消化系统课件：克罗恩病.ppt

克罗恩病  Crohn’s Disease
概念
病因未明
曾“克隆病”, “Crohn’s病”…
可侵及全消化道任何部位，病变呈阶段性或跳跃性分布
非干酪性肉芽肿
病因及发病机制Etiology & pathogenesis
一 感染因素 Infectious factors
二 免疫因素 Immunologic mechanism
三 遗传因素 Genetic factors
四 其他
病理 pathology
1 分布
2 大体病理
粘膜溃疡
肠管狭窄
多发炎性息肉
组织病理
肠壁全层炎、粘膜下层增宽
非干酪性肉芽肿
裂隙溃疡
Pathology includes: thickening of the involved intestinal wall with transmural serpiginous or linear ulcerations leading to cobble-stoning and fistula formation secondary to areas of normal and involved mucosa
This portion of terminal ileum demonstrates the gross findings with Crohn's disease. the small intestine and the terminal ileum in particular--is most likely to be involved. The middle portion of bowel seen here has a thickened wall and the mucosa has lost the regular folds. The serosal surface demonstrates reddish indurated adipose tissue that creeps over the surface. Serosal inflammation leads to adhesions. The areas of inflammation tend to be discontinuous throughout the bowel.
This is another example of Crohn‘s disease involving the small intestine. Here, the mucosal surface demonstrates an irregular nodular appearance with hyperemia and focal superficial ulceration.
One complication of Crohn's disease is fistula formation. Seen here is a fissure extending through mucosa at the left into the submucosa toward the muscular wall, which eventually will form a fistula. Fistulae can form between loops of bowel, bladder, and skin. With colonic involvement, perirectal fistulae are common.
Microscopically, Crohn's disease is characterized by transmural inflammation. Here, inflammatory cells (the bluish infiltrates) extend from mucosa through submucosa and muscularis and appear as nodular infiltrates on the serosal surface with pale granulomatous centers.