病理学ppt课件 肠炎.ppt
第三节 非特异性肠炎,局限性肠炎慢性溃疡性结肠炎,一、局限性肠炎（Crohn病）又称克罗恩病、克隆氏病（一）定义：是一种病因未明的主要侵犯消化道 的全身性疾病。（二）常见人群：20-30岁青年（三）好发部位：回肠末端结肠回肠近端空肠等（四）病因、发病机制：免疫、遗传、感染有关,（五）病理变化 肉眼观：病灶呈节段性分布 病变处粘膜高度水肿增厚呈卵石状 粘膜面有裂隙状溃疡（深、长）穿孔、肠瘘 病变肠壁因纤维化而增厚、变硬、肠腔狭窄 可与邻近肠管发生粘连,Crohn病发生在小肠。黏膜表面有不规则的充血结节和浅表溃疡灶。This is another example of Crohns disease involving the small intestine.Here,the mucosal surface demonstrates an irregular nodular appearance with hyperemia and focal superficial ulceration.,女，63，反复便血。直肠和乙状结肠可见节段性粘膜溃疡糜烂，并见渗血、粘液和脓液；距肛门100cm至135cm这一段肠道可见多个结节隆起，基底僵硬。脆易出血，蠕动缺失。病理：粘膜炎性坏死，部分腺体轻度不典型增生。,女，63，反复便血。直肠和乙状结肠可见节段性粘膜溃疡糜烂，并见渗血、粘液和脓液；距肛门100cm至135cm这一段肠道可见多个结节隆起，基底僵硬。脆易出血，蠕动缺失。病理：粘膜炎性坏死，部分腺体轻度不典型增生。,光镜下：裂隙状溃疡，表面被覆坏死组织 穿壁性炎症：肠壁全层慢性炎症，有淋巴 滤泡形成。粘膜下层淋巴管高度扩张，有严重的淋巴水肿 50%-70%病例肠壁有结核样肉芽肿形成,可见类上皮细胞和多核巨细胞，但无干酪样坏死,Crohn病并发症瘘管。左边可见裂缝从黏膜延伸到黏膜下层、肌层，最终形成瘘管。瘘管可在肠袢间、膀胱和皮肤形成。累及结肠的直肠周瘘管常见。One complication of Crohns disease is fistula formation.Seen here is a fissure extending through mucosa at the left into the submucosa toward the muscular wall,which eventually will form a fistula.Fistulae can form between loops of bowel,bladder,and skin.With colonic involvement,perirectal fistulae are common.,显微镜下Crohn病的特点是穿壁性炎症。炎细胞（兰色浸润）从黏膜层到黏膜下层、肌层均有浸润，在浆膜表面苍白的肉芽肿中心出现结节性浸润。Microscopically,Crohns disease is characterized by transmural inflammation.Here,inflammatory cells(the bluish infiltrates)extend from mucosa through submucosa and muscularis and appear as nodular infiltrates on the serosal surface with pale granulomatous centers.,Crohn病炎性肉芽肿，有上皮样细胞、巨细胞和许多淋巴细胞。微生物特殊染色阴性。At high magnification the granulomatous nature of the inflammation of Crohns disease is demonstrated here with epithelioid cells,giant cells,and many lymphocytes.Special stains for organisms are negative.,（四）临床表现 1、腹痛、腹泻、腹部肿块、肠穿孔、肠瘘 形成等。2、肠外免疫性疾病，如游走性多关节炎、强直性脊柱炎等。,二、慢性溃疡性结肠炎（一）定义：是一种病因不明的慢性结肠炎症。（二）常见人群：30岁以上（三）好发部位：结肠各段（四）发病机制：多认为是自身免疫性疾病,（五）病理变化 肉眼观：粘膜隐窝多发性小脓肿 不断扩大、相互沟通、融合破溃 坏死粘膜脱落表浅小溃疡大片溃疡（多发、大而不规则）残存肠粘膜充血、水肿、增生形成假息肉,假息肉清晰可见发红炎性的岛屿状粘膜。假息肉间仅存肌层。