溃疡性结肠炎教材.pptVIP

溃 疡 性 结 肠 炎ulcerative colitis，UC吉林大学第一医院消化科王 丹 概 述 UC是一种病因不明的慢性、非特异性溃疡性直肠和结肠炎 消化性溃疡不是消化道溃疡，UC是肠溃疡 好发部位：大肠，直、乙状结肠 病理改变：以溃疡形成为特征 临床表现：腹泻、腹痛、粘液脓血便 病变特点——早期 大体：弥漫充血、水肿、灶状出血；粘膜细颗粒状、 质脆、易出血；广泛浅小溃疡。 镜下：大量中性粒细胞浸润固有层、隐窝上皮、隐窝内及表面上皮。 后果：少数重症患者可发生中毒性巨结肠，一般情况 者并发结肠穿孔、瘘管或周围脓肿少见。 病 理 粘膜弥漫性充血水肿、糜烂、出血、隐窝脓肿、溃疡、炎性息肉、肠壁僵硬缩短、结肠袋消失、肠腔狭窄等。少数癌变。 溃疡 炎 性 息 肉 病理表现 病 理 This gross appearance is characteristic for ulcerative colitis. The most intense inflammation begins at the lower right in the sigmoid colon and extends upward and around to the ascending colon. At the lower left is the ileocecal valve with a portion of terminal ileum that is not involved. Inflammation with ulcerative colitis tends to be continuous along the mucosal surface and tends to begin in the rectum. The mucosa becomes eroded, as in this photograph, which shows only remaining islands of mucosa called pseudopolyps. 病 理 Here is another example of extensive ulcerative colitis (UC). The ileocecal valve is seen at the lower left. Just above this valve in the cecum is the beginning of the mucosal inflammation with erythema and granularity. As the disease progresses, the mucosal erosions coalesce to linear ulcers that undermine remaining mucosa.. 病 理 UC 肠结核 Pseudopolyps are seen here in a case of severe ulcerative colitis. The remaining mucosa has been ulcerated away and is hyperemic. 病 理 病 理 病变特点——后期 炎性息肉 粘膜萎缩 肠腔狭窄 结肠癌变 There is a risk for adenocarcinoma with ulcerative colitis. Here, more normal glands are seen at the left, but the glands at the right demonstrate dysplasia, the first indication that there is a move towards neoplasia. ㈡ 全身表现 ⒈ 发热：较少见 中重型：低或中度发热；暴发型：高热伴全身中 毒症状。 ⒉ 营养障碍 衰竭、消瘦、贫血；水电平衡紊乱；低蛋白血症 临 床 表 现 ㈢ 肠外表现 眼睛：虹膜睫状体炎、葡萄膜炎 口腔：口腔溃疡 皮肤：结节红斑、坏疽性脓皮病 关节：杵状指、关节炎 血管：血管炎 胆道：硬化性胆管炎 肝脏：慢性活动性肝炎 临 床 表 现 ㈣ 临床分型 ⒈ 根据病程经过： ①初 发 型 ②慢性复发型 ③慢性持续型 ④急性暴发型 ⒉ 根据病变范围： ?直