溃疡性结肠炎的诊断与鉴别诊断.ppt

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1、溃疡性结肠炎的诊断和鉴别诊断ClinicalPresentationIntestinalSymptoms70%ofpatientswithUCreport>5bowelmovementsduringacutephases.Themainreasonfordiarrheaiscolonicinflammation,butbileacidandfoodmalabsorptionsecondarytoinflammationintheterminalileumortheproximalsmallbowelcan

2、contributetothissymptom.Ahistoryofsurgicalresectionscanbeseminalinexplainingsymptoms.AcutephasesofUCalmostalwayspresentwithbloodydiarrhea(“hematochezia”).Activeinflammatoryanorectallesionsresultinurgencyofdefecationandcrampsarounddefecation(“tenesmus”).UC

3、patientsoftencomplainoflowerleftquadrantpain.ExtraintestinalManifestationsWafikEl-DieryandDavidMetz,SectionEditors．DiagnosticsofInflammatoryBowelDisease．Gastroenterology，2007;133:1670–1689．肠外表现(Extraintestinalmanifestations)肠外表现包括：皮肤黏膜表现(如口腔溃疡、结节性红斑和坏疽性脓皮

4、病)关节损害(如外周关节炎、脊柱关节炎等)眼部病变(如虹膜炎、巩膜炎、葡萄膜炎等)、肝胆疾病(如脂肪肝、原发性硬化性胆管炎、胆石症等)血栓栓塞性疾病等。MendozaJL,LanaR,TaxoneraCetal.Extraintestinalmanifestationsininflammatoryboweldisease:differencesbetweenCrohn’sdiseaseandulcerativecolitis.Med.Clin.(Barc.)2005;125:297–300.并发症(Com

5、plications)并发症包括：中毒性巨结肠（toxicmegacolon）肠穿孔下消化道大出血上皮内瘤变和癌变钱家鸣,等.溃疡性结肠炎合并中毒性巨结肠六例及文献复习.中华内科杂志[J].2012，51(9):694-697/ChowDK，LeongRW，TsoiKK,eta1．Long—termfollow—upofulcerativecolitisintheChinesepopulation．AmJGastroenterol，2009，104：647-654．SerologicalmarkersTh

6、etwomostwidelystudiedserologicalmarkersininflammatoryboweldiseaseinrecentyearshavebeenp-ANCAandASCA.Theclinicalutilityofp-ANCAorASCAtestinginthediagnosisofinflammatoryboweldisease,inpatientswithnon-specificgastrointestinalsymptoms,islimitedbecauseofthevar

7、yingseroprevalenceoftheseantibodiesinpatientswithinflammatoryboweldiseaseandtheinadequatesensitivityoftheassays.ReeseGE,ConstantinidesVA,SimillisCetal.Diagnosticprecisionofanti-Saccharomycescerevisiaeantibodiesandperinuclearantineutrophilcytoplasmicantibo

8、diesininflammatoryboweldisease.AmJGastroenterol.2006(Oct);101(10):2410–22.尿白蛋白目的：探讨炎症性肠病患者尿中白蛋白的临床意义。方法：对临床确诊的32例IBD患者（UC27例，CD5例)在疾病的不同时期，用免疫放射比浊法测定尿中白蛋白，并结合临床Harvey和Bradshaw指数进行综合分析，选取25例健康人为正常对照。结果：患者尿白蛋白活动期比缓解期明