Seven, treatment
(a) general treatment
1. Rest 2 high-calorie diet, high protein and vitamin rich foods easy to digest as appropriate. Hepatic dysfunction or hepatic encephalopathy aura should be restricted or prohibited food proteins; have ascites salt or no salt diet should be. alcohol and to avoid eating hard foods rough, disable damage the liver support treatment drug .3 patients with decompensated anorexia, eating less, cutting and more nausea and vomiting, should be intravenous hypertonic glucose solution to supplement the heat, the infusion can be added Vitamins C, insulin, kcl, etc.; should pay special attention to maintain water and electrolyte and acid-base balance, the condition can be heavier compound amino acid, albumin or blood.
(b ) There is no cure for drug treatment, usually available vitamins and digestive enzymes. colchicine have some antifibrotic effect on liver functional reserve in patients with decompensated better have a certain effect, 1mg / d, 2 times service, 5 days a week. TCM treatment of drug commonly used blood stasis syndrome differentiation-based.
(c) ascites
1. limitation of water, sodium intake
2. diuretic use main use of spironolactone (spironolactone, potassium retention diuretics, alone can lead to hyperkalemia, there are hormone-like side effects such as gynecomastia, can use ammonia or Ben pteridine) and furosemide (furosemide , Pai potassium-sparing diuretics, alone should be taken KCl). currently advocated in combination.
3. paracentesis plus albumin lost
4. increase the plasma colloid osmotic pressure a small amount of blood or albumin infusion times
5. ascites reinfusion treatment of refractory ascites. paracentesis 5000-10000ml, through the enrichment process for the 500ml, come back to lose. to clear some of the water and sodium retention, but can increase the plasma concentrations of albumin and effective blood volume to improve the renal blood circulation to eliminate or reduce ascites. There can not be infected ascites reinfusion.
6. celiac - jugular vein drainage (Le Veen drainage method)
(d) Surgical treatment of portal hypertension portal vein pressure decreased and the elimination of hypersplenism. no jaundice or ascites, mild liver damage and no complications, surgery is better.
(e) complications of treatment
1. upper gastrointestinal bleeding First aid measures: fasting , supine, intensive care, the rapid and effective blood volume supplement to correct the hemorrhagic shock and hemostasis to take effective measures to prevent hepatic encephalopathy.
2. stepped up to support the treatment of spontaneous bacterial peritonitis and the use of antimicrobial agents. emphasized earlier, adequate and joint use of antimicrobial drugs, to immediately upon diagnosis. the main consideration for the G-G + cocci bacteria and drugs, such as Ampicillin, cefotaxime sodium masonry, cephalosporins it fixed, ceftriaxone, ciprofloxacin and other select 2 -3 types of joint use. According to the results of treatment response and to consider adjusting the training of antimicrobial agents; started a few days dose should be large, stable condition after the reduction; due to recurrence of complications, medication time, not less than 2 weeks.
3. Liver encephalopathy see below section
4. currently no effective treatment of hepatorenal syndrome. In a positive context to improve liver function, to take a rapid control of gastrointestinal bleeding, infection, predisposing factors; 2 strictly control the fluid volume, measure out the entry, correcting water, electrolyte and acid-base balance disorder; 3 infusion of dextran, albumin or concentrated ascites reinfusion to raise circulating blood volume, improve renal blood flow, based on the expansion of diuretics; 4 vasoactive drugs such as dopamine , PGI2 can improve renal blood flow, increased glomerular filtration rate; 5 focus on prevention, to avoid a strong diuretic, simply put a lot of damage to liver function with ascites and taking drugs.
