中毒性结肠炎与中毒性巨结肠
小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热/寒战
- 心动过速
- 精神状态改变
- 低血压
- 腹胀
其他诊断因素
- 腹泻
- 腹痛
- 腹部压痛
危险因素
- 溃疡性结肠炎 (UC)
- 克罗恩结肠炎
- 伪膜性结肠炎
- 感染性结肠炎
- HIV/AIDS/免疫抑制
- 停用治疗炎症性肠病的药物
- 抑制动力药物
- 化疗/化学免疫抑制
- 电解质异常
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 血清电解质
- 血清白蛋白水平
- 血清乳酸
- 粪便检查
- 腹部/盆腔 CT
- 腹部 X 线检查
- 胸部 X 线检查
需考虑的检查
- C 反应蛋白 (CRP)
- 红细胞沉降率 (ESR)
- 血液培养
- 乙状结肠镜检查
- 直肠活检
- 外科切除标本
治疗流程
所有患者
撰稿人
作者
Jan Rakinic, MD
Chief
Colorectal Surgery
Department of Surgery
Southern Illinois University School of Medicine
Springfield
IL
利益声明
JR is the President of the American Board of Colon and Rectal Surgery.
V. Prasad Poola, MD, MBBS, MS, FASCRS
Assistant Professor of Surgery
Department of Surgery
Southern Illinois University School of Medicine
Springfield
IL
利益声明
VPP declares that he has no competing interests.
鸣谢
Dr Jan Rakinic and Dr V. Prasad Poola would like to gratefully acknowledge Dr Scott A. Strong, Dr Mukta V. Krane, and Dr Alessandro Fichera, previous contributors to this topic.
利益声明
SAS, MVK, and AF declare that they have no competing interests.
同行评议者
Sharon Stein, MD
Assistant Professor of Surgery
Division of Colon and Rectal Surgery
University Hospital Case Medical Center
Cleveland
OH
利益声明
SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
利益声明
DJH declares that he has no competing interests.
James Wheeler, MB, BCh, MD, FRCS
Consultant
Colorectal Surgeon
Addenbrookes Hospital
Cambridge
UK
利益声明
JW declares that he has no competing interests.
鉴别诊断
- 结肠假性梗阻
- 急性肠系膜缺血
- 大肠梗阻
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