缺血性肠病的学习课件.pptxVIP

缺血性肠病的学习课件第1页/共30页 Ischemic Colitis第2页/共30页 Reference booksHarrison’s online 15thMarx: Rosens Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright ? 2002 Mosby, Inc第3页/共30页 Ischemic ColitisIschemia of the colon most often affects the elderly (90% of patients 60 y/o ).Ischemic colitis is almost always nonocclusive. (emboli are the most common cause of acute mesenteric ischemia)Shunting of blood away from the mucosa may contribute to this condition, but the mechanism is unknown.第4页/共30页 Ischemic ColitisMost patients ischemia occurs secondary to arteriolar shunting, spasm, or poor perfusion of mucosal vessels.Most cases involve the splenic flexure, which is supplied by end-arteries. The rectum is usually spared, because its blood supply is different from the rest of the colon and less dependent on the inferior mesenteric artery .Marx: Rosens Emergency Medicine: Concepts and Clinical Practice, 5th ed 第5页/共30页 Types of Ischemic ColitisAcute fulminant ischemic colitis Subacute ischemic colitis HARRISON’S ONLINE 15TH 第6页/共30页 Types of Ischemic ColitisGangrenous ischemic colitis a complete loss of arterial flow causes bowel wall infarction and gangrene, which can progress to perforation, peritonitis, and death. Stricturing ischemic colitis a gross impairment of the arterial supply, leading to hemorrhagic infarction of the mucosa, which ulcerates, heals by fibrosis, and finally leads to stenosis. Transient ischemic colitis a transient, reversible impairment of the arterial supply, which causes a partial mucosal slough that heals by mucosal regeneration in a few days. the most common Marx: Rosens Emergency Medicine: Concepts and Clinical Practice, 5th ed 第7页/共30页 Acute fulminant ischemic colitis manifestations The onset is characteristically acute, with generalized lower abdominal pain, usually in the left lower quadrant, followed within 24 hours by bloody diarrhea or rectal bleeding .Dilation of the colon and physical signs of peritonitis are seen in sever