溃疡性结肠炎的诊断与治疗

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1、溃疡性结肠炎的诊断与治疗临床症状常见：腹痛、发热(<38˚C)、腹泻、血便、消瘦。肠外表现：关节炎、口腔溃疡、强直性脊柱炎（HLA-B27）、微型硬化性胆管炎。内镜检查及X线检查内镜检查表现：中毒性巨结肠是内镜绝对禁忌症钡剂灌肠：铅管征、毛刺样改变、粘膜颗粒粗糙EndoscopicfeaturesofactiveulcerativecolitisFigure4-1.Endoscopicfeaturesofactiveulcerativecolitis.Findingsincludediffuselyerythemato

2、us,edematous,andgranularmucosawithareasofsubmucosalhemorrhageand,whensevere,frankmucopurulentexudate.Inflammationinvariablybeginsintherectumandextendsproximallyforvaryingextents.Thechronicityoftheprocessissuggestedbythelossofcolonichaustrations;otherwise,theendo

3、scopicpictureisnonspecificandcouldbeconsistentwithacuteinfectiouscolitis,chroniculcerativeorCrohn`scolitis,oranynumberofotherspecificcausesofcolitis.A,Milddistalulcerativecolitiswithdiffuseerythemaandfriabilitywelldemarcatedfromthenormalmucosamoreproximallyisdep

4、icted.B,Thisexampleshowsmoderatelysevereulcerativecolitiswithirregular,inflamed,ulceratedmucosaandapatchyexudate.UlcerativecolitisinremissionFigure4-2.Ulcerativecolitisinremission.Thenormalvascularpatternisabsentandawhitescarindicatesthesiteofapreviousulcer.Seve

5、reulcerativecolitisFigure4-3.Severeulcerativecolitis.Themucosashowsextensiveulcerationanddiffusethickeningwithaninflammatoryinfiltrate.IncontrasttoCrohn`scolitis,theulcerationlacksdepth.ChroniculcerativecolitisFigure4-5.Chroniculcerativecolitis.Inlong-standingul

6、cerativecolitis,themucosahasanatrophicandscarredappearancewithabluntedvascularpattern.Pseudopolypsareoftenpresent.SevereulcerativecolitiswithpseudopolypsFigure4-4.Severeulcerativecolitiswithpseudopolyps.Inadditiontoseveremucosalulcerationandinflammation,chronicu

7、lcerativecolitisisoftenassociatedwiththeformationofpseudopolyps,whichrepresentislandsofregeneratingmucosaandexuberantinflammationamidstdiffusemucosaldestruction.Pseudopolypshavenomalignantpotential.SevereulcerativecolitisFigure4-6.Radiographicappearanceofsevereu

8、lcerativecolitis.Thissingle-contrastbariumenemademonstratesthetypicalraggedandulcerativeappearanceofthemucosainactiveulcerativecolitis.Characteristiccollar-buttonorun