Crohn's disease nyob rau hauv tus me nyuam yog ib yam kab mob uas tsis yog tshwj xeeb inflammatory chronic granulomatous kab mob ntawm lub plab zom mov nrog rau qhov chaw tseem ceeb ntawm cov cuam tshuam foci hauv cov hnyuv. Cov tsos mob tseem ceeb yog raws plab thiab mob plab. Thaum lub sij hawm exacerbation, cov tsos mob tshwm sim tshwm sim - qaug zog, kub taub hau. Hauv cov menyuam yaus, cov tsos mob ntawm Crohn tus kab mob ua rau kev loj hlob qeeb thiab lwm yam cim ntawm malabsorption. Tsis tas li ntawd cov yam ntxwv yog tsim ntawm fistulas, fistulas, kev loj hlob ntawm plab hnyuv obstruction. Clinically kuaj mob, tau lees paub los ntawm cov txiaj ntsig ntawm kev ntsuas ntsuas ntsuas. Lub hom phiaj ntawm kev kho mob yog ua kom tiav thiab tswj lub xeev ntawm kev zam txim.
Kev mob tshwm sim hauv menyuam yaus
Crohn tus kab mob feem ntau hu ua terminal ileitis, vim nws yog qhov kev kho mob ntawm foci uas yog qhov tshwj xeeb ntawm cov kab mob no. Qhov zaus ntawm qhov tshwm sim tsis ntau tshaj 0.1%. Nws raug kuaj pom feem ntau hauv cov hluas. Hauv Pediatrics, Crohn's diseaseNws muaj qhov cuam tshuam loj heev, uas cuam tshuam nrog qhov xwm txheej ntawm cov kab mob pathology, thiab yog li ntawd txhua qhov kev kho mob tsis tu ncua yog palliative. Nws yuav tsum raug sau tseg tias tam sim no cov laj thawj ntawm kev loj hlob ntawm tus kab mob tseem tsis tau qhia meej, yog li nws tsis tuaj yeem ua cov kev ntsuas rau kev tiv thaiv. Lub sijhawm ntawm lub neej thiab nws qhov zoo tau txo qis, hauv cov menyuam yaus Crohn tus kab mob ua rau muaj kev txheeb cais ntawm kev tsis taus thiab kev tuag.
Kev faib tawm thiab ua rau hauv kev kho menyuam yaus
Tam sim no, etiology ntawm tus kab mob tseem tab tom tshawb xyuas. Cov kab mob thiab kab mob, tshuaj, cov yam ntxwv ntawm kev ua haujlwm thiab cov qauv ntawm cov hnyuv yog ib qho tseem ceeb. Nyob rau tib lub sijhawm, nrog rau kev hloov pauv hauv cov txheej txheem, cov yam ntxwv no tuaj yeem ua rau mob plab hnyuv loj nrog kev loj hlob ntawm granulomas hauv txheej submucosal, uas yog tus yam ntxwv ntawm tus kab mob no hauv cov neeg laus thiab menyuam yaus.
Ua rau Crohn tus kab mob yuav tsum tau txiav txim los ntawm kws kho mob.
Hauv cov neeg mob, muaj qhov tsis txaus ntseeg ntawm cytokine kev tswj hwm, uas yog tswj hwm los ntawm cov kab mob cytokines. Lub permeability ntawm lub plab hnyuv phab ntsa yog nce, uas ua rau ib tug tseem ceeb nce nyob rau hauv lub antigenic load ntawm tib neeg lub cev.
