— 生理適應 · HARD · MCQ —
護理師正在照護一位潰瘍性結腸炎病人。哪項發現提示發生了像毒性巨結腸症（toxic megacolon）這樣的嚴重併發症？
A nurse is caring for a client with ulcerative colitis. Which finding suggests a serious complication like toxic megacolon?
- AMild fever and increased heart rate輕微發燒和心率增加
- BAbdominal distension with decreased bowel sounds✓ 正解腹部膨脹伴隨腸鳴音減弱
- CAnemia貧血
- DBloody diarrhea with mucus帶黏液的血便腹瀉
— Explanation · 中文詳解 —
毒性巨結腸症是潰瘍性結腸炎的危及生命的併發症，其特徵是結腸異常擴張，常伴隨發燒、心搏過速、腹脹、腹部壓痛、腸鳴音消失或減弱，以及毒性症狀（如意識改變）。雖然血便、發燒、心搏過速和貧血是潰瘍性結腸炎的常見表現，但明顯的腹脹合併腸鳴音消失是腸道麻痺的徵兆，高度提示毒性巨結腸症。
Toxic megacolon is a life-threatening complication of ulcerative colitis characterized by abnormal colonic dilation, fever, tachycardia, abdominal distension, tenderness, decreased or absent bowel sounds, and toxic features (e.g., altered mental status). Marked distension with absent bowel sounds indicates paralytic ileus and strongly suggests toxic megacolon.
✦ 台美臨床差異
美國的消化系內科醫師對於毒性巨結腸症的診斷與緊急手術指征有明確的標準；台灣的處理模式也遵循國際準則，但病人對症狀變化的警覺性是早期發現的關鍵。