




版權(quán)說明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡介
What’sthis?1畢錫文Sarcoidosisindigestivesystem2Multisystemdisease
3Lung
5Lung
6Lung
7Lung
8Skin
10Salivarygland
12NS
14Larynx
15Muscle
16Nose
17Sarcoidosisindigestivesystem18Esophagus
ClinicalmanifestationsDysphagiaWeightlossAchalasialikesymptoms20Esophagus
ImagingPlaquelikemucosallesions,mucosalirregularitiesStricturesEsophagealdilatationBulkymediastinal
lymphadenopathyDecreasedperistalsis(蠕動(dòng)減弱)21Stomach
Themostcommonform,10%ptswithsarcoidosishavegastricinvolvmentonautopsyAntrumisthemostcommonsitePathologictypesSubclinicalgastricsarcoidosisUlcerativegastricsarcoidosisInfiltrativegastricsarcoidosisPolypoidgastricsarcoidosis23Stomach
PathologictypesSubclinicalgastricsarcoidosisThemostcommontypeofgastricsarcoidosisMostlyasymptomatic,incidentallydiscoveredwithgastricmucosalbiopsyMucosamayappearnormal(sarcoidosisrisesfrommuscularlayer)HyperemicwithsuperficialnodularityAtrophicgastritisinchroniccases,usuallybenign24Stomach
Pathologictypes3.InfiltrativegastricsarcoidosisLocalizedtype→thedistalpartofthestomach→smooth,coned-shapedantralnarrowinganddeformityDiffusedtype→linitis
plastica-likeappearance→shouldbedifferentiatedfromgastriccarcinoma4.PolypoidgastricsarcoidosisRareMultipleorsingle26Stomach
ClinicalmanifestationsEpigastricpain(75%),usuallypostprandialNauseaVomitingBloatingEarlysatietyWeightloss25%ptswithupperGIbleeding,sometimessevereObstruction:extensiveretroperitonealadenopathymayextrinsicallycompressthegastricantrum27StomachLabtestGastricaspiratesACElevel>serumAnti-parietalcellAb(+)AntiH+/K+ATPasepumpAb(+)Derangedparietalcellfunction→Gastricacid↓→serumgastrin↑28Inthispatient,moreadvancedgastricsarcoidosisismanifestedbymarkedantralnarrowinganddeformity3031Smallintestine
TheleastcommonformPathologictypesGranulomatousenteritis(isolatedorasapartofdisseminatedGItractsarcoidosis)ObstructionVillousatrophy→malabsorption32Smallintestine
ClinicalmanifestationsChronicdiarrheaAbdominalpainNauseaVomitingMalabsorption→protein-losingenteropathy→peripheraledemaGIhemorrhageMegaloblasticanemia→folatedeficiencyormalabsorptionofvitaminB12withterminalilealdiseaseorachlorhydria(胃酸不足)Obstruction→intrinsicorextrinsic(腸道狹窄或淋巴結(jié)壓迫)33CASE134353637CASE2Markedcircumferentialthickeningoftheterminalileum
38CASE267Gawhole-bodyscanlungs(?)nose(straightarrow)Lacrimalandparotidglandshemipelvis
midlinepelvicactivityrepresentsthebladder(B).39Colon&RectumRareSigmoidcolonismostcommonsitePathologictypesStrictureandnarrowingPlaquelikelesionsUlcersFoldthickening(結(jié)腸皺襞增厚)FocalnodularityPolypoidlesionsHistologicevidenceofcolonicinvolvementhasbeenfoundingrosslynormalmucosa40Colon&Rectum
ClinicalmanifestationsAbdominalpain(>50%pts)DiarrheaTenesmus(里急后重)Hematochezia(血便)Distention(腹脹)Obstruction(mostlycausedbycompressionoflymphadenopathy)ConstipationWeightloss41CASE142CASE143CASE144CASE2Irregularnarrowingoftherectosigmoidduetosarcoidosishastheappearanceofinflammatorydiseaseormalignancy45Appendix
Extremelyrare,only1caseamong50,000appendectomyspecimensAppendicitisPerforationAbscessformation46DiagnosisofGIsarcoidosis
Difficult,isolatedGIsarcoidosisisevenmorehardThediagnosisofGItractsarcoidosisissuggestedinapatientwithsystemicsarcoidosiswithGIsymptomsDemonstrationofnoncaseating
granulomainGItractisnecessary3. OthercausesofGItractgranuloma
shouldbeexcluded:Tuberculosis,fungalinfections,schistosomiasisVasculitis,ForeignbodyreactionsRadiationinjuryCrohn’sdiseaseMicroscopiccolitisWhipple’sdiseaseLymphomaandcarcinoma47DiagnosisofGIsarcoidosis
LabtestsCBC:一系or三系下降(脾亢or骨髓浸潤)高血鈣,高尿鈣(無高血鈣也可高尿鈣,由于marcophage
產(chǎn)生VitD類似物導(dǎo)致)血ACE↑為活動(dòng)性指標(biāo),與病情相關(guān)Kveim-siltebach皮試(不常用)Ga67核素掃描:巨噬細(xì)胞攝取鎵,縱膈和雙側(cè)肺門攝取增高(λ征);淚腺、腮腺、唾液腺高濃聚(熊貓臉)48
SarcoidosisORCrohn?
