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 Tarih: Çrş Ksm 12, 2008 2:57 am Mesaj konusu: EL SALVADOR ATLAS OF GASTROİNTESTİNAL VİDEO ENDOSCOPY |
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EL SALVADOR ATLAS OF GASTROİNTESTİNAL VİDEO ENDOSCOPY
Video Endoscopic Sequence 1 of 28.
Crohn´s Disease
(Regional Enteritis, Granulomatous Colitis).
This sequences display severe endoscopic lesions.
A 42 year-old Salvadorian woman, that has been living in
The United States of America for more than 20 years.
The patient presented with weigh loss of 22 pounds,
abdominal pain and diarrhea during two years.
This lesions display ulcerations and retraction of
the sigmoid mucosa. Causing some difficulties when
advancing with the endoscope forward. After some
maneuvers the stenosis was overcome.
A second colonoscopy was performed shortly after some
treatment. In that colonoscopy we were able to find that
the terminal ileum was affected.
For more endoscopic details download the video clips of
this sequences by clicking on the endoscopic images.
All endoscopic images shown in this Atlas contain a video
clip. We recommend seeing the video clips in full screen
mode press Alt and Enter Windows Media, for Real Player
Ctrl and 3.
Video Endoscopic Sequence 2 of 28.
Crohn´s Disease.
Another view of the lesion describes before. Some ulcers
were found in the sigmoid colon.
Many lesions were found in the entire colon, with
severe inflammation, edema, fibrosis, ulcers and nodules.
Large and deep, penetrating ulcers surrounded by areas
of normal appearing mucosa were also found.
Video Endoscopic Sequence 3 of 28.
Crohn´s Disease.
Nodular stenosis due to Crohn's disease.
The transverse colon has two nodular and ulcerated
stenosis. However, this stenosis was overcome by passing
the colonoscope to the next lesion.
The severity of the diseases varies widely between
individuals. Some suffer only mild symptoms, but others
have severe and disabling symptoms. Some have a gradual
onset of symptoms, some develop them suddenly.
About half of patients have mild symptoms, the other half
suffer frequent flare-ups.
Pathophysiology: The exact cause of Crohn disease
remains unknown. Current theories implicate the role of
genetic, microbial, immunologic, environmental, dietary,
vascular, and even psychosocial factors as potential
causative agents. It has been suggested that patients have
an inherited susceptibility for an aberrant immunologic
response to one or more of these provoking factors.
Video Endoscopic Sequence 4 of 28.
Crohn´s Disease.
A close up of the first nodular stenosis of the transverse
colon.
This is Crohn's disease affecting part or all of the colon.
This form comprises about 20% of all cases of CD.
Various patterns are seen. In about half of these cases CD
lesions may be seen throughout one continuous
subsegment of the colon. In another quarter, skip areas are
seen between multiple diseased areas. In the remaining
quarter, the entire colon is involved, with no skip areas
Video Endoscopic Sequence 5 of 28.
Crohn´s Disease.
The video clip displays passing of the colonoscope
through to the first nodular stenosis, displaying a second
transverse colon lesion which is nodular and ulcerated
also.
Crohn´s Disease.
Microscopically, the initial lesion starts as a focal
inflammatory infiltrate around the crypts, followed by
ulceration of superficial mucosa. Later, inflammatory cells
invade deep layers and, in that process, begin to organize
into noncaseating granulomas. The granulomas extend
through all layers of the intestinal wall and into the
mesentery and the regional lymph nodes. Although
granuloma formation is pathognomonic of Crohn disease,
absence does not exclude the diagnosis.
Video Endoscopic Sequence 6 of 28.
Crohn´s Disease
This lesion belong to the second stenosis of the transverse
colon, which is nodular and ulcerated. The orifice is very
small and impossible to pass through.
We performed a second colonoscopy, after 7 days of
treatment. See the sequence below, where this stenosis
was overcome and the terminal ileum was visualized.
Video Endoscopic Sequence 7 of 28.
Crohn´s Disease.
Transverse colon, high grade nodular stenosis
The biopsies were taken from different ulcerated nodules.
Crohn´s Disease.
Transmural inflammation results in thickening of the bowel
wall and narrowing of the lumen. As the disease
progresses, it is complicated by obstruction, fistulization,
abscess formation, adhesions, and malabsorption.
Video Endoscopic Sequence 8 of 28.
Crohn´s Disease.
The rectum seen in retroflexed view. A polyp is observed
We were not sure if this polyp was caused by the Crohn’s
disease itself. However, we observed after a short time
of treatment, administered with steroids and antibiotics,
we observed that this lesion appeared as a hypertrophic
papillae. See video endoscopic sequence 27.
Video Endoscopic Sequence 9 of 28.
Crohn´s Disease after short-time treatment.
Prominent rectum vessels were found, giving a congestive
appearance after a short-time treatment with steroids.
Video Endoscopic Sequence 10 of 28.