(f) Eight liver transplant
pathology
naked eye: the early and middle liver volume is normal or slightly larger, slightly harder texture. late liver volume reduced weight. nodular surface was small, similar in size, the largest nodule diameter of less than 1.0cm, see the summary section fibrous tissue between sections of the cable package to Rao, yellow brown nodules (steatosis) or yellow-green (cholestasis)
microscope: normal lobular structure was destroyed by the extensive proliferation of fibrous tissue to regeneration Results divided into sections of varying sizes surrounded, round or oval-shaped liver cell mass, known as the fake leaflets. false lobular liver cell cord disorder, more liver cells, and a large, deeply stained, often found in liver cells dual-core . centrilobular vein absent, partial-bit or more than two. pseudolobuli weeks the fibrous tissue outside the Zhouzeng Sheng is also the number of different chronic inflammatory cell infiltration, and often oppressed, destroyed small bile ducts, causing bile duct in cholestasis. In addition in the proliferation of fibrous tissue in the newborn can see the small bile duct and bile duct without the false lumen.
nine, clinical features
1. portal hypertension in liver cirrhosis as the liver vascular system is destroyed when alterations caused (see pathogenesis), clinical manifestations see above clinical manifestations.
2. liver dysfunction liver is mainly the result of long-term repeatedly damaged. See also the related clinical manifestations of clinical manifestations.
7 . primary liver cancer (Primary Carcinoma of the Liver)
I, misprision of clinical manifestations of early onset
lack of typical symptoms. The early detection of cases of AFP screening may be no symptoms and signs, called subclinical hepatic cancer. self-treatment were mostly in the late stage, the main features of
1. more than half of liver pain liver pain, mostly persistent swelling or dull pain. If lesions violations diaphragm, right shoulder pain may be involved, such as tumors grow slowly, may be completely painless or only slightly dull. When the surface of the nodules of liver rupture and necrosis of cancer tissue and blood into the abdominal cavity, it can cause sudden severe pain, from the liver rapidly spread to the whole abdomen , resulting in acute abdominal symptoms. such as the large amount of bleeding, which can cause fainting and shock
2. hepatomegaly of the liver was carried out large, hard, uneven surface, with nodules, or massive, blunt the edge of not neat, often with different degrees of tenderness. hepatocellular carcinoma protruding from under the right costal arch or xiphoid, the upper abdomen can present as partial or full of uplift, such as Qi in the diaphragm, is mainly for raising the liver under the diaphragm margin can be small. nodules under the costal arch at the most likely to be touched.
3. jaundice usually appears in late may be due to liver cell damage caused, or because of oppression or violation of Aikuai hepatic bile duct near the door, or loss caused by cancer and blood clots caused by biliary obstruction
4. cirrhosis of the liver signs of liver cirrhosis and portal hypertension may have splenomegaly, ascites, venous collateral circulation, such as performance. ascites rapidly increased, usually transudate. hemorrhagic ascites due to cancer, multiple violations of the liver capsule or rupture of the abdominal cavity caused by, oh, because of stroke caused by metastatic cancer.
5. malignancies general performance of weight loss, fever, loss of appetite, fatigue, nutrition cachexia and other poor and minority cancer patients with liver cancer itself, as the host body's metabolism and thus affect the endocrine or metabolic abnormalities, systemic manifestations may have a special, called paraneoplastic syndrome to spontaneous hypoglycemia, polycythemia common. on the performance of the liver is large and there are such patients should be alert to the existence of the disease.
6. In case of metastatic lung symptoms, bone, chest, etc. transfer, can generate response symptoms. pleural metastasis to the right common, may have pleural effusion . bones, or spinal metastases, may have local tenderness or symptoms of nerve compression, brain metastasis may have symptoms of nerve localization.
Second, hospitals are often self-diagnose
with typical symptoms, generally to the middle and late. on middle-aged history of liver disease, especially in male patients, if unexplained liver pain, weight loss, progressive hepatomegaly, should be measured and selected AFP do other laboratory tests for early diagnosis. AFP continued to increase in low concentration However, normal aminotransferases, often sub-clinical liver cancer mainly.
Third, the differential diagnosis
1. secondary liver cancer originating in the gastrointestinal tract, respiratory tract, breast, etc. of the foci often transfer to the liver . this type of cancer, slow progression of the disease, symptoms mild. AFP tests revealed a small number of primary cancer cases in the digestive tract of (+), in general, as (-). The key to diagnosis and pathological examination found outside the primary liver cancer evidence.
