病理学ppt课件 肠炎.ppt

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1、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

2、 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1

3、00cm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 he

4、re 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

5、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

6、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

7、：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

8、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 neutrophili

9、c 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.

10、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 mu

11、cosa.,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

12、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、

13、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。,