Ulcerative colitis complicating pseudomembranous colitis of the right colon.
A 73-year-old man presented with chronic watery diarrhea and abdominal cramping of three months duration. Was under multiple antibiotics therapy prescribed from his general practitioner.
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Video Endoscopic Sequence 2 of 4.
This image and the video clip display a long tract of the descending colon with ulcerative colitis.
Video Endoscopic Sequence 3 of 4.
Ulcerative Colitis and superimposed pseudomembranous colitis involving the right colon.
Colonoscopy revealed pseudomembranous colitis extending from the ascending colon to the cecum, and Clostridium Difficile, toxin was positive in the feces. The administration of vancomycin in addition to oral steroids resulted in rapid improvement of the condition.
Video Endoscopic Sequence 4 of 4.
Total colonoscopy is recommended for precise diagnosis when patients with ulcerative colitis develop intractable diarrhea during or after antibiotic therapy.
Video Endoscopic Sequence 1 of 7.
Pancolitis. Disease in entire colon.
This is the case of a patient with long standing ulcerative colitis, male 37 year-old.
UC is marked by diffuse, superficial inflammation of the colonic mucosa, beginning in the rectum and extending proximally to involve any contiguous length of colon. The small intestine is not involved, except in the setting of extensive colitis, in which the most distal terminal ileum may exhibit similar superficial inflammation, termed backwash ileitis. Because the extent of colitis usually remains constant from the onset, the length of involved colon defines the classification of UC: proctitis (limited to the rectum), proctosigmoiditis or left-sided colitis (extending up to the splenic flexure), or pancolitis (extending into the transverse colon).
Video Endoscopic Sequence 2 of 7.
A depressed ulcer is observed
Proximal extension occurs in approximately one third of patients with distal disease, and regression from pancolitis is also possible The extent of involvement does not necessarily imply severity but does pertain to prognosis (e.g., the risk of cancer) and to treatment selection. The symptoms and course of UC relate to both the extent and the severity of inflammation within the involved segment of colon.
Video Endoscopic Sequence 3 of 7.
Extensive colitis (pancolitis). In pancolitis, inflammation extends into the transverse or right colon. Patients are more likely to present with diarrhea because of diminished absorptive capacity of the colon, accompanied by rectal bleeding and urgency. Abdominal cramps may be diffuse or localized, and patients are more likely to have weight loss, systemic or extraintestinal symptoms, and anemia.
Video Endoscopic Sequence 4 of 7.
Clinical Severity
The severity of UC depends on both the length of colon involved and the severity of colonic inflammation.
Video Endoscopic Sequence 5 of 7.
The cecum, the Ileocecal valve
Clinical Severity
Mild. In mild UC, patients have less than four bowel movements daily, with minimal cramps and urgency. Usually, most of the bowel movements occur early in the day; and after the morning evacuations, the patient is able to proceed with activities of daily life.
Video Endoscopic Sequence 6 of 7.
The cecum.
Clinical Severity: Moderate. Patients with moderate UC have four to eight bowel movements daily, more frequent rectal urgency, and postprandial cramping and bowel movements. Blood is present in most stools, and nocturnal wakening for bowel movements is common. The disease can interfere with daily work or school activities and social life.
Severe. Patients with severe UC have more than eight bowel movements daily, nocturnal bowel movements, severe urgency with or without incontinence, and systemic signs that include low -grade fever, night sweats, weakness, and weight loss. Abdominal tenderness, tachycardia, anemia, leukocytosis, and hypoalbuminemia are common.
Fulminant. Patients with fulminant colitis have more than 10 bowel movements a day, nocturnal bowel movements, severe abdominal pain or relentless tenesmus, and rebound tenderness or distention with tympanic bowel sounds. They also have prostration, high fever, and hypotension. Radiographic studies show evidence of mucosal edema, intramural air (pneumatosis coli), colonic dilatation (toxic megacolon), or free abdominal air (perforation).
Video Endoscopic Sequence 7 of 7.
Terminal Ileum
This video clip shows the cecum, the endoscope is advancing into the ileocecal valve to the terminal ileum which is completely normal.
Video Endoscopic Sequence 1 of 5.
Ulcerative Colitis.
Endoscopic findings in ulcerative colitis — Endoscopy in UC typically reveals the following findings: Erythema Loss of the usual fine vascular pattern Granularity of the mucosa Friability Edema.
