ENTEROCOLITIS坏死性小肠结肠炎ppt课件.pptVIP

临床医学于波心房选择性钠通道阻滞剂在房颤中的应用颅内非肿瘤性病变的影像学表现基础医学慢性鼻窦炎鼻息肉围手术期综合治疗的临床指引泌尿生殖道感染衣原体检测和支原体培养及药敏结果分析 NECROTIZING ENTEROCOLITIS Janice Nicklay Catalan M.D. OBJECTIVES Ability to diagnose and treat the signs and symptoms of NEC Ability to evaluate radiographs for the classic findings of NEC List several long-term complications associated with NEC NECROTIZING ENTEROCOLITIS Epidemiology: most commonly occurring gastrointestinal emergency in preterm infants leading cause of emergency surgery in neonates overall incidence: 1-5% in most NICU’s most common in VLBW preterm infants 10% of all cases occur in term infants NECROTIZING ENTEROCOLITIS Epidemiology: 10x more likely to occur in infants who have been fed males = females blacks whites mortality rate: 25-30% 50% of survivors experience long-term sequelae NECROTIZING ENTEROCOLITIS Pathology: most commonly involved areas: terminal ileum and proximal colon GROSS: bowel appears irregularly dilated with hemorrhagic or ischemic areas of frank necrosis focal or diffuse MICROSCOPIC: mucosal edema, hemorrhage and ulceration NECROTIZING ENTEROCOLITIS MICROSCOPIC: minimal inflammation during the acute phase increases during revascularization granulation tissue and fibrosis develop stricture formation microthrombi in mesenteric arterioles and venules NECROTIZING ENTEROCOLITIS Pathophysiology: UNKNOWN CAUSE……. PRIMARY INFECTIOUS AGENTS Bacteria, Bacterial toxin, Virus, Fungus CIRCULATORY INSTABILITY Hypoxic-ischemic event Polycythemia MUCOSAL INJURY ENTERAL FEEDINGS Hypertonic formula or medication Malabsorption, gaseous distention H2 gas production, Endotoxin production INFLAMMATORY MEDIATORS Inflammatory cells (macrophage) Platelet activating factor (PAF) Tumor necrosis factor (TNF) Leukotriene C4, Interleukin 1; 6 RISK FACTORS Prematurity: primary risk factor 90% of cases are premature infants immature gastrointestinal system mucosal barrier poor motility immature immune response impaired circulatory