溃疡性结肠炎的诊断与重点治疗.ppt

* 临床症状 常见：腹痛、发热(38?C)、腹泻、血便、 消瘦。 肠外表现：关节炎、口腔溃疡、强直性脊柱 炎（HLA-B27）、微型硬化性胆 管炎。 内镜检查及X线检查 内镜检查表现：中毒性巨结肠是内镜绝对 禁忌症 钡剂灌肠：铅管征、毛刺样改变、粘膜颗 粒粗糙 Endoscopic features of active ulcerative colitis Figure 4-1. Endoscopic features of active ulcerative colitis. Findings include diffusely erythematous, edematous, and granular mucosa with areas of submucosal hemorrhage and, when severe, frank mucopurulent exudate. Inflammation invariably begins in the rectum and extends proximally for varying extents. The chronicity of the process is suggested by the loss of colonic haustrations; otherwise, the endoscopic picture is nonspecific and could be consistent with acute infectious colitis, chronic ulcerative or Crohn`s colitis, or any number of other specific causes of colitis. A, Mild distal ulcerative colitis with diffuse erythema and friability well demarcated from the normal mucosa more proximally is depicted. B, This example shows moderately severe ulcerative colitis with irregular, inflamed, ulcerated mucosa and a patchy exudate. Ulcerative colitis in remissionFigure 4-2. Ulcerative colitis in remission. The normal vascular pattern is absent and a white scar indicates the site of a previous ulcer. Severe ulcerative colitisFigure 4-3. Severe ulcerative colitis. The mucosa shows extensive ulceration and diffuse thickening with an inflammatory infiltrate. In contrast to Crohn`s colitis, the ulceration lacks depth. Chronic ulcerative colitisFigure 4-5. Chronic ulcerative colitis. In long-standing ulcerative colitis, the mucosa has an atrophic and scarred appearance with a blunted vascular pattern. Pseudopolyps are often present. Chronic ulcerative colitisFigure 4-7. Radiographic appearance of chronic ulcerative colitis. Long-standing chronic ulcerative colitis, as shown in this single-contrast barium enema, is characterized by shortening and straightening of the colon with loss of haustrations, resulting in the appearance of a featureless tube. No ulce