clevelsreflectglucosecontroloverthepreceding2-3months.HbA1cisnotconsideredasreliableasFPGorOGTTtestingforDxDMandusedmainlyformonitoringDMcontrol.TheMeasurementofPlasmaGluc32Diagnosticcriteria(byintravenousglucoseprevail)(1)Diabetessymptoms:(Typicalsymptomsincludepolyphagia,polydipsia,polyuria,andunexplainedweightloss)plus:1)Randombloodglucose(referstonotconsiderthelastmeal,bloodglucoseanytimeofday)≥11.1mmol/L(200mg/dl)

Or2)Fastingglucose(fastingstatereferstoatleasteighthourswithouteatingcalories)≥7.0mmol/L(126mg/dl)

Or3)2hoursafterglucoseload

≥11.1mmol/L(200mg/dl)(2)Withoutdiabetessymptoms,anextradayrepeatexaminationtoconfirmthediagnosisDiagnosticcriteria(byintr33

Treatmentprinciples

Thebasicprinciplesoftreatmentofdiabetes,includingdiabeteseducation,dietcontrol,exercisetherapy,diseasemonitoring,andintegrativemedicinemedications,bothso-called

“FiveCarriages”HealthEducationExerciseNutritionTherapyDiseaseSurveillanceOralAnti-diabeticAgentTreatmentprinciples34

DiabetesHealthEducationHealtheducationisconsideredthekeytothesuccessoftreatment.DiabetesHealthEducatio35

MedicalNutritionTherapyThereisn'tone"diabetesdiet."

Theamountoffoodyoucaneatdailydependson:-Age-Bodysize-Activitylevel-Gender-Pregnancyorbreastfeeding(母乳喂養(yǎng))Withthehelpfromadietician,adietisplannedbasedontherecommendedamountofcalories,protein,carbohydrates,andfats.Amealplanisaguidethattellsyouwhatkindsoffoodyoucanchooseatmealsandsnacktimeandhowmuchtohave.Formostpeoplewithdiabetes(andthosewithout,too),ahealthydietconsistsof40%to60%ofcaloriesfromcarbohydrates,20%fromproteinand30%orlessfromfat.MedicalNutritionThera36

ExerciseExercise:Beforediabeticpatientsengageinexerciseprogram,theyshouldconsultwiththeirhealthcareproviderbecausetheyneedtohaveacompletehistoryandphysicalexamination.Exerciseincludesanythingthatkeepsthemmove.Exercise(totalofabout30minutesaday,atleast5daysaweek)lowersbloodsugarlevelsbyimprovingcelluptakeofglucose,causingthebodytoprocessglucosefaster.ExerciseExerc37

ExerciseExercise38

DiseaseSurveillanceRegularmonitoringofbloodglucoseisrecommendedtouseaportablebloodglucosemeter（便攜式血糖測量儀）;periodicrevieweverythreetoJuneHBA1c,inordertoadjusttreatment.Comprehensivereviewonceortwiceayear,earlydetectionrelatedcomplications.定期檢查便攜式，手提式DiseaseSurveillanc39

OralAnti-diabeticAgentBiguanides-Metformin(Glucophage)雙胍類decreasingliverglucosereleaseandcellularinsulinresistance.Alpha-GlucoseInhibitors:α-糖苷酶抑制劑-Slowsdigestionandabsorptionofcarbohydratestomaintainnormalbloodglucoselevels.SulfonylureasandMeglitinides:(Prandin)磺脲類和格列奈類-Stimulatespancreastosecreteinsulin.Thiazolidinediones:(Avandia,Actos)噻唑烷二酮類-Increasesinsulinsensitivityatreceptorsitesonliver,muscle,andfatcells.

Themedicationworksbyhelpingmakeyourcellsmoresensitivetoinsulin.Theinsulincanthenmoveglucosefromyourbloodintoyourcellsforenergy.OralAnti-diabeticAge40

InsulinTherapyInsulintherapyisanimportantmeanstocontrolhighbloodsugar.Afterstartinginsulintherapyshouldcontinuetoadheretodietandexercise,andtostrengthenthepatient'smissiontoencourageandguidethepatienttoself-monitoringofbloodglucose,inordertoadjusttheinsulindoseandpreventionofhypoglycemia.Insulintreatmentprogramsshouldsimulatephysiologicalinsulinsecretionpatterns,includingbasalinsulinandprandialtwocomplementaryparts.ClassificationofInsulin:regular(short-acting)insulin,intermediate-actinginsulinandlong-actinginsulin(includingultra-long-actinginsulinanalogue)andpremixedinsulin(includingpremixedinsulinanalogues)InsulinTherapyIns41

TherapyInTCMDiabetiesMellitusinwesternmedcineis“xiaoke”areasinTCM。Accordingtochinesemedicinetheory,thebasicpathogenesisof“xiaoke”（consumptivethirst）isyinscorchingontherootwhilefirepreponderanceonthebranch,besides,itcouldinvolvedifferentorgansandparts,andcouldalsocausethedisorderingofqi,blood,jin,yinandyang.Xiaokeisusuallyclassifiedi