Nyob hauv menyuam yaus, tus kab mob Crohn tuaj yeem cuam tshuam rau txhua lub chaw ua haujlwm digestive. Los ntawm qhov chaw, terminal ileitis yog qhov txawv, uas yog tshwj xeeb tshaj yog tshwm sim, ileocolitis, colitis, lesions ntawm lub plab hnyuv siab raum, anorectal cheeb tsam. Tej zaum kuj muaj cov ntawv sib xyaw. Anatomically, inflammatory-infiltrative, nruj-forming thiab fistula-formingdaim ntawv. Lub tsev kho mob ntawm thawj ntau yam yog tus cwj pwm los ntawm cov quav mob, cov cim qhia ntawm malabsorption, kub taub hau, cuam tshuam qhov hnyav poob thiab kev loj hlob qeeb. Hauv qhov thib ob, Crohn tus kab mob hauv cov menyuam yaus tau tshwm sim los ntawm cov tsos mob ntawm plab hnyuv thiab ib qho mob ze rau nws, provoked los ntawm stenosis ntawm txoj hnyuv lumen. Nyob rau hauv rooj plaub thib peb, pathological tshwm sim yog vim kev tsim ntawm fistulas.
Cov tsos mob ntawm pathology
Crohn tus kab mob hauv tus menyuam yog tus cwj pwm los ntawm kev kawm tsis zoo nrog kev hloov pauv thiab ua kom hnyav dua. Feem ntau, cov kab mob pathology yog oligosymptomatic, lub sij hawm ntawm qhov tsis pom kev kho mob tsis tshua muaj tshwm sim. Muaj cov tsos mob ntawm plab hnyuv thiab plab hnyuv ntawm Crohn tus kab mob hauv cov menyuam yaus. Feem ntau cov tsos mob ntawm plab hnyuv, uas tshwm sim nyob rau hauv yuav luag txhua tus neeg mob, yog mob plab thiab raws plab. Cov mob yog cramping, raws li txoj cai, lawv cov kev siv yog insignificant. Yog hais tias lub inflammatory foci nyob rau hauv lub esophagus thiab lub plab, muaj ib tug hnov ntawm hnyav, ntuav thiab xeev siab. Raws li cov kab mob pathology loj hlob hauv cov menyuam yaus, kev mob plab tuaj yeem ntxiv rau qhov mob. Tenesmus tsis tshua muaj.
Zoo plab
Teem ib qho ntawm cov tsos mob tseem ceeb yog raws plab. Tus kab mob tuaj yeem pib nrog kev hloov ntawm cov quav. Qhov sib txawv ntawm qhov khoob khoob, muaj kev sib txuas nrog lub zos ntawm granulomatous foci - qhov siab dua qhov mob ntawm lub plab zom mov, qhov ntau tshaj tawm raws plab. Tsis tshua muaj cov ntshav me me hauv cov quav (feem ntau thaum lub sijhawm exacerbation nrog kev tsim cov kab mob tawg). Mob raws plab nyob rau hauv Crohn tus kab mobnrog rau cov cim qhia ntawm malabsorption hauv cov menyuam yaus. Tus me nyuam muaj tsis muaj roj-soluble vitamins, hlau, calcium thiab lwm yam micronutrients. Vim li no, lub cev kev loj hlob qeeb qeeb. Kev mob tshwm sim tshwm sim los ntawm kev qaug zog, ua npaws, poob phaus. Feem ntau tshwm sim ntawm cov kab mob hauv plab yog aphthous stomatitis, arthralgia, iridocyclitis, erythema nodosum, sacroiliitis, thiab lwm yam.
Kev kuaj mob Crohn tus kab mob hauv cov menyuam yaus
Qee cov tsos mob ntawm tus kab mob yog tus yam ntxwv ntawm ntau tus kab mob plab hnyuv. Hauv cov menyuam yaus, tus kab mob Crohn, ntxiv rau, tsis tshua muaj, thiab ua ke nrog cov tsos mob tsis tshwj xeeb, kev nyuaj rau kev kuaj mob tshwm sim. Clinically, tus kws kho mob yuav xav tias Crohn tus kab mob los ntawm qhov muaj mob thiab raws plab, uas tsis muaj lwm yam kev piav qhia. Kev kuaj mob kuj tseem qhia tau los ntawm kev loj hlob qeeb, muaj cov kab mob hauv plab hnyuv pathologies hauv cov txheeb ze, thiab poob phaus. Txhawm rau tshem tawm lwm yam nosologies, txheej txheem ntsuas ntsuas tau ua tiav.
