潰瘍性結(jié)腸炎的診斷與鑒別診斷

1、會計學(xué)1潰瘍性結(jié)腸炎的診斷與鑒別診斷潰瘍性結(jié)腸炎的診斷與鑒別診斷bloody diarrhea (“hematochezia”). nActive inflammatory anorectal lesions result in urgency of defecation and cramps around defecation (“tenesmus”). UC patients often complain of lower left quadrant pain. nExtraintestinal ManifestationsWafik El-Diery and David Metz, Se

2、ction EditorsDiagnostics of Inflammatory Bowel DiseaseGastroenterology，2007;133:16701689in the secretions overlying most mucosal surfaces that interact directly with external pathogens, including saliva, tears, vaginal secretions, feces, synovial fluid, and mammalian breast milk. It is a major compo

3、nent of the secondary granules of polymorphonuclear neutrophils and is shown to be a primary factor in the acute inflammatory response. In the intestinal lumen, fecal lactoferrin levels quickly increase with the influx of neutrophils during inflammation.nSugi and colleagues investigated lactoferrin,

4、 polymorphonuclear neutrophil (PMN) elastase, andlysozyme together with myeloperoxidase in fecal material and whole-gut lavage fluid from IBD patients.nLanghorst J, Elsenbruch S, Mueller T et al. Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative col

5、itis. Inflamm. Bowel Dis. 2005; 11: 108591.n檢查所見的主要改變?yōu)椋簄(1)黏膜粗亂和(或)顆粒樣改變；n(2)腸管邊緣呈鋸齒狀或毛刺樣，腸壁有多發(fā)性小充盈缺損；n(3)腸管短縮，袋囊消失呈鉛管樣。Ulcerative colitis with backwash ileitis. Axial CT enterographic sections show continuous involvement of the large bowel (white arrrows) and backwash ileitis (black arrow in b).Els

6、ayes KM，AIHawary MM，Jagdish J，et a1CT enterography：principles，trends，and interpretation of findingsRadiographics，2010，30：19551970Danese S，F(xiàn)iocehi CUlcerative colitisN Engl J Med，2011365：1713 1725n 結(jié)腸鏡檢查并活組織檢查(后文簡稱活檢)是UC診斷的主要依據(jù)。n 結(jié)腸鏡下UC病變多從直腸開始，呈連續(xù)性、彌漫性分布，表現(xiàn)為：n (1)黏膜血管紋理模糊、紊亂或消失，黏膜充血、水腫、質(zhì)脆、自發(fā)或接觸出血和膿性

7、分泌物附著，亦常見黏膜粗糙、呈細(xì)顆粒狀；n (2)病變明顯處可見彌漫性、多發(fā)性糜爛或潰瘍；n (3)可見結(jié)腸袋變淺、變鈍或消失以及假息肉、橋黏膜等。n (A) UC with mild inflammation and reduced haustration, vascular transparency is missing. n (B) Moderate inflammation with reduced haustration. The mucosa is edematous, covered with fibrin, and shows multiple erosions.n (C) S

8、evere inflammation with inflammatory narrowing of the lumen through pseudopolyps.n 內(nèi)鏡下黏膜染色技術(shù)能提高內(nèi)鏡對黏膜病變的識別能力，結(jié)合放大內(nèi)鏡技術(shù)，通過對黏膜微細(xì)結(jié)構(gòu)的觀察和病變特征的判別，有助UC診斷，n 姜泊，等放大內(nèi)鏡結(jié)合黏膜染色技術(shù)診斷潰瘍性結(jié)腸炎附1 16例放大內(nèi)鏡形態(tài)分析現(xiàn)代消化及介入診療，2005，10：116118n Subtle lesions as seen at small-bowel capsule endoscopyn Bourreille A，Ignjatovic A，Aabakk

9、en L，et a1Role of smallbowel endoscopy in the management of patients with inflammatory bowel disease：an international OMED-ECCO consensusEndoscopy，2009，41：618637Riley SA, Mani V, Goodman MJ, et al. Microscopic activity in ulcerative colitis: what does it mean? Gut. 1991;32:174178.n (D, E) Crypt absc

10、ess in UC. (F) Pseudopolyp formation. L, lymph follicle.n Nikolaus S，Schreiber SDiagnostics of inflammatory bowel diseaseGastroenterology，2007，133：16701689Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol. Suppl. 1989; 170: 26;discussion 1619.夏冰，等. 缺血性結(jié)腸炎與潰瘍性結(jié)腸炎的臨

11、床鑒別診斷. 胃腸病學(xué). 2010， 15(11)： 681-683.感謝您的觀看！Ulcerative colitis with backwash ileitis. Axial CT enterographic sections show continuous involvement of the large bowel (white arrrows) and backwash ileitis (black arrow in b).Elsayes KM，AIHawary MM，Jagdish J，et a1CT enterography：principles，trends，and interpretation of findingsRadiographics，2010，30：19551970Danese S，F(xiàn)iocehi CUlcerative colitisN Engl J Med，2011365：1713 1725