hulin1978 Posted at 2010-4-26 21:17
Crohn's disease, ulcerative colitis, irritable bowel syndrome, bowel disease study notes
Crohn disease (Crohn's disease)
Crohn disease (Crohn's disease) in the past as the limitations of colitis, segmental colitis or granulomatous enterocolitis, a gastrointestinal tract of unknown etiology of chronic inflammatory granulomatous sexually transmitted diseases. Non-necrotizing granulomas cheese. (Legend: Tuberculosis is a necrotizing granulomatous caseous.)
Mainly in the ileum and adjacent colon is not. However, sections of the digestive tract mouth to anus may be involved, often has the distribution segment.
Lesions were segmental and jumping.
Summary: Crohn's disease is not a good site is the ileum segments were segmental distribution, between the mucosa and the mucosa to form a paving stone or pebble-like changes. Longitudinal fissure-like ulcers are ulcers. Histology non-caseating granulomas. Can form inside and outside the fistula.
Clinical manifestations
Abdominal pain, increased after meals, relieved by defecation or anal discharge.
Diarrhea: Fecal most paste, usually without pus and blood and mucus.
Fistula formation, is the manifestation of clinical features of the disease.
The most common complication is intestinal obstruction. Followed by intra-abdominal abscess.
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X-ray barium meal, longitudinal ulcer or fissure, pebbles Zheng, false polyps, multiple stenosis, fistula formation. Segmental distribution of lesions were
Line-like symptoms, intestinal loop separation
Colonoscopy: The lesions were segmental, see longitudinal ulcers, ulcers were normal or around the cobblestone-like mucosa, luminal narrowing, inflammatory polyps, lesions of mucous membrane between the appearance of normal bowel.
Diagnosis: colon biopsy, see non-necrotizing granulomatous cheese or a large number of lymphocytes together
Differential Diagnosis
Changes of intestinal tuberculosis, mainly in the ileocecal area, mostly secondary to open pulmonary tuberculosis. Crohn's lesions in the ileum did not segment.
Treatment
Drug treatment:
1
Amino acid formulations: sulfasalazine only for those lesions confined to the colon.
2
Corticosteroids: disease activity is more effective control of drugs for the disease active.
3
Immunosuppressant: effect of hormone therapy apply to the poor or steroid dependent chronic active cases. Not a preferred drug.
Surgical treatment:
Mainly for complications, including complete obstruction, failure of medical treatment of the fistula and abscess formation, acute perforation, can not control the heavy bleeding, cancer and so on.
Ulcerative colitis
Mainly with the immune disease and heredity.
Clinically, abdominal pain, mucoid pus and blood stools, abdominal pain, a direct diagnosis of the three symptoms of ulcerative colitis.
Predilection sites: the rectum colon.
Contrast Memory: Ulcerative colitis in the rectosigmoid major predilection
Crohn's disease in the ileum is not the main section of the predilection
Intestinal tuberculosis, mainly in the cecum predilection
Ulcerative colitis lesions were continuous, non-segmental distribution. Because the disease is generally limited to mucosa and submucosa, so the concurrent colon perforation, abscess fistula formation, or colon are rare. (With the identification of Crohn's disease)
Clinical manifestations
1
Diarrhea
Nature of the mucus pus and blood will. Is an important manifestation of active
The surface of the blood in the stool, indicating that lesions mainly confined to the rectum
Among the blood mixed with feces, indicating that lesions extended to the rectum above.
2
Abdominal pain
Pain - it means - and after the law of mitigation
The title of abdominal pain, mucus pus and blood stools, diarrhea and direct diagnosis of ulcerative colitis.
If there is peritoneal irritation, should be noted that the expansion in toxic megacolon, intestinal perforation complications.
3
Symptoms
4
Intestinal manifestations
Complications:
1, toxic megacolon, ulcerative colitis is the most common complication
Good site: toxic megacolon with transverse colon in the most serious
Predisposing factors: often due to low potassium, barium enema, the use of anticholinergic drugs or opioid induced by tincture.
Clinical manifestations: drums intestines, abdominal tenderness, bowel sounds disappear.
KUB: visible increase colon, colon bags disappear.
2
, Colorectal cancer can become cancerous, but no such complications of Crohn's disease.
Colonoscopy
Colonoscopy can see 1, multiple shallow ulcers, with pus and blood secretions
2, coarse granular mucosa
3, inflammatory polyps
X-ray barium enema
1, burr-like jagged little Kanying
2, colon bags disappear and intestines can lead pipe was. (Fulminant cases generally do not do heavy or barium enema, to avoid worse.)
Differential Diagnosis
Ulcerative disease of the colon with the identification of colonic Crohn see P588 Table 13-09
Treatment
The same drug treatment and Crohn's disease 1, amino acid preparations, sulfasalazine (referred to as SASP)
2, glucocorticoid
3, immunosuppressive agents
Irritable bowel syndrome
A kind of abdominal pain or discomfort associated with change in bowel habits, characterized by functional diseases.
Is characterized by symptoms of mental stress can make symptoms worse.
Diagnosis: abdominal pain, anxiety + + + does not affect the stool without sepsis diagnosis of the disease can sleep.
Treatment to remove precipitating factors, symptomatic treatment
Posted at 2010-4-27 10:52 413749053
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