Plain radiography ntawm lub plab hnyuv plab yog ua nrog ob qhov sib txawv. Vim li no, txoj hnyuv lumen, cov qauv thiab dav ntawm lub cev raug soj ntsuam. Piv txwv li, nws feem ntau tuaj yeem pom qhov chaw mob xws li "cobblestone pavement". Xws li tus qauv yog pom tsuas yog nrog tus kab mob no thiab yog provoked los ntawm ib tug loj tus naj npawb ntawm intersecting kab nrib pleb nyob rau hauv txoj hnyuv phab ntsa. Hauv cov menyuam yaus, tus kab mob Crohn feem ntau tshwm sim nyob rau hauv daim ntawv ntawm cov fistulas sab hauv thiab sab nraud, uas kuj tau kuaj pom radiographically lossis thaum lub sijhawm.lub sij hawm ntawm kev ntsuam xyuas yog ib tug fistula qhib ntawm daim tawv nqaij. Feem ntau nrog tus kab mob, qhov chaw perianal ntawm fistulas thiab lwm yam kab mob ntawm thaj chaw no tau pom: pararectal infiltrates, rwj, tawg.
Irrigoscopy
Irrigoscopy tab tom ua. Txhawm rau tshem tawm cov kab mob ntawm txoj hnyuv loj, sigmoidoscopy nrog biopsy yog ua. Txawm hais tias tsis muaj granulomas, cov tsos mob tshwm sim ntawm cov kab mob pathology hauv cov menyuam yaus feem ntau kuaj pom histologically. Ob qho tib si colonoscopy thiab sigmoidoscopy ua kom pom cov hnyuv mucosa, uas tuaj yeem nyob rau hauv lub sij hawm ntawm infiltration nyob rau hauv daim ntawv ntawm "quilt" thiab "cobblestone pavement" nyob rau theem ntawm ulcers-tawg..
Tseem muaj cais thaj chaw ntawm qhov tsis tuaj yeem stenosis thiab yaig. Kev kuaj ntshav dav dav qhia qhov nrawm ntawm ESR thiab lwm yam kev mob tshwm sim. Kev kuaj quav yog yuav tsum tau txiav txim siab lwm yam ua rau raws plab.
Hauv qab no yog cov txheej txheem kho mob Crohn tus kab mob hauv cov menyuam yaus.
Cov lus qhia tseem ceeb hauv kev kho mob
Cov tub ntxhais hluas thiab cov menyuam yaus uas muaj feem ntau ntawm kev puberty thiab kev loj hlob qeeb hauv daim duab kho mob (tsis suav nrog cov tsev neeg) yuav tsum xub muab qhov sib piv ntawm cov hnyuv loj thiab cov hnyuv. Cov tsos mob ntawm cov kab mob ib txwm muaj ntawm Crohn tus kab mob yog: ib qho kev sib tshuam ntawm cov kab mob, cov hnyuv me yog koom nrog hauv cov txheej txheem; plab hnyuv thiab fistula; lub xub ntiag ntawm nodularity thiab ulceration ntawm lub mucosa, raws li zoo raws li nruj nyob rau hauv lub cheeb tsam ntawm qhov muag tsis pom thiab ileum.
Cov lus qhia kho mob rau Crohn tus kab mob hauv menyuam yaus yog dab tsi?
Cov me nyuam raws plab thiabHauv cov quav ntshav nrog cov kev hloov hauv chaw kuaj pom (tsis suav nrog cov kab mob sib kis), nws raug pom zoo ua ntej ua kev kuaj ntshav nrog colonoscopy. Thaum ua qhov colonoscopy, tus kws endoscopist yuav tsum sim tshuaj xyuas lub davhlau ya nyob twg ileum, nqa biopsies los ntawm nws thiab los ntawm txhua qhov chaw ntawm txoj hnyuv loj.
