Inflammatory bowel disease肠道炎症性疾病.pptVIP

Inflammatory bowel disease Ulcerative colitis Definition A chronic inflammatory disease of unknown etiology that involves the mucosa of the colon and rectum characterized by acute exacerbations and remissions. Clinical features Diarrhoea is the most prominent feature, usually associated with presence of blood and mucus. Non-specific features such as malaise and anorexia are common. Extraintestinal manifestations also occur. Extraintestinal features of ulcerative colitis Aetiology and pathogenesis Unkown aetiology but there is an association with HLA-b27 and ankylosing spondylitis which is suggestive of a genetic basis but no conclusive evidence is yet available Histological features are similar to those seen in infectious diarrhoea but no agent has been shown to be responsible. Aetiology and pathogenesis Perinuclear antineutrophil cytoplasmic antibodies can be found in 60%of patients with ulcerative colitis, which suggests an underlying immunological cause, but it is difficult to ascertain whether the changes in autoantibodies are a cause or a result of the disease. Ulcerative colitis affects the rectum and may extend along the whole length of the colon. Except backwash ileitis Macroscopically the mucosa looks inflamed and bleeds easily and in severe disease, extensive ulcerative is seen with neighbouring mucosa appearing like polyps. Pathology The inflammation is limited to the mucosa and submucosa with inflammatory cells accumulating in the lamina propria and colonic gland to form crypt abscesses. goblet cell depletion is also seen. Long standing colitis results in fibrosis of mucosa and submucosa, hence loss of haustral pattern and a shortened and featureless colon Complications Toxic megacolon is seen on plain abdominal x-ray. Dilatation of 5cm or greater is associated with a risk of perforation and peritonitis. The patient is usually unwell with fever, abdominal tenderness, and tachycardia. The risk of developing adenocarcinoma after 10 year