Crohn´s Disease after short-time treatment.
Some polyps are founded into the sigmoid colon,
not seen by the previous colonoscopy. It may
be due to a better colon preparation.
“ Pseudo polyps.”
Video Endoscopic Sequence 11 of 28.
Crohn´s Disease, after a short-time treatment.
The video clip displays the difficulties in advancing the
colonoscope throughout recto-sigmoid junction due to
the narrowing caused by the ulcer.
Video Endoscopic Sequence 12 of 28.
Crohn´s Disease.
Upgrading information.
Long and serpiginous ulcers and nodules of sigmoid.
The patient was hospitalized and received 50 mg. oral
prednisone daily, 500 mg IV ciprofloxacin every 8 Hrs.and
500 mg IV metronidazole every 8 Hrs.
Its is Important to remark that the therapeutical
effectiveness of these medications are seen in
the new colonoscopy, performed 7 days after the initiating
the treatment. We could overcome the nodular stenosis
previously described, by finding the ileocecal valve
destroyed, by the disease; after passing throughout the
valve, we could exam around 30 cm of the terminal ileum
finding an active disease.
The colon was found to measure 120 CM. long.
Video Endoscopic Sequence 13 of 28.
Ulcers and nodules of the sigmoid and descending colon.
Though any portion of the gastrointestinal tract may be
involved with Crohn's disease, the small intestine--and the
terminal ileum in particular--is most likely to be involved.
Video Endoscopic Sequence 14 of 28.
Crohn´s Disease.
The video clip displays a colonoscopy of the transverse
colon, displaying a narrowing with nodules and ulcers.
Video Endoscopic Sequence 15 of 28.
Crohn´s Disease.
The image and the video clip display a lesion caused
by this disease. Theses are nodularity, deformed and
stenosis with ulcers.
Video Endoscopic Sequence 16 of 28.
Crohn´s Disease.
The cecum and the ileocecal valve are destroyed due to
nodules and ulcers.
Video Endoscopic Sequence 17 of 28.
The appendiceal orifice is observed. There are some tiny
rounded ulcers like the aphthous ulces or hyperplasic
follicles.
Video Endoscopic Sequence 18 of 28.
The ileocecal valve is destroyed by the disease itself,
this valve is nodular and ulcerated.
Video Endoscopic Sequence 19 of 28.
Terminal ileum.
The image and video of this sequence reveals the passage
of the colonoscope through the ileocecal valve to terminal
ileum.
You must see the video by clicking on the image.
Video Endoscopic Sequence 20 of 28.
Crohn´s Disease.
Terminal ileum. Irregular ulceration, erithema and nodules
are appreciated.
When we look at the spectrum of Crohns disease, probably
one-half to two-thirds of the patients have the disease, involving the
last portion of the small intestine and the first portion of the colon
Maybe another quarter of patients have disease only in the small
intestine,and another quarter only in the large intestine. So the
distribution of Crohns disease in the intestinal track is important
because we now have different medical therapies that can actually
be targeted to sites along the intestine both the anti-inflammatory
therapies, called the five ASA agents and new steroid treatments
are actually targeted to the ileum and the first portion of the colon.
So the location of the disease is very important, to begin with.
Video Endoscopic Sequence 21 of 28.
Terminal ileum “ileitis”.
At one time, Crohn´s Disease was thought to affect only the
ileum, and for this reason the name "ileitis" was at one
time synonymous with CD but now simply refers to Crohn's
disease of the ileum.
Video Endoscopic Sequence 22 of 28.
Junction of the cecum with the ascending colon.
The condition occurs in both sexes and among all age
groups, although it most frequently begins in young people
Jewish people are at increased risk of developing Crohn's,
while African Americans are at decreased risk, which
indicates the genetic link in this disease.
Video Endoscopic Sequence 23 of 28.
The video clip display a long segment of the
colonoscopy displaying from the appendiceal orifice
to the sigmoid.
You should see the video clip, which is quite long and
takes some time to download.
Video Endoscopic Sequence 24 of 28.
Crohn’s is a serious inflammatory disease of the
gastrointestinal tract that causes diarrhea, abdominal
cramps, fever and rectal bleeding. The cause of Crohn’s
disease is unknown.
Video Endoscopic Sequence 25 of 28.
(Serpiginous linear ulcers) Inflammatory bowel disease
("cobblestone" like mucosa).
Video Endoscopic Sequence 26 of 28.
Crohn´s Disease.
Rectum.
Video Endoscopic Sequence 27 of 28.
Crohn´s Disease
Rectum Retroflexed Image.
Video Endoscopic Sequence 28 of 28.
Crohn´s Disease.
Antrum: gastric wall thickening resembles chronic
erosions.
Crohns disease is an inflammation of the digestive track that
can affect any portion of the digestive track.
ALINTI : http://www.gastrointestinalatlas.com/English/Colon_and_Rectum/Crohn_s_Disease_/crohn_s_disease_.html
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