Crohn tus kab mob yog tus cwj pwm los ntawm cov tsos mob hauv qab no: ib qho kev sib tshuam ntawm cov kab mob me me-nodular (nyob rau hauv daim ntawv ntawm "cobblestone pavement") ntawm cov mucous membrane nrog nws qhov tsis hloov pauv, hom kab ntawm ulceration, me me aphthous ulcers, ib tug txheeb ze txo nyob rau hauv cov theem ntawm cov txheej txheem inflammatory ntawm lub plab hnyuv, nqaim thiab ulceration ntawm lub ileocecal li qub, strictures thiab plab hnyuv fistulas. Cov kev tshawb pom histological uas paub qhov txawv ntawm qhov mob colitis muaj xws li basal lymphoplasmocytosis thiab crypt architectural defects. Cov kev tshawb pom histological uas tsis yog-caseating granulomas uas tsis nyob ib sab ntawm cov crypts tawg, lymphoid transmural aggregates.
Cov lus qhia kho mob yuav tsum ua raws li cov menyuam yaus uas muaj tus kab mob Crohn.
Kev kho, kev tiv thaiv thiab kev kuaj mob hauv menyuam yaus
Kev kho mob yog tsom rau kev ua tiav thiab tswj kev zam txim. Kev noj zaub mov tshwj xeeb raug sau tseg. Nws lub hom phiaj txhawm rau txhim kho qhov nqus ntawm cov as-ham rau kev txhim kho lub cev ntawm tus neeg mob. Tshwj xeeb high-molecular sib tov yog sau tseg. Hom tshuaj tseem ceeb hauv kev kho tshuaj ntawm Crohn tus kab mob hauv kev kho menyuam yaus yogaminosalicylates. Kev kho mob tiv thaiv kab mob nrog corticosteroids, suav nrog tshuaj pleev xim rau hauv cov hnyuv me.
Nyob tshiab yog kev siv cov tshuaj lom neeg, suav nrog TNFα inhibitors.
Cytostatic tshuaj qee zaum siv los kho Crohn tus kab mob rau cov menyuam yaus. Yog tias muaj teeb meem ntawm plab hnyuv, cov tshuaj tua kab mob tau sau tseg. Kev phais mob yog qhov yuav tsum tau ua nyob rau hauv txoj kev loj hlob ntawm fistulas, plab hnyuv abscesses thiab obstructive. Qhov taw qhia rau kev ua haujlwm kuj yog qhov tsis muaj txiaj ntsig ntawm cov txheej txheem kev saib xyuas. Resection ntawm txoj hnyuv lobe yog nqa tawm tsuas yog nyob rau hauv heev mob, nws yog nqa tawm kom zoo zoo li sai tau. Qhov no feem ntau ua rau kev zam txim, tab sis cov txheej txheem ntawm o nyob rau hauv txhua rooj plaub tshwm sim dua nyob rau hauv lwm qhov ntawm lub plab hnyuv ib ntsuj av. Nyob rau lub sijhawm tom qab ua haujlwm, lawv tau txais kev kho mob nrog tshuaj tua kab mob thiab corticosteroids.
Cov tsos mob thiab kev kho mob Crohn tus kab mob hauv cov menyuam yaus muaj kev cuam tshuam.
Hauv cov menyuam yaus, kev tiv thaiv kab mob yog ua raws li kev noj zaub mov zoo raws li lub hnub nyoog ntawm tus neeg mob, kev tiv thaiv thiab kev kho mob ntawm plab hnyuv kab mob, kab mob cab thiab lwm yam kev zom zaub mov hauv lub sijhawm. Kev kwv yees thiab qhov tshwm sim rau lub neej ntawm tus menyuam yog txiav txim siab los ntawm qhov hnyav ntawm chav kawm thiab cov teeb meem uas twb muaj lawm. Tej zaum yuav muaj kev zam txim ntev, tab sis ib tus yuav tsum paub tias hauv cov menyuam yaus, Crohn tus kab mob yog mob ntev, yog li nws muaj qhov tsis zoo rau kev rov zoo. Cov niam txiv yuav tsum tau sab laj, lawv tau ceeb toom rau txhua txoj hauv kev los txhim kho lub neej zoo thiab txo cov tsos mob ntawm tus menyuam.