SarcoidosisCrohn瘺管和肛周病變少見多見ACE↑N肺部或淋巴結(jié)結(jié)節(jié)病多有多無Schaumannbodies可有無浸潤深度腸壁淺層全層病變程度粘膜破壞和炎癥反應(yīng)輕重激素反應(yīng)好,數(shù)天可緩解較前者差*結(jié)節(jié)病和Crohn病可合并存在,雖然極少見49CytoplasmicSchaumannbody50Liver
>50%ofptswithsarcoidosishavehepaticinvolvementbybiopsyand67–70%byautopsyOnly10-30%havelaboratoryevidenceofliverdiseaseClinicalmanifestationsUsuallyasymptomatic,rarelyorgandysfunctionFeverandarthralgias,althoughnotspecific,arepresentinthemajorityofindividualswithactivehepaticsarcoidosis
Chronicinflammationandfibrosis→portalhypertension,Budd-Chiarisyndrome,cirrhosis,andcarcinoma51Liver
ClinicalmanifestationsPruritis-commonRightupperquadrantabdominalpain-commonHepatomegaly-20%ptsclinicallyand50%ptsonCTJaundice-rareintrahepatic
granulomasintheportalspacethroughexternalcompressionofbileductsfromgranulomasinextrahepaticlymphnodes.52LiverLabtestALPand/orγ-GT↑,correlatehighlywithcholestasisandliverinvolvement50%ofasymptomaticptshavemildly↑ALT&ASTHyperglobulinemiaisalsocommonACE↑,60%ofpatientswithactivesarcoidosis,butlesssoinchronicsarcoidosis,andpatientsoncorticosteroids.NormalACElevelsdonotruleoutdiseaseACE↑c(diǎn)anbehelpfulindifferentialdiagnosisCTorMRIrevealhepatomegalyandgranulomasrepresentedbymultiplehypointensenodules.535455Spleen
Mostofteninthepresenceofsystemicdiseaseratherthanasanisolatedentity24-53%ofptsisinvolvedonFNAUsuallyasymptomatic,Splenomegaly(5-14%),abdominalpain,andhematologicabnormalitiessuchasleukopenia(20%).SplenicinfiltrationcanbehomogeneousorisolatedasmultiplegranulomatousnodulesCTorMRIaslow-attenuatinglesions,andcaneasilybeconfusedwithlymphoma,metastasesorinfection56575859Pancreas
1–3%ofcasesonautopsy,rarelypresentssymptomaticallyAbdominalpain,weightloss,obstructivejaundice,nauseaandvomiting.ElevatedamylaseandlipasearepossibleDiffuselynodular(50%),orapancreaticmass(50%),mostlyintheheadofthepancreas.60Pancreas
RadiologicalimagingDilatationofthecommonbileductandpancreaticductSolitaryill-definedpancreaticmassesMultiplemasseswithlowT1,mildhighT2onMRIEnlargedlymphnode616263PeritoneumRareThemostfrequentclinicalpresentationisexudative
ascites(bothbloodyandnon-bloody)andabdominalpainSingleormultiplelesionsCA125↑(主要由腹膜間皮細(xì)胞在炎癥時(shí)分泌)Needbiopsytobedifferentiatedbetweencarcinomatosisandtuberculousperitonitis64LymphomaORsarcoidosis?6566Sarcoidosis:singlebulkymesentericlymphnodemimickingalymphoma
FazziP,SolfanelliS,MorelliG,etal.Sarcoidosis1995;12:75–77.Apreviouslyhealthymanpresentedwithacuteabdominalpainthatextendedfromtheleftlumbarar
溫馨提示
- 1. 本站所有資源如無特殊說明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁內(nèi)容里面會(huì)有圖紙預(yù)覽,若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫網(wǎng)僅提供信息存儲(chǔ)空間,僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 出國建筑合同范本
- 健身車外貿(mào)合同范本
- 代建租賃合同范本
- 凍庫驗(yàn)收合同范本
- ipad制作合同范本
- 長寧區(qū)制作家具施工方案
- 使用保姆合同范本
- ppp 外貿(mào)合同范本
- 公寓租給酒店合同范本
- 仿古街建設(shè)合同范本
- 《國際貿(mào)易實(shí)務(wù)(英文版)》(英文課件) -Ch 6 International Cargo Transport-Ch 11 Cross-border Commerce
- 退休延期留用崗位協(xié)議書
- 3.1 歌曲《音階歌》課件(10張內(nèi)嵌音頻)
- 中醫(yī)適宜技術(shù)-中藥熱奄包
- 2024年儲(chǔ)能行業(yè)市場全景分析及發(fā)展趨勢展望報(bào)告
- 2024-2025學(xué)年小學(xué)科學(xué)五年級(jí)下冊青島版(六三制2024)教學(xué)設(shè)計(jì)合集
- 林海雪原課件6張
- 文言文雙文本閱讀:重耳出亡(附答案解析與譯文)
- 銀發(fā)經(jīng)濟(jì)產(chǎn)業(yè)發(fā)展規(guī)劃
- DL∕T 664-2016 帶電設(shè)備紅外診斷應(yīng)用規(guī)范
- 團(tuán)體標(biāo)準(zhǔn)-電化學(xué)儲(chǔ)能電站能量管理系統(tǒng)技術(shù)規(guī)范
評(píng)論
0/150
提交評(píng)論