溃疡性结肠炎的诊断与鉴别诊断

1、会计学1溃疡性结肠炎的诊断与鉴别诊断溃疡性结肠炎的诊断与鉴别诊断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检查所见的主要改变为：n(1)黏膜粗乱和(或)颗粒样改变；n(2)肠管边缘呈锯齿状或毛刺样，肠壁有多发性小充盈缺损；n(3)肠管短缩，袋囊消失呈铅管样。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，Fiocehi CUlcerative colitisN Engl J Med，2011365：1713 1725n 结肠镜检查并活组织检查(后文简称活检)是UC诊断的主要依据。n 结肠镜下UC病变多从直肠开始，呈连续性、弥漫性分布，表现为：n (1)黏膜血管纹理模糊、紊乱或消失，黏膜充血、水肿、质脆、自发或接触出血和脓性

7、分泌物附着，亦常见黏膜粗糙、呈细颗粒状；n (2)病变明显处可见弥漫性、多发性糜烂或溃疡；n (3)可见结肠袋变浅、变钝或消失以及假息肉、桥黏膜等。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 内镜下黏膜染色技术能提高内镜对黏膜病变的识别能力，结合放大内镜技术，通过对黏膜微细结构的观察和病变特征的判别，有助UC诊断，n 姜泊，等放大内镜结合黏膜染色技术诊断溃疡性结肠炎附1 16例放大内镜形态分析现代消化及介入诊疗，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. 缺血性结肠炎与溃疡性结肠炎的临

11、床鉴别诊断. 胃肠病学. 2010， 15(11)： 681-683.感谢您的观看！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，Fiocehi CUlcerative colitisN Engl J Med，2011365：1713 1725