How relatedCrohn tus kab mob thiab UC hauv cov menyuam yaus?
Ulcerative colitis thiab nws qhov sib txawv
Nyob rau hauv cov me nyuam, ulcerative colitis yog ib tug mob inflammatory plob tsis so tswj kab mob ntawm lub hauv paus ntsiab lus uas tsis paub hais tias nws characterizes ulcerative-destructive hloov nyob rau hauv lub colonic mucosa.
Ob hom kab mob plab hnyuv - mob plab thiab Crohn's kab mob - zoo li zoo ib yam thaum xub thawj siab ib muag. Tab sis lawv muaj ntau yam khoom uas tso cai rau lawv sib txawv ntawm ib leeg.
Qhov sib txawv tseem ceeb ntawm cov kab mob no yog qhov chaw ntawm qhov mob thiab qhov xwm txheej ntawm qhov txhab. Crohn tus kab mob tuaj yeem cuam tshuam rau ib feem ntawm txoj hnyuv, los ntawm lub qhov ncauj mus rau qhov quav, tab sis feem ntau cov kab mob tshwm sim hauv lub davhlau ya nyob twg ileum. Hloov pauv, ulcerative colitis tsuas yog cuam tshuam rau txoj hnyuv xwb. Nws yog microscopically txwv rau o ntawm lub plab hnyuv mucosa, thaum Crohn tus kab mob cuam tshuam rau tag nrho cov hnyuv phab ntsa.
Vim lawv qhov kev nthuav qhia kev kho mob zoo sib xws, Crohn tus kab mob thiab cov kab mob ulcerative colitis suav nrog cov kab mob plab hnyuv. Kev kuaj mob yog qhov nyuaj vim qhov sib tshooj ntawm cov cim qhia nrog cov tsos mob ntawm lwm yam kab mob, tshwj xeeb, mob enteritis, dysentery, salmonellosis, kab mob lupus erythematosus thiab tsis-ulcerative colitis..
UC, lossis tsis yog tshwj xeeb ulcerative colitis, yog ib yam kab mob thiab tshwm sim yuav luag thoob plaws ntiaj teb. Nws cov zaus kuj yog siab heev rau cov menyuam yaus, ntxiv rau, tsis ntev los no tau muaj "rejuvenation"pathology.
Kev tshuaj xyuas ntawm Crohn tus kab mob hauv cov menyuam yaus
Kev tshuaj xyuas ntawm cov neeg tiag tiag tso cai rau peb los xaus lus txog cov yam ntxwv ntawm Crohn tus kab mob. Cov neeg hais tias ob qho tib si UC thiab Crohn tus kab mob yog qhov kho tsis tau thiab tsis xis nyob, tab sis nrog kev kho kom raug thiab noj zaub mov kom zoo, kev kho mob mus ntev tuaj yeem ua tiav. Nrhiav tus kws kho mob muaj peev xwm tau pom zoo.
Kev kuaj mob Crohn tus kab mob feem ntau tshwm sim thaum yug los thiab nyuaj rau kev kuaj mob vim nws zoo sib xws rau lwm yam kab mob. Hauv qhov no, tshuaj tua kab mob pab ib ntus. Cov tshuaj Remicade, uas yog dripped rau tus menyuam, ua tau zoo. Nws kim heev, tab sis tus neeg mob lub neej hloov pauv mus rau qhov zoo dua.
Qee zaum qhov kev kuaj mob tau ua thaum hluas, piv txwv li, tom qab mob, mob tam sim ntawd. Tom qab ua haujlwm, tus neeg mob ua lub neej zoo, thaum xub thawj nws ua raws li kev noj haus.
Cov niam txiv kuj nco ntsoov tias menyuam yaus muaj peev xwm ua neej nyob raws li lawv tau ua, tab sis koj yuav tsum tau saib xyuas lawv cov zaub mov ntau ntxiv.