2. cirrhosis of the liver if the liver cirrhosis patients had significantly large, hard of large nodules, or liver atrophy and image inspection also found that lesions, the possibility of large liver cancer, repeated Check the AFP or AFP heterogeneity, close follow-up can be diagnosed.
3. active liver disease, such as AFP and ALT increased dynamic curve parallel or simultaneous, or ALT continued to increase to several times normal, the possibility of active liver disease large. If curve separation, AFP normal or elevated ALT decreased by the high, more consideration to liver cancer.
4. liver abscess generally have significant clinical manifestations of inflammation, swelling of the liver surface is smooth without nodules, tenderness was . close to the abdominal wall abscess often edema, right upper quadrant abdominal muscle tension. WBC increased. Ultrasonography of the liver liquid dark area. When the pus thick, dark area has not been formed when the liquid is difficult to diagnose ultrasound examination should be done repeatedly necessary to make a diagnosis of ultrasound guided.
5. near the liver to the hepatic tumor retroperitoneal soft tissue tumors from kidney, adrenal gland, pancreas, colon cancer, etc. can also be present in the upper abdomen abdominal mass , resulting in confusion. ultrasonography helps to distinguish the nature of the tumor, AFP test should be negative. identification of difficulties need to be confirmed exploratory laparotomy.
6. hepatic lesions of non-cancerous liver hemangioma, polycystic liver , echinococcosis and other available CT, Ho Su radioactive blood pool scan, MRI and ultrasound to help diagnosis, exploratory laparotomy is sometimes necessary to diagnose.
IV pathological
(a) of the eye type
1. early HCC : Small hepatocellular carcinoma nodule diameter is less than a single 3cm, or nodules of not more than 2, the sum of the 3cm diameter less often in patients with no clinical symptoms, and serum AFP positive hepatocellular carcinoma. nodules were spherical or lobulated, gray and white matter is relatively soft, cut surface without hemorrhage and necrosis, clear boundaries with the surrounding tissue.
2. of advanced liver cancer type:
I. bulky tumor is a massive entity, prototype, diameter, often more than 15cm, and more in the right lobe. soft, variegated cut surface, often hemorrhagic necrosis. often scattered around the tumor-like nodules in the satellite.
II. nodules up to see more often occurs with cirrhosis of the liver. nodules more scattered, round or oval sizes in diameter from a few millimeters to several centimeters, some merging into larger nodules. capsule of the tumor nodules to the surface uplift, green brown cut surface, and sometimes see the bleeding
III. diffuse diffuse distribution in the liver cancer tissue, no obvious nodules, this type of rare.
(b) The histological type < br> I. carcinoma the most common type of liver cells from the cancer. well differentiated cancer cells and normal liver cells were similar. poorly differentiated cancer cell atypia were obvious, often the nuclear and multinucleated giant tumor cells. Some cancer cells were arranged in cords (cord-like type); also showed duct-like (false tubular type). Sometimes there are a large number of cancer fibrous tissue segmentation (sclerosis).
II. bile duct carcinoma is less common, intrahepatic bile duct epithelium from cancer. its organizational structure, or simple, mostly adenocarcinoma cancer. less cirrhosis. sometimes secondary to clonorchiasis patients.
III. mixed with hepatocellular carcinoma two structures and bile duct carcinoma, the most rare.
(c) clinical
see above
(d) pathways
liver spread and metastasis in the liver first. cancer cells along the portal vein usually spread, the formation of metastatic cancer nodules in the liver, but also retrograde spread to the extrahepatic portal vein, thrombus formation, causing portal hypertension. extrahepatic metastasis primarily through lymphatic metastasis to hilar lymph nodes, abdominal lymph nodes and retroperitoneal lymph nodes . late can be transferred to the lungs through the hepatic vein, adrenal gland, brain and bone, etc..
8. hepatic encephalopathy (Hepatic encephalopathy HE)
one cause,
is by the majority of hepatitis HE sclerosis (the most common viral cirrhosis of the liver) caused also by the improvement of portal hypertension caused by portosystemic shunt surgery. a small part of the HE seen in severe viral hepatitis, toxic hepatitis and acute liver disease or drug-induced fulminant hepatic failure. more rare There are reasons for primary liver cancer, acute fatty liver of pregnancy, severe biliary tract infections.
major cause of a large number of rows of upper gastrointestinal bleeding in 2 high-protein diet for 4 3 potassium diuretic sedative hypnotic uremic 7 6 5 release constipation 8 9 ascites surgical infections.
