溃疡性结肠炎的诊断与治疗精要.ppt

溃疡性结肠炎的诊断与治疗 临床症状 常见：腹痛、发热(38?C)、腹泻、血便、 消瘦。 肠外表现：关节炎、口腔溃疡、强直性脊柱 炎（HLA-B27）、微型硬化性胆 管炎。 内镜检查及X线检查 内镜检查表现：中毒性巨结肠是内镜绝对 禁忌症 钡剂灌肠：铅管征、毛刺样改变、粘膜颗 粒粗糙 Ulcerative colitis in remissionFigure 4-2. Ulcerative colitis in remission. The normal vascular pattern is absent and a white scar indicates the site of a previous ulcer. Severe ulcerative colitisFigure 4-3. Severe ulcerative colitis. The mucosa shows extensive ulceration and diffuse thickening with an inflammatory infiltrate. In contrast to Crohn`s colitis, the ulceration lacks depth. Chronic ulcerative colitisFigure 4-5. Chronic ulcerative colitis. In long-standing ulcerative colitis, the mucosa has an atrophic and scarred appearance with a blunted vascular pattern. Pseudopolyps are often present. Severe ulcerative colitis with pseudopolypsFigure 4-4. Severe ulcerative colitis with pseudopolyps. In addition to severe mucosal ulceration and inflammation, chronic ulcerative colitis is often associated with the formation of pseudopolyps, which represent islands of regenerating mucosa and exuberant inflammation amidst diffuse mucosal destruction. Pseudopolyps have no malignant potential. Severe ulcerative colitisFigure 4-6. Radiographic appearance of severe ulcerative colitis. This single-contrast barium enema demonstrates the typical ragged and ulcerative appearance of the mucosa in active ulcerative colitis. Characteristic collar-button or undermining ulcers are seen. In general, barium enema and colonoscopy should be avoided in fulminant ulcerative colitis because of the possibility of precipitating toxic megacolon. Chronic ulcerative colitisFigure 4-7. Radiographic appearance of chronic ulcerative colitis. Long-standing chronic ulcerative colitis, as shown in this single-contrast barium enema, is characterized by shortening and straightening of the colon with loss of haustrations, resulting in the appearance of a featureless tube. No ulcerations are seen. 其他辅助检查 血沉、白细胞计数（10.0X10