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Case

Case. A 25-year-old woman A 4-m history of abdominal pain in the left lower quadrant and bloody diarrhea. ？. Case. Stool Examination: WBC + ,RBC ++ Microbiologic cultures of stools : negative. Colonoscopy. Colonoscopy. Continuous ulcers begin in the rectum.

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Case

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  1. Case A 25-year-old woman A 4-m history of abdominal pain in the left lower quadrant and bloody diarrhea

  2. ？

  3. Case • Stool Examination: WBC + ,RBC ++ • Microbiologiccultures of stools : negative

  4. Colonoscopy

  5. Colonoscopy Continuous ulcers begin in the rectum

  6. Colonoscopy biopsy

  7. Pathology crypt abscesses (H/E, 4x) (H/E, 10x)

  8. Ulcerative Colitis Yan Chen 陈焰 Second Affiliated Hospital

  9. Concept • Idiopathic Inflammatory Bowel Disease ( IBD) • Ulcerative colitis(UC) • Crohn’sdisease (CD)

  10. IBD 有关内容

  11. Learning Objectives • Understand the current theories of IBD pathogenesis • Understand the clinical presentation, and management of ulcerative colitis and Crohn’s disease • Understand the fundamental differences between ulcerative colitis and Crohn’s

  12. commendatory websites and books • commendatory websites • http://content.nejm.org/ • http://www.ccfa.org • http://www.gastrolab.net/show.html • http://www-medlib.med.utah.edu/WebPath/TUTORIAL/IBD/IBD.html • commendatory books • Harrison’s principles of internal medicine 15th Edition • Goldman: Cecil Medicine, 23rd ed Chapter 144 

  13. Ulcerative Colitis (UC) • Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  14. Concept • Ulcerative Colitis An idiopathic inflammatory disorderinvolving primarily the mucosa and submucosa of the colon • especially the rectum • often with mucosal erosions and ulcers

  15. Concept • colitis confined • rectum (proctitis) • rectum and sigmoid colon (proctosigmoiditis) • splenic flexure (left sided colitis) • colitis up to • the hepatic flexure (extensive colitis) • the whole colon (pancolitis)

  16. Concept

  17. Ulcerative Colitis (UC) • Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  18. Mucosal Immune System (Immuno-regulatory Defect) Genetic Predisposition IBD Environmental Triggers (Lumenal Bacteria, Infection) Etiologic Theories inIBD

  19. Ulcerative Colitis (UC) • Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  20. Pathology • Tends to begin in the rectum and be continuous • Limited inflammation • Mucosa and submucosa • Crypt abscess

  21. Pathology • Tends to be continuous along the mucosal surface; • Tends to begin in the rectum.

  22. Pathology • Tends to begin in the rectum and be continuous • Limited inflammation • Mucosa and submucosa • Crypt abscess

  23. Normal colon

  24. Ulcerative colitis

  25. Pathology • Tends to begin in the rectum and be continuous • Limited inflammation • Mucosa and submucosa • Crypt abscess: Characteristic finding

  26. Characteristic finding Crypt abscess

  27. Pathology • Tends to begin in the rectum and be continuous • Limited inflammation • Mucosa and submucosa • Crypt abscess

  28. Ulcerative Colitis (UC) • Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  29. Clinical presentation • variable • Bloody diarrhea hallmark • Abdominal pain • Fecal urgency • Tenesmus

  30. U C Mild Moderate Severe Bowel movements <4/d 4-6/d >6/d Blood in stool Small Moderate Severe Fever None <37.5℃ >37.5℃ Tachycardia None <90 >90 Anemia Mild Moderate Severe ESR <30mm >30mm Endoscopic Erythema Marked Erythema Spontaneous appearance contract bleeding bleeding, ulcerations

  31. extraintestinal manifestation Pyoderma gangrenosum Erythema nodosum Episcleritis

  32. Ulcerative Colitis (UC) • Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  33. Diagnosis • Essentials of Diagnosis • Bloody diarrhea • Lower abdominal pain and fecal urgency • Anemia,low serum albumin • Negative stool cultures • Colonoscopy is key to diagnosis • Imaging is helpful sometimes

  34. Laboratory finding • Negative stool cultures • Anemia, ESR,CRP • low serum albumin • p-ANCA: 70% positive

  35. Negative stool cultures • Very important

  36. Imaging • Plain abdominal • Barium enemas

  37. Plain abdominal Severe patients colonic dilation Toxic megacolon

  38. Diagnosis • Essentials of Diagnosis • Bloody diarrhea • Lower abdominal pain and fecal urgency • Anemia,low serum albumin • Negative stool cultures • Colonoscopy is key to diagnosis • Imaging is helpful sometimes

  39. Concept • Etiology • Pathology • Clinical presentation • Diagnosis and differential diagnosis • Complications • Treatment

  40. Differential diagnosis • Infectious disease：ameba, dysentery… • CD • Colon cancer • IBS • Tub • Ischemic colitis

  41. amebiasis HE stain PAS ： trophozoite

  42. amebiasis colonscopy amebiasis amebiasis

  43. UC CD Colon only, proximally from rectum Pan-intestinal, Skip-lesions

  44. UC CD mucosa and submucosa Transmural granulomas crypt abscess

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