Second, the pathogenesis of
(a) of the doctrine of ammonia poisoning ammonia generated
increased less clear, [ammonia] increased energy metabolism can interfere with the brain. mechanism has the following two aspects:
1. inhibited alanine dehydrogenase activity, thereby affecting the Co-A formation, interfere with the brain the citric acid cycle.
2. in the brain detoxification process, the amine and a-ketoglutarate combined into glutamic acid, glutamate by glutamine synthetase in astrocytes under the action of the enzyme combination of glutamine and ammonia. glutamine is an infiltration of organic matter, excessive synthesis of stellate cells can lead to swelling, resulting in cerebral edema. a-ketoglutarate is an important intermediate in the Krebs cycle, the lack of brain cells when the energy supply can not maintain normal function. Glutamate is the major excitatory neurotransmitter in the brain, lack of inhibition of the brain increases, ammonia can interfere with nerve conduction directly affect brain function.
HE the causes of elevated blood ammonia when: 1 excess nitrogen intake of food (high protein diet) or drugs, or upper gastrointestinal bleeding (containing about 20g per 100ml of blood protein) is increased intestinal production of ammonia 2 metabolic alkalosis hypokalemic alkalosis prompted NH3 into the cells through the blood-brain barrier toxic 3 hypovolemic constipation and ascites 4 5 6 infection low blood sugar 7 Other (sedative, hypnotic, anesthesia, surgery, etc..)
(b) (g-aminobutyric acid / Ben benzodiazepines [GABA / BZ] complex theory)
can promote Cl-ion conduction into the postsynaptic neuron, causing inhibition of nerve conduction.
(c) of the amines, thiols, and short-chain fatty acids synergistic toxicity
(d) false doctrine
excitatory neurotransmitter neurotransmitters are: catecholamines in norepinephrine and dopamine, acetylcholine, glutamate, aspartate and so on. inhibitory neurotransmitter in the brain to form only.
aromatic amino acids in food such as tyrosine, Phe acid by intestinal bacteria decarboxylase, respectively, into the role of tyramine and phenylethylamine. normal, the two amines is cleared in the liver, liver failure, the removal occurs barriers, two kinds of amine into the brain tissue. b-hydroxylase in the brain were formed under the influence? J amines (b hydroxyl tyramine) and phenylethanolamine. After the two kinds of chemical structure and normal neurotransmitter norepinephrine similar structure, so called false neurotransmitters. When false neurotransmitter uptake by brain cells and synapses in the normal place of neurotransmitters, the nerve conduction disorder in the excitement not normally conducted impulses to the cerebral cortex and abnormal inhibition, disturbance of consciousness and coma.
(five ) imbalance in amino acid metabolism in patients with decompensated liver cirrhosis
theory of plasma aromatic amino acids (Phe, casein, color) increase in the branched chain amino acids decrease. normal catabolism of aromatic amino acids in the liver, liver failure decreased when the decomposition Therefore, increased blood concentrations. normal skeletal muscle branched-chain amino acids mainly in the decomposition of insulin to promote the role of these amino acids into muscle, liver failure inactivation of insulin reduced to a large number of branched-chain amino acids into muscle, blood concentration decreased. The two groups competitive exclusion of amino acids enter the brain. aromatic amino acids into the brain increased, further the formation of false neurotransmitters. hematoma in patients with cirrhosis of the liver tryptophan increased number of tryptophan in the brain can be derived for the 5 - HT, is the central nerve of some neurons inhibitory neurotransmitter, have antagonistic effects of norepinephrine may also be concerned with the unconscious.
