Ендоскопічна картина гастроентерологічних захворювань Ілюстративний матеріал для практичних занять для лікарів-інтернів та лікарів- курсантів за фахом «Загальна практика-сімейна медицина» цикл «Внутрішні хвороби» розділ «Гастроентерологія» підготувала доцент кафедри сімейної медицини ФПО ДДМА к.м.н. Василевская Ирина Васильевна

The Normal Esophagus The normal esophagus as visualized with an electronic video endoscope

By spraying lugol on the mucosal surface of the esophagus, the normal non-keratinized squamous epithelium (abundant in glycogen) is stained brown while the columnar epithelium of the most distal esophagus (glycogen depleted) remains unstained. The Normal Esophagus Lugol staining.

The Normal Esophagus Normal esophagus with impressions caused by normal adjacent structures.

Barrett's Esophagus

The Esophagus Sliding type Hiatal Hernia Hiatal hernia as seen from above. With the instrument's tip positioned just below the lower esophageal sphincter, a portion of the stomach is seen sliding up through the hiatus of the diaphragm that changes in diameter in relation to the respiratory movements.

The Esophagus Prolapsing Stomach Mucosa A small part of the stomach is seen prolapsing through the hiatus. This may occur as a result of retching during endoscopy.

The Esophagus Achalasia Dilated and partially filled esophageal lumen (upper left) due to an impaired relaxation of the lower esophageal sphincter (upper right and lower left). The sphincter can be passed to some extent by applying gentle pressure (lower right).

The Esophagus Stricture with concomitant inflammatory changes. Mild stricture accompanied by exudates (left) and a high grade stenosis with severe inflammation (right).

The Esophagus Intramural diverticula Intramural diverticula of the upper esophagus seen as small holes in the mucosa.

STOMACH NORMAL

Autoimmune Atrophic Gastritis Atrophic gastritis with increased visibility of the vascular pattern and absense of rugal folds.

Bile-stained hemorrhagic gastritis.

Erosive Gastritis Mild erosive corpus gastritis.

Hemorrhagic Gastritis Hemorrhagic gastritis with multiple intramural bleeding spots accompanied by xanthomata.

Gastric Candidiasis Gastric candidiasis with extensive green-white exudates covering an scirrhous tumor of the antrum.

Small and round ulceration on the anterior wall of the antrum. STOMACH ULCUS

STOMACH ULCUS PENETRAT

STOMACH Malignant Pyloric Stenosis Gastric cancer compromising and occluding the pylorus.

STOMACH Deformity of the pyloric region secondary to chronic peptic ulcer disease.

STOMACH Double Pylorus Double pylorus secondary to fistula formation between the prepyloric antrum and the duodenal bulb. Identify both openings by clicking with the mouse.

Gastric Hyperplastic Polyps Pedunculated hyperplastic polyp in a background of atrophic gastritis manifested by an increased vascular pattern and absence of rugal folds.

Borrmann type 1 Adenocarcinoma Polypoid adenocarcinoma on the major curvature of a gastric remnant.

Borrmann type 3 Adenocarcinoma Infiltrating and partially ulcerated adenocarcinoma.

TUMOR After passing the cardia and inverting the instrument's tip in the upper corpus, the ulcerated and infiltrative cardial adenocarcinoma is well observed.

MALT Lymphoma A circumscribed thickened fold on the major curvature of the corpus in a case of MALT lymphoma.

Zollinger-Ellison Syndrome Zollinger-Ellison syndrome showing giant rugal folds at endoscopy.

The duodenal angle (angulation between the duodenal bulb and the descending duodenum) is usually sharp. The duodenal papilla seen from the distance and at close view. The Normal Duodenum The duodenal bulb seen after just passing the instrument tip through the pylorus.

Duodenitis Healed duodenal ulcer with scarring and fold convergence accompanied by duodenitis manifested as erythematous mucosa.

Duodenal ulcer Small ulcer with fibrinoid necrosis and surrounding erythema on the anterior wall of the duodenal bulb. Small ulcerations in the descending duodenum with an aphtoid appearance. The yellow exudate at the bottom image could probably be explained by overgrowth of candida yeasts at the base of the ulcer.

Crohn's Disease of the upper GI tract Small ulcerations with irregular borders and clean base seen in the proximal part of the descending duodenum in a patient with Crohn's disease. Granulomas were not found at histology.

The Terminal Ileum

The cecum. On each image identify the appendix orifice with the mouse pointer.

Mild form of antibiotic-associated colitis with multiple small raised plaques. PSEVDOMEMBRANOSIS COLITIS

Trichocephaliasis (Trichuris Trichiura) Whipworm attached to the mucosa of the cecum through its thin anterior segment (lower right).