英文课件激素在溃疡性结肠炎的应用ppt

1、激素在溃疡性结肠炎的应用此ppt下载后可自行编辑英文课件The Clinical Application of Corticosteroids in Ulcerative ColitisTwo partsThe introduction of Ulcerative colitisThe clinical application of Corticosteroids in Ulcerative colitisUlcerative colitis Definition:Chronic non-specific colitisInflammation of the mucosa and submuc

2、osa of the large intestine Features:diarrhea with feces containing mucus, pus and blood, abdominal pain and tenesmus; and recurrence is commonMostly seen in 20-50 years of age, and in EuropeLess common in ChinaInfection Environmental factorsGenetic susceptibleImmune & inflammatory systemEtiology and

3、 pathogenesisLocation: rectum and sigmoid colon, then descending, transverse or pan-colon, even terminal ileumMucosa diffused inflammation with edema, congestion and local bleedings.PathologyInfiltration of lymphocytes, plasma cells, eosinophilic cells and neutrophilic cells in mucosaCryptic abscess

4、 and superficial ulcersInflammatory polyps or pseudopolyps;UCUCCryptic abscess in UCClinical Manifestations Symptoms: diarrhea abdominal pain, others : tenesmus, anorexia, nausea and vomiting Signs: tenderness in the left hypogastrium and rebound tendernessManifestations of digestive systemSystemic

5、manifestations fever,tachycardia,Anemia, malnutrition, volume depletion, disturbance in acid-basebalance and hypoalbuminemia in advanced patientsExtra-intestinal manifestationserythema nodosum, arthritis, ankylosing spondylitis, iritis，episcleritis, conjunctivitis, ulcers of oral mucosa, chronic act

6、ive hepatitis and so on.erythema nodosumA.course classificationinitial typechronic relapse typechronic permanent type acute and fulminant typeClinical classificationUC B.Extent classification (1) mild type (2) moderate type (3)severe typeClassificationUC C.range classificationProctitis or proctosigm

7、oiditis:40-50%Left-sided or intermediate colitis :30-40%Pancolitis:20% D.period classificationActive phaseAlleviative phaseClassificationUCUCendoscopic examinationDiseased mucosa: hyperemic and edematous, blood vessels not clear-cut, mucosa erosions and multiple shallow ulcers; rough, fragile, bleed

8、ing easily granular, pus; pseudopolyps seen Mucosa irregularity, saw-tooth like, loss of haustrations, shortening of colon and pseudopolyps formationContraindicated in fulminant typeUCBarium enematypical symptoms+one of endoscopic appearances and biopsy (or one of x-ray barium enema signs)+eliminati

9、on of other alike disease Notice:1.symptoms are not typical,while endoscopic appearances are typical-diagnosis 2.symptoms are typical, while endoscopic appearances are not typical-suspectDiagnosisTreatmentGeneral treatmentDrug treatmentSulfasalazineCorticosteroidsImmune inhibitorFirst choiceSevere p

10、atientsSurgical therapyIndications: abscess formation, canceration, perforation, fistula, mega-colon and refractory colitis, failure of medical therapy etcSecond partThe clinical application of Corticosteroids in Ulcerative colitisFinding CORTISONE IN ULCERATIVE COLITIS FINAL REPORT ON A THERAPEUTIC

11、 TRIALBRITISH MEDICAL JOURNAL On OCTOBER 29 1955S. C. TRUELOVE, M.D., M.R.C.P. AND L. J. WITTS, M.D., F.R.C.P.Conclusion the patients receiving cortisone enjoyed a clear-cut advantage over the patients on a dummy preparation. About two out of every five patients on cortisone therapy were in clinical

12、 remission at the end of six weeks treatment, compared with less than one out of every six patients receiving the inert therapy.Among the patients treated with cortisone those in their first attack have fared somewhat better than those in relapse.How to decide the dose of CorticosteroidsThe American

13、 Journal of GASTROENTEROLOGY Ulcerative Colitis Practice Guidelines in Adults by American College of Gastroenterology Practic Parameters CommitteeUlcerative Colitis Practice Guidelines in AdultsOral prednisone shows a dose response effect between 20 and 60 mg per day , with 60 mg per day modestly mo

14、re effective than 40 mg per day but at the expense of greater side-effects .Ulcerative Colitis Practice Guidelines in AdultsNo randomized trials have studied Corticosteroids taper schedules; most recommendations have advised 40 60 mg per day until significant clinical improvement occurs and then a d

15、ose taper of 5 10 mg weekly until a daily dose of 20 mg is reached. At this point tapering generally proceeds at 2.5 mg per week. The therapeutic plan is determined by the Patients condition and preferencessevere and fulminant typeFor patients who suffer from severe and fulminant type of UC ：intrave

16、nous injection Corticosteroids is First choice , recommend dosage hydrocortisone 300mg or meprednisone 60d and moderate type with largely lesion For mild and moderate patient, First choice oral Sulfasalazine ，while it is not effective，recommend oral prednisone 2060 mg/dmild and moderate type w

17、ith Distal lesion Corticosteroids topical therapiesEffect of topical administration of budesonide and tranditional corticosteroids on active distal ulcerative colitis or proctitisShang hai Jiao tong University School of MedicineResearch fromConclusionThe effects of budesonide and traditional cortico

18、steroids on active distal Ulcerative colitis or Proctitis are similar.However, budesonide maybe Preferable to traditional corticosteroids ,since its inhibitory effect on Plasma cortisol level is lower than traditional corticosteroids.adverse effectsSuch as cushingoid features, emotional and psychiatric disturbances, infections, glaucoma.Complicationsinclude gastroduodenal mucosal injury, impaired wound healing, and metabolic bone disease.steroid-dependencyAlthough sho