III clinical
a (prodromal phase) with mild personality changes and behavioral disorders, such as the euphoric excitement or less indifferent words, disheveled or Urinating or defecating. response is still accurate, and slowly spit the word unclear. may have flapping wing-like vibrations, also known as liver flutter (Zhu Huanzhe Stretch arms, elbow fixed , extending to the dorsal hand, fingers separated, the visible hand of the lateral deflection, metacarpophalangeal joints, wrist or elbow and shoulder to fall on rapid, irregular shakes). EEG were normal, this period lasted several days or weeks, sometimes less marked
two (pre-coma) to confusion, sleep disturbance is, behavioral disorders based. before one of the symptoms. orientation and understanding were decreased, and when people , land of confusion, unable to complete simple calculations and intellectual composition, slurred speech, writing disorders, abnormal behavior. more than a perversion of sleep time, or even the illusion of fear or mania. The signs of the patients had significant neurological, such as tendon reflexes hyperthyroidism, increased muscle tone, spasm and ankle Babinski sign positive matrix. flapping wing-like tremor persists, there are specific EEG abnormalities can occur in patients with involuntary movements and movement disorders
three (sleeping period) to lethargy and mental disorder-based, all into the spirit of the symptoms persist or worsen, patients were comatose most of the time, but you can wake up. wake up to answer the questioning style, but often confusion and hallucinations. flapping wing-like chatter can lead to . to increase muscle tone, limb movements are often passive resistance. pyramidal tract signs often has positive abnormal EEG waveforms.
IV (coma period) complete loss of consciousness, can not wake up. light coma, on pain stimulus and response there is not position, tendon reflexes and muscle tone is still hyperthyroidism; the patient can not cooperate, tremor-like flapping wing can not be elicited. deep coma, a variety of reflexes, reducing muscle tension, often dilated pupil may appear intermittency convulsions, spasm and hyperventilation ankle array. electroencephalogram was abnormal.
IV diagnosis
diagnosis is based on a serious liver disease (or) lateral branch circulation 2 door wide mental disorder, lethargy or coma 3 liver 4 encephalopathy obvious incentive to liver damage or blood ammonia increased. flapping wing-like tremor and EEG changes have important diagnostic value.
patients with cirrhosis of the mental routine tests can be found in subclinical hepatic encephalopathy.
V.
the differential diagnosis of psychiatric symptoms as the only outstanding performance of hepatic encephalopathy was misdiagnosed as mental illness.
can cause coma and other identification of other diseases: such as diabetes, low blood sugar , uremia, cerebrovascular accident, brain infections and other sedative overdose.
six, treatment
(a), eliminating incentives to reduce drug induced or exacerbated by HE the use, control infection and upper gastrointestinal bleeding, to avoid a large number of rows quickly diuretic and paracentesis of potassium, pay attention to correcting water, electrolyte and acid-base balance
(b) reduce the generation and absorption of intestinal toxic
I. protein diet started a few days of fasting. Daily 5.0-6.7kJ and heat supply adequate amounts of vitamins. to carbohydrates as the main food. conscious after gradually increasing protein to 40-60g / d, the plant protein is better.
II. enema or cathartic available physiological enema salt water or weak acid solution, or oral or nasal 30-60ml of 33% magnesium sulfate catharsis. portosystemic shunt in acute HE 500ml with 66.7% of lactulose treatment of choice to do enema.
III. inhibit the growth of oral bacteria in a new mold Su 2-4g / d or paromomycin to vancomycin, rifaximin. on the need to avoid using neomycin or long-term treatment of patients with lactulose or milk pear alcohol as the drug of choice
(c ), promote metabolic clearance of toxic substances, to correct the disorder of amino acid metabolism drugs
I. 1 drop of ammonia and potassium glutamate sodium glutamate. oliguria when agents with potassium, significant ascites or edema caution Sodium agent .2 10-20g of arginine added Gs in the VD. applicable to patients with high blood pH 4 acid sodium benzoate 5 .3 Ornithine-a-ketoglutarate and ornithine aspartate. lowering drugs ammonia chronic recurrent HE portosystemic shunt is better for acute severe hepatitis HE invalid.
II. branched-chain amino acids of portal systemic shunt the treatment of HE controversial. For those who can not tolerate the protein food, get enough volume of the mixture rich in branched-chain amino acids on the recovery of patients with positive nitrogen balance is an effective and safe.