Video Endoscopic Sequence 2 of 5.
This image and the video clips shows the typical serpinginous ulcers of ulcerative colitis after using indigo carmine stain.
Video Endoscopic Sequence 3 of 5.
High magnification of the ulcers.
Video Endoscopic Sequence 4 of 5.
A focal area of ulcerative colitis is appreciated, showing redness and ulcerations.
Video Endoscopic Sequence 5 of 5.
A high magnification of a focal area of ulcerative colitis.
Video Endoscopic Sequence 1 of 3.
Ulcerative Colitis.
There are several serpingenous ulcer´s friability, exudation, and bleeding, with increasingly larger areas of ulcerations.
Video Endoscopic Sequence 2 of 3.
More images of ulcerative colitis, with increasingly larger areas of ulcerations.
There are cryptic microabsceses, chronic inflamation of colonic mucosa and loss of glands, Click on the histopathological image to enlarge it.
sa is friable, erythematous, and edematous.
Video EndoscopicSequence 2 of 6.
Ulcerative Colitis.
The recto-sigmoid junction. Coarsely nodular deformity of mucosal contour in ulcerative colitis. The mucosa is erythematous and friable. Coarsely nodular deformity of mucosal contour in ulcerative colitis.
VideoEndoscopic Sequence 3 of 6.
Ulcerative Colitis.
Moderate to severe colitis is characterized by granularity, friability, exudate, spontaneous bleeding and increasingly larger areas of ulceration. Pathophysiology: Ulcerative colitis is defined as continuous idiopathic inflammation of the colonic or rectal mucosa. The rectum is involved in more than 95% of cases. Some authorities believe that the rectum is always involved in an untreated patient. Partial healing may occur in a patient treated with topical therapy, creating diagnostic confusion.
VideoEndoscopicSequence 4 of 6.
Ulcerative Colitis.
Necrosis, edema, exudate and friability are observed. Causes: An unknown factor causes an immune-mediated inflammatory response in the intestinal mucosa. Genetic susceptibility (chromosomes 12 and 16) is a factor associated with ulcerative colitis. A positive family history (observed in 1 of 6 relatives) is associated with a higher risk for developing the disease. Smoking is not associated with ulcerative colitis This relationship is reversed in Crohn disease. Environmental factors. Dietary factors: Milk consumption may exacerbate the disease. Appendectomies have a negative association with ulcerative colitis.
VideoEndoscopicSequence 5 of 6.
Ulcerative Colitis.
Some biopsies are taken from irregular areas in order to rule out malignancy or dysplasia.
There are ulcer and purulent exudate of colonic mucosa. Click on the histopathological image to enlarge it.
Video Endoscopic Sequence 6 of 6.
Ulcerative Colitis.
Multiples pseudopolyposis are seen and the video clip displays hundreds of pseudopolyps.
There are pseudopolyps chronic inflamation of colonic mucosa, click on the histopathological image to enlarge it.
VideoEndoscopicSequence 1 of 3.
Ulcerative Colitis of long stand evolution.
On the image and the video clip are observed multiple pseudo polyps and scar areas of the ascending colon.
There are pseudopolyps and chronic inflammation of colonic mucosa.
Video EndoscopicSequence 2 of 3.
The video clip displays the cecum; a pseudo polyp is observed; some biopsies were taken.
VideoEndoscopicSequence 3 of 3.
The biopsy forceps is observed.
Ulcerative Colitis.
There are several serpingenous ulcers with pseudo polyps, friability, exudate, and bleeding, with increasingly larger areas of ulcerations.
Ischemic Colitis.
Later endoscopic finding in a mild case of colonic ischemia. Note the more pronounced submucosal hemorrhage as well as the presence of pseudomembranes.
Video Endoscopic Sequence 1 of 2.
A 65 year-old male presented with chronic diarrhea Rectal bleeding associated with the passage of mucus
The image and the video clip displays a pancolitis. The mucosa is friable, erythematous, and edematous. This is uniform throughout the entire circumference of the colon.
Video Endoscopic Sequence 2 of 2.
Ulcerative Colitis.
Collagenous Colitis.
A 37 year-old female with diarrhea of 6 months. She was hospitalized in another institution, a barium enema performed and The Rx resulted negative; the entire colon was affected with segmental redness. Patients are usually middle-aged women (9:1 is the female-male ratio in collagenous colitis).
