课件：溃疡性结肠炎的诊断与鉴别诊断.ppt

可编辑 溃疡性结肠炎的诊断和鉴别诊断 Clinical Presentation Intestinal Symptoms 70% of patients with UC report 5 bowel movements during acute phases. The main reason for diarrhea is colonic inflammation, but bile acid and food malabsorption secondary to inflammation in the terminal ileum or the proximal small bowel can contribute to this symptom. A history of surgical resections can be seminal in explaining symptoms. Acute phases of UC almost always present with bloody diarrhea (“hematochezia”). Active inflammatory anorectal lesions result in urgency of defecation and cramps around defecation (“tenesmus”). UC patients often complain of lower left quadrant pain. Extraintestinal Manifestations Wafik El-Diery and David Metz, Section Editors．Diagnostics of Inflammatory Bowel Disease．Gastroenterology，2007;133:1670–1689． 肠外表现(Extraintestinal manifestations) 肠外表现包括： 皮肤黏膜表现(如口腔溃疡、结节性红斑和坏疽性脓皮病) 关节损害(如外周关节炎、脊柱关节炎等) 眼部病变(如虹膜炎、巩膜炎、葡萄膜炎等)、 肝胆疾病(如脂肪肝、原发性硬化性胆管炎、胆石症等) 血栓栓塞性疾病等。 Mendoza JL, Lana R, Taxonera C et al. Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn’s disease and ulcerative colitis. Med. Clin. (Barc.) 2005; 125: 297–300. 并发症(Complications) 并发症包括： 中毒性巨结肠 （toxic megacolon） 肠穿孔 下消化道大出血 上皮内瘤变和癌变 钱家鸣, 等.溃疡性结肠炎合并中毒性巨结肠六例及文献复习. 中华内科杂志[J]. 2012，51(9): 694-697/ Chow DK，Leong RW，Tsoi KK, et a1．Long—term follow—up of ulcerative colitis in the Chinese population．Am J Gastroenterol，2009，104：647-654． Serological markers The two most widely studied serological markers in inflammatory bowel disease in recent years have been p-ANCA and ASCA. The clinical utility of p-ANCA or ASCA testing in the diagnosis of inflammatory bowel disease, in patients with non-specific gastrointestinal symptoms, is limited because of the varying seroprevalence of these antibodies in patients with inflammatory bowel disease and the inadequate sensitivity of the assays. Reese GE, Constantinides VA, Simillis C et al. Diagnostic precision of anti-Saccharomyces cerevisiae antibodie