III. GABA / BZ receptor antagonist compound IV liver (d), liver transplantation
(V) Other symptomatic treatment
1. correcting water, electrolyte and acid-base balance is less than 2500ml per day into the appropriate solution. ascites (urine +1000 ml), potassium supplement those KCl, arginine available alkali poisoning .2 acid infusion ice cap to protect brain cell function by reducing intracranial temperature and reduce energy consumption 3 to keep the airway open deep coma, tracheotomy should be done 4 expectoration oxygen intravenous hypertonic cerebral edema prevention Gs, mannitol dehydration prevention and treatment of cerebral edema and other
9. tuberculous peritonitis (Tuberculous Peritonitis)
First, clinical manifestations
I. toxemia common symptoms of TB, mainly fever and night sweats. heat to low heat type and in the heat as much, 1 / 3 patients remittent fever, a few were missed can be hot. febrile disease with significant toxicity study were found in exudative, cheese, accompanied by Su-grain type or tuberculosis, caseous pneumonia, tuberculosis and other serious patients. late after malnutrition, weight loss, edema, pallor, glossitis.
II. abdominal pain early is not obvious, since there may be persistent pain and dull pain, or abdominal pain has not. pain and more at Cullen, lower abdomen, sometimes in the whole abdomen.
III. Abdominal palpation is generally believed that the sense of the abdominal wall flexibility clinical features of tuberculous peritonitis. blood, abdominal, or peritoneal cancer patients may also have. generally mild abdominal tenderness, a few severe tenderness, with rebound pain, common in cheese type of tuberculous peritonitis.
IV. ascites patients often feel abdominal distension, accompanied by tuberculosis sepsis or peritonitis caused by intestinal dysfunction, may not have ascites.
V. prevalent in the abdominal mass adhesion type or cheese type, often located in Cullen, also found in other parts. sizes, surface uneven, and sometimes a sense of nodules, not easy to push.
VI. Other common diarrhea, generally no more than 3-4 per day times, mostly paste-like stool. complication more common
II obstruction, diagnosis
diagnosis is based on a young patient, any history of tuberculosis, TB in other organs associated with evidence of unexplained fever 2, more than 2 weeks, with abdominal pain, bloating, ascites and abdominal mass, abdominal tenderness and / or flexibility of a sense of abdominal paracentesis to obtain ascites 3, the nature of the exudate to lymphocyte predominant, generally negative for bacterial culture, cytology of ascites was not found cancer 4 gastrointestinal barium meal X-ray examination showed other signs of adhesion strongly positive tuberculin test 5
Third, the differential diagnosis of ascites as the main
I. performers
? abdominal cancer, including peritoneal carcinomatosis, malignant lymphoma, peritoneal mesothelioma and so on. ascites cytology in differentiating benign and malignant ascites is the main method. primary liver cancer or liver cancer, malignant lymphoma, when in the absence of peritoneal metastasis and ascites tested negative, this time mainly by B-, CT and other tests to find the primary tumor.
? simply cirrhosis transudate ascites was cut with a typical expression of decompensated liver cirrhosis. If cirrhosis complicated with tuberculous peritonitis, ascites leakage accessible fluid. If the patient ascites to L-based, general bacterial culture was negative. necessary, laparoscopy
? other causes of ascites such as connective tissue inflammation, Meigs syndrome, Budd-Chiari syndrome, constrictive pericardium go far.
II. the abdominal mass as the main performance and abdominal tumors should, Crohn disease identification. cheese-type substance mass mass non-B ultrasonic examination, caseous necrosis puncture see things. adhesions type of young onset, duration long, generally good, not very hard texture.
