暴发性溃疡性结肠炎临床诊治现状课件.ppt
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1、暴发性溃疡性结肠炎临床诊治现状 Current Management of Fulminant Ulcerative Colitis,导读,你是否已了解:本次课程将带你对以上问题一一进行探索,一、定义与概论,为一组以肠道破坏、出血、坏死、纤维化和梗阻为主要表现慢性炎症。目前认为,IBD发病与遗传背景和肠道与正常菌群之间的异常免疫反应有关 溃疡性结肠炎(ulcerative colitis,UC)克罗恩病(Crohn disease,CD)未定型结肠炎(indeterminate colitis,IC),炎症性肠病(inflammatory bowel disease,IBD),一、定义与概论,
2、何为暴发型溃疡性结肠炎?,暴发型溃疡性结肠炎(Fulminant ulcerative colitis,FUC)为溃疡性结肠炎急性发作中最为严重的类型。患者发病急骤,病情凶险,发热、大量粘液脓血便,病情在短时间内迅速恶化,虽经内、外科积极治疗,但仍有不少患者需要经全结肠切除才可缓解,部分患者则可能病死于重症感染、休克、中毒性巨结肠、肠出血和肠穿孔等并发症。,从FUC的定义来看,我们是否就能认为它是UC的一个分支呢?,Reports of manifestations of IBD(Crohns Disease?)have been reported as early as 850 AD whe
3、n King Alfred,Englands Darling,suffered from an illness which caused pain on eating,discomfort,and much embarrassment.This affliction plagued the King from the age of 20,without remission.At the time the illness was thought to be due to witchcraft,or a punishment for the Kings infidelities.In retros
4、pect,however,the illness was probably Crohns Disease from todays knowledge.,History of IBD,An article was published in the British Medical Journal of 1913 by T.Kennedy Dalziel,who reported treating 13 patients who had suffered from intestinal obstruction.On autopsy he found that all 13 patients had
5、inflamed gut,especially in the jejunal,ileal and colonic areas.On examining the inflamed bowel more closely,the transmural inflammation that is characteristic of the disease was clearly seen.,History of IBD,文献对FUC定义有不同看法,溃疡性结肠炎慢性过程的急性暴发加剧也归于FUC,也有的将结肠型克罗恩病(Crohn disease,CD)或CD结肠受累者出现重症暴发表现者,也称之为急性重症
6、结肠炎(acute severe colitis,ASC),ASC与FUC可通用,二、诊断问题,二、诊断问题,二、诊断问题,IBD评级指标的确立也是一个不断完善的过程!,二、诊断问题,重症溃结还可细分为重度、极重度和暴发型 极重度:血便9次/日;体温38;脉搏90次/分;血红蛋白90g/L;血浆白蛋白30g/L;明显营养不良或中毒症状 上述指标只要符合三项即可判极重度或危重型FUC指突然发作的极重度或重度UC,也即突然发作,加以下4条中2条:心动过速;体温38.6;外周血白细胞10.5106/L;低蛋白血症,欧阳钦,等.临床内科杂志 2006:23(8):512,二、诊断问题-内镜检查,二、诊
7、断问题,病理组织学改变,肠腺排列紊乱,隐窝肿大、破坏、融合和隐窝脓肿,大量急性炎症细胞浸润,基底膜断裂,粘膜下层血管炎,浅溃疡,融合成片,弥漫性充血水肿、血性渗出,好医生课件,鉴别诊断的要点,全结肠镜检查的安全性问题,Modigliani R,et al.Inflam Bow Dis 2002;8(2):129-134,4,全结肠镜检查的注意事项,三、FUC的临床处理,相关标准评定为重症,即按FUC住院重症监护,内外科联合管理;保持外科专家联系严格禁食,根据腹泻与粘液血便和肠粘膜修复情况实施营养管理每天体检,了解腹部压痛和反跳痛每天记录4次生命体征,2448小时测血常规、ESR、CRP、大便、
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- 暴发 性溃疡 结肠炎 临床 诊治 现状 课件
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