消化内科常见病的诊治与药物合理应用.pptVIP

知识回顾Knowledge Review * * definition * Peptic ulcers are caused by increased damaging and/or decreased protective defence factors. Acid and pepsin appear to be the most important factors in PU. Helicobacter pylori colonisation and/or non-steroidal anti-inflammatory drug (NSAID) use are also present in almost all PU patients. The most important defence factors have not been completely defined. Decreased duodenal bicarbonate and/or mucus production may contribute to the pathogenesis of PU. Moreover, it appears that locally produced growth factors are critical in the ulcer healing process. Soll AH. Pathogenesis of peptic ulcer and implications for therapy. N Engl J Med 1990; 322: 909–16. * 6. Anatomical location of ulcerative colitis Ulcerative colitis usually extends proximally from the rectum in a continuous fashion. The extent of proximal spread varies, but ulcerative colitis is always confined to the colon with the exception of occasional mild inflammation of the most distal part of the terminal ileum (backwash ileitis Pettit Irving 1992; Podolsky 1991; Shanahan Targan 1989) * Erythema nodosum (10%) Tender, red subcutaneous nodules Extensor surfaces of arms legs Correlates with disease activity Often responds to therapy for IBD Prednisone may also be used Pyoderma Gangrenosum (5%) Lesions exhibit pathergy Begin as single or multiple pustules Evolve to sterile necrotic ulceration with violaceous edges Dorsum of feet and lower legs Parallels IBD activity in 50% Spontaneous healing rarely occurs Most respond to high dose steroids Primary Sclerosing Cholangitis (5%) 75% of patients with PSC will have IBD Predilection for young males with UC Does not parallel IBD activity Does not respond to IBD therapy Insidious course with asymptomatic increase in alkaline phosphatase and bilirubin Associated with increased risk for biliary ductal tumors and colorectal cancer Peripheral “enteropathic” arthritis (20%) Most common extra-intestinal manifestation of IB