III. with fever as the main performers
IV. have acute abdominal pain as the main performers of tuberculous peritonitis may be due to rupture of caseous necrosis caused by acute peritonitis, or abdominal pain due to acute intestinal obstruction, and you should identify with the common acute abdomen. inquired with a history of looking outside the peritoneal lesions.
four anti-TB treatment
I. chemotherapy
II. If massive ascites, ascites can be properly placed to alleviate the symptoms
III. surgical treatment indications: 1 concurrent complete, acute intestinal obstruction, or incomplete, chronic intestinal obstruction after medical treatment did not improve in 2 acute intestinal perforation peritonitis, or limitations of septic peritonitis did not improve after antibiotic treatment of intestinal fistula in 3 anti-TB chemotherapy by better nutrition and not closed in 4 of the disease difficult to diagnose, and intra-abdominal tumors or acute abdomen due to some reason can not be Identification will be considered exploratory laparotomy.
10. Inflammatory bowel disease (Inflammaotoy Bowel Disease IBD) (Table I)
Ulcerative Colitis
Crohn Disease
Also called non-specific ulcerative colitis, is A rectum and colitis of unknown cause disease. lesions were limited to large intestinal mucosa and submucosa. has said the limitations of enteritis, gastrointestinal tract of unknown etiology chronic granulomatous disease. disease prevalent in the terminal ileum and adjacent colon, from the mouth to the anus digestive tract can be affected.
clinical manifestations of a digestive system performance
(a) of the diarrhea, blood, mucus is the active stage of the disease an important performance. stool frequency and severity reflects the degree of blood in the stool.
(b) complained of abdominal pain and generally mild to moderate abdominal pain, left lower abdomen or lower abdomen, Department of the pains, pain - it means - and after the law of mitigation.
(c) other symptoms of abdominal distention, and might For appetite, nausea, vomiting.
(d) only in patients with mild and moderate signs of mild left lower quadrant tenderness, and sometimes reach the descending colon or sigmoid colon spasm. heavy and often broke obvious tenderness and drum-type intestine.
II symptoms usually appear in patients with severe, often low on their activities to moderate fever. myasthenia or disease sustained activity may have weakness, weight loss, anemia, hypoproteinemia, fluid and electrolyte acid-base balance disorders.
Third, the intestinal manifestations of peripheral arthritis, erythema nodosum, pyoderma gangrenosum, dermatitis outer sclera, anterior uveitis, recurrent oral ulcers.
four clinical types
(a) According to After typing in early onset disease / chronic relapsing / chronic persistent / acute fulminant
(b) severity classification based on light <4 / Medium> 4 / heavy> 6
(c) According to lesions type proctitis / rectosigmoid inflammation / left colitis / extensive or total colitis.
(d) according to the patient on the active / remission
five toxic complications
1 2 colorectal distention in 3 colorectal cancer or other complications of a variable, digestive performance
(a) of the first intermittent episodes of diarrhea, the course may be turned into sustained after. faecal mostly like, generally no pus and blood and mucus. lesions involving the lower colon or the anus and rectum may have bloody mucus and tenesmus.
(b) the most common symptoms of abdominal pain. more in the right lower abdomen or Cullen, intermittent seizures, often spastic abdominal pain or Ming.
(c) more in the right lower quadrant abdominal mass or Cullen.
(d) fistula formation is a clinical characteristic of the disease. since the beginning of fistula and fistula. The former can lead to other intestines, mesentery, ureter, **, and other retroperitoneal Department; which can lead to abdominal wall or perianal skin.
(e) around the anus and rectum around the lesion anorectal fistula, abscess formation, and anal and other diseases
Second, the systemic symptoms
(a) of intermittent fever low heat or in the heat of common, a few showed remittent fever with toxaemia.
(b) Nutrition disorders manifested as weight loss, anemia, hypoproteinemia and vitamin deficiencies and so on. prepubertal patients with growth retardation.