At higher magnification,the pseudopolyps can be seen clearly as raised red islands of inflamed mucosa.Between the pseudopolyps is only remaining muscularis.,光镜下：炎症主要累及粘膜、粘膜下层，一般不波及肌层、外膜（中性粒C、淋巴C、浆C及嗜酸性粒C浸润）多个隐窝小脓肿形成 溃疡形成，溃疡底部血管壁纤维素样坏死 溃疡边缘肠粘膜上皮可见不典型增生易癌变 晚期病变区肠壁有大量纤维组织增生,急性溃疡性结肠炎结肠显示粘膜隐窝有小脓肿，腺腔内可见中性粒细胞渗出。黏膜下层有严重的炎症。不典型炎症中腺体缺少杯状细胞和细胞核深染。The colonic mucosa of active ulcerative colitis shows crypt abscesses in which a neutrophilic exudate is found in glandular lumens.The submucosa shows intense inflammation.The glands demonstrate loss of goblet cells and hyperchromatic nuclei with inflammatory atypia.,溃疡性结肠炎典型的组织学表现是粘膜隐窝小脓肿。不幸的是，并不是所有的炎症性肠病都能精确归类。Crypt abscesses are a histologic finding more typical with ulcerative colitis.Unfortunately,not all cases of inflammatory bowel disease can be classified completely in all patients.,显微镜，溃疡性结肠炎最初限制在黏膜，溃疡破坏局部粘膜同时逐渐破坏周围粘膜。Microscopically,the inflammation of ulcerative colitis is confined primarily to the mucosa.Here,the mucosa is eroded by an ulcer that undermines surrounding mucosa.,高倍镜下见严重的黏膜炎症。结肠黏膜上皮表明缺少杯状细胞，表面上有渗出物。急慢性炎症细胞都存在。At higher magnification,the intense inflammation of the mucosa is seen.The colonic mucosal epithelium demonstrates loss of goblet cells.An exudate is present over the surface.Both acute and chronic inflammatory cells are present.,随着时间的推移，溃疡性结肠炎病人有患腺癌的危险。左侧可见很多正常腺体，但是右侧腺体明显异常，是第一个恶变的标志。Over time,there is a risk for adenocarcinoma with ulcerative colitis.Here,more normal glands are seen at the left,but the glands at the right demonstrate dysplasia,the first indication that there is a move towards neoplasia.,（六）临床表现 1、腹痛、腹泻等 2、肠外免疫性疾病，如游走性多关节炎、原发性硬化性胆管炎等。,女，42岁。循腔进镜至结肠脾曲，可见直肠、乙状结肠、降结肠弥漫性充血水肿，糜烂溃疡。表面覆白苔脓液病理结果：1.溃疡性结肠炎；2.腺瘤型息肉，伴慢性炎。,女，48岁。直肠和横结肠粘膜分别可见弥漫性充血水肿、点、片状糜烂溃疡，覆污苔和脓性分泌物，渗血，脆性增加。,患者殷某某，女，45岁。从直肠至横结肠的左半段，可见弥漫性充血水肿、点、片状糜烂溃疡，覆污苔和脓性分泌物，渗血，脆性增加，其中从距肛门25至40cm处可见大小不等、数目较多的圆形或卵圆形隆起，并见粘膜桥形成。病理检查诊断：溃疡性结肠炎，部分腺体增生。,三、急性出血性坏死性肠炎1、发生在小儿2、主要发生在小肠3、病变呈节段性分布，4、病变肠壁呈急性炎症，有严重的出血、坏死，粘膜面有假膜形成。5、可能是细菌或病毒感染后引起的激烈的变 态反应性疾病。,四、菌群失调性肠炎1、发生在各年龄2、肠道各段可发病3、假膜性炎4、长期大量应用广谱抗生素，肠内菌群失调 所致。,
