最新Inflammatory bowel disease肠道炎症性疾病-药学医学精品资料.ppt

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1、最新Inflammatoryboweldisease肠道炎症性疾病-药学医学精品资料UlcerativecolitisDefinitionAchronicinflammatorydiseaseofunknownetiologythatinvolvesthemucosaofthecolonandrectumcharacterizedbyacuteexacerbationsandremissions.AetiologyandpathogenesisPerinuclearantineutrophilcytoplasmicantibodiescanbefoundin60%ofpatients

2、withulcerativecolitis,whichsuggestsanunderlyingimmunologicalcause,butitisdifficulttoascertainwhetherthechangesinautoantibodiesareacauseoraresultofthedisease.Ulcerativecolitisaffectstherectumandmayextendalongthewholelengthofthecolon.ExceptbackwashileitisMacroscopicallythemucosalooksinflamedandbl

3、eedseasilyandinseveredisease,extensiveulcerativeisseenwithneighbouringmucosaappearinglikepolyps.PathologyTheinflammationislimitedtothemucosaandsubmucosawithinflammatorycellsaccumulatinginthelaminapropriaandcolonicglandtoformcryptabscesses.gobletcelldepletionisalsoseen.Longstandingcolitisresults

4、infibrosisofmucosaandsubmucosa,hencelossofhaustralpatternandashortenedandfeaturelesscolonComplicationsToxicmegacolonisseenonplainabdominalx-ray.Dilatationof5cmorgreaterisassociatedwithariskofperforationandperitonitis.Thepatientisusuallyunwellwithfever,abdominaltenderness,andtachycardia.Therisko

5、fdevelopingadenocarcinomaafter10yearsofcolitisisapproximately5%higherthanthegeneralpopulation.ComplicationsCholangiocarcinomaariseswithincreasingfrequencyinpatientswithulcerativecolitiswhenprimarysclerosingcholangitisispresent.Amyloidosisisprobablyrelatedtohighlevelsofcirculatingacutephaseprote

6、induringexacerbationsDiagnosisThediagnosisreliesontheclinicalpicture(mainlythehistory),astoolexamination,thesigmoidoscopicorcolonoscopicappearances,andthehistologicassessmentofrectalorcolonicbiopsyspecimens.PrognosisThecourseofthediseaseisvariable,butcharacteristicallyitisachronicrelapsingdisea

7、se.patientswithproctitisalonehaveagoodoverallprognosis.withonly10%progressingtomoreextensivedisease.severefulminantdiseaseisassociatedwithupto25%mortalityTreatmentCorticosteroids5-aminosalicylicacidcompoundsareeffectiveinreducinga