炎症性肠病-吴小琴2.ppt

idiopathic chronic inflammation of GI tract refers to two chronic diseases with unknown aetiology: ulcerative colitis (UC) and Crohn’s disease (CD) Ulcerative Colitis Superficial mucosal inflammation of colon only Begins at rectum and spreads continuously 30% proctitis, 40% L sided colitis, 30% pancolitis Sxs: bloody diarrhea, fecal urgency, tenesmus, abdominal cramping Crohn’s Disease Transmural inflammation of any part of GI tract, presence of “skip” lesions and noncaseating granulomas Rectum often spared small bowel (usually terminal ileum), ileum/colon, colon, stomach/duodenum Sxs: non-bloody diarrhea, weight loss, fever, RLQ pain and/or mass, perianal disease with abscess and/or fistulas Epidemiology Rate higher in Northern-Western Europe and North America -incidence in USA: 10 cases per 100,000 -prevalence:~200 cases per 100,000 Incidence is increasing Gender: -CD: women have higher risks -UC: male preponderance Peak incidence: CD 20y UC 30y Etiology and pathogenesis Environmental factors Pathology--UC From rectum to proximal colon -continue and diffuse Limited to mucosa and submucosa -superficial Acute/Active: - Neutrophils and Eosinophils - Cryptitis, crypt abscess - Erosion, ulcer Pathology--UC Chronic changes: -Lymphocytes and Plasma cells aggregate -Crypt distortion: transformed, disorganized, loss of gland -Muscularis mucosae hyperplasia -Cell metaplasia Pathology--CD From mouth to anus—any part of GI tract -segmental: skip lesions -terminal ileum: most common Transmural inflammation -aphthous ulcer-- stellate ulcer-longitudinal ucler -cobblestone mucosa - fistulas, abscesses Pathology--CD Pathology--CD Acute/Active: - Neutrophils and Eosinophils - Cryptitis, crypt abscess - Erosion, ulcer Chronic changes: -Lymphocytes and Plasma cells aggregate -Non-caseating granulomas -Neuronal hyperplasia Presentation--UC Symptoms depend on extent and severity of inflammation -Blood