Third, the intestinal manifestations clubbing, arthritis, erythema nodosum, pyoderma gangrenosum, oral mucosa ulcers, iridocyclitis, uveitis, inflammation around the small bile ducts, sclerosing cholangitis, chronic hepatitis other.
four most common complications of intestinal obstruction, followed by intra-abdominal abscess. expansion of a rare toxic colon. rectum or colon cancer involvement may occur. extraintestinal complications of gallstones, urinary stones, fatty liver .
diagnosis of persistent or recurrent bloody diarrhea and mucus, abdominal pain associated with (or without) the extent systemic symptoms, remove bacillary dysentery, amoebic dysentery, chronic schistosomiasis, intestinal tuberculosis and other infectious enteritis and Crohn disease, ischemic colitis, radiation enteritis, based on a characteristic change in colonoscopy and mucosal biopsy at least 1 or with X-ray barium enema examination signs of at least one can diagnose the disease.
clinical manifestation typical and typical performance of a colonoscopy or a typical X-ray barium enema examination can diagnose this disease are.
typical or typical clinical manifestations of past history and current colonoscopy or barium enema X-no typical changes should be followed up.
of young Recurrent right lower abdominal pain and diarrhea, abdominal mass or tenderness, fever, such as performance, X line (or) and colonoscopy found that intestinal inflammatory disease, mainly in the terminal ileum and adjacent colon and showed segmental distribution, should consider the diagnosis of this disease. At present no uniform diagnostic criteria, mainly based on clinical manifestations and X-ray examination and (or) a comprehensive analysis of colonoscopy. Differential difficulty by the need to rely on exploratory surgery pathology .
inflammatory bowel disease (Inflammaotoy Bowel Disease IBD) (Table II)
Ulcerative Colitis
Crohn Disease
differential diagnosis 1. chronic dysentery often the history of acute bacillary dysentery, stool examination can be Shigella isolated, colonoscopy mucopurulent secretions obtained high positive rate of culture, antimicrobial treatment is effective
2. amebic colitis major invasion of the right colon, but also involving the left colon, colonic ulcers deeper edge stealth, more than normal mucosa between ulcers. histolytica stool and more can be found in trophozoites / parcel. anti-amoebic treatment is effective.
3. schistosomiasis had history of exposure to contaminated water, often hepatosplenomegaly, fecal check can be found in schistosome eggs, hatching miracidia positive. endoscopy in acute rectal mucosa of visible brown granules, tablet or tissue biopsy mucosal pathology can be found in schistosome eggs.
4.Crohn Disease
5. colorectal cancer see and middle age, digital rectal examination by the palpable mass, colonoscopy and barium enema X-value in the diagnosis.
6.IBS stool with mucus but no pus, microscopic examination is normal or only see a small amount of white blood cells, colonoscopy examination without evidence of organic disease.
1. intestinal tuberculosis intestinal tuberculosis primarily involves the ileocecal change, sometimes involving the adjacent colon, but not presented segmental distribution. fistula and a rare disease around the anus and rectum; tuberculin test positive.
2. the small intestine of primary malignant lymphoma malignant lymphoma of the small intestine is often a long time confined to the small intestine and (or) near the mesenteric lymph nodes, some patients showed multifocal tumors can be distributed. If X-ray examination at the same time see the involvement of the small intestine colon , segmental distribution, fracture-like ulcers, cobblestone Zheng, fistula formation, which are beneficial to Crohn disease diagnosis; if examination showed a wide range of erosion within the intestine, was greater pressure finger marks, or filling defects, B ultrasound or CT examination intestinal wall significantly thicker, more support for major abdominal lymph nodes of malignant lymphoma of small bowel diagnosis. exploratory surgery when necessary.
3.Ulcerative Colitis.
4. acute appendicitis rarely diarrhea, often with metastatic right lower abdominal pain, tenderness limit and Malmquist point, WBC increased, but exploratory surgery is sometimes required.
5. others such as schistosomiasis, chronic dysentery, amoebic colitis, and other infectious enteritis, hemorrhagic enteritis, ischemic colitis, radiation enteritis , collagen colitis, Behcet's disease, colorectal cancer and the various causes of intestinal obstruction
treatment of one, stressed that the general treatment of rest, diet and nutrition. Activities of the liquid diet. to correct acid-base balance of water and electrolyte disturbance. diarrhea, abdominal pain by atropine. should be noted that given a large number of anticholinergic drugs or toxic diarrhea medicine has evoked the risk of colorectal distention.
Second, drug treatment
1. amino acid preparations SASP SASP is the treatment of the disease commonly used drugs.
2. glucocorticoid ...
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