Gastric Ulcers III, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
A 75 year-old female, presented with severe abdominal pain since three days. Endoscopy displays a deep ulcer at the lesser curvature of the stomach. This patient has a klatskinīs tumor (bile duct bifurcation).

Video Endoscopic Sequence 1 of 5.

 A 75 year-old female, presented with severe abdominal
 pain since three days. Endoscopy displays a deep ulcer at
 the lesser curvature of the stomach.

 This patient has a klatskinīs tumor (bile duct bifurcation).

 For further endoscopic information, download the video clip
 by clicking on the endoscopic image. Wait to be
 downloaded complete then Press Alt and Enter for full
 screen ( Windows Media), Real Player: Ctrl and 3.

 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode.

 
A close-up to gastric ulcer. The congestion in the portal system is the main pathogenetic element in gastroesophageal ulcerogenesis.

Video Endoscopic Sequence 2 of 5.

 A close-up to gastric ulcer. The congestion in the portal
 system is the main pathogenetic element in
 gastroesophageal ulcerogenesis.

 
The prevalence of gastric ulcer in cirrhotic patients was found to be significantly higher than in the age-and sex-matched healthy subjects. Portal hypertension with a hepatic venous pressure gradient more than 12 mmHg. may be an important factor contributing to the increased prevalence of gastric ulcer observed in patients with liver cirrhosis.

Video Endoscopic Sequence 3 of 5.

 The prevalence of gastric ulcer in cirrhotic patients was
 found to be significantly higher than in the age- and
 sex-matched healthy subjects. Portal hypertension with a
 hepatic venous pressure gradient > 12 mmHg. may be an
 important factor contributing to the increased prevalence of
 gastric ulcer observed in patients with liver cirrhosis.

 

 
Esophageal Varices are observed.

Video Endoscopic Sequence 4 of 5.

 Esophageal Varices are observed.

 The prevalence of gastric ulcers in patients with liver
 cirrhosis is increased compared with that in the general
 population, and portal hypertension may contribute to the
 increased risk of gastric ulcer in cirrhosis patients.
 Aggressive factors involved in the pathogenesis of gastric
 ulcer are diminished in association with portal hypertension.
 In contrast, most of the important gastric mucosal defense
 mechanisms are shown to be impaired in portal
 hypertension; many of these mechanisms are also found to
 be altered in patients with liver cirrhosis. Portal
 hypotensive treatment with propranolol reduces ethanol
 -induced gastric mucosal damage in portal hypertensive
 rats and improves endoscopic signs of portal hypertensive
 gastropathy in cirrhosis patients.

 
The Larynx is yellowish Jaundice.

Video Endoscopic Sequence 5 of 5.

 The Larynx is yellowish (Jaundice).

 
This video endoscopic sequence shows two ulcers in a cirrhotic patient. This 82 year old woman who had had severe ascites and previously in the paracentesis procedure had drained 6 liters of ascites liquid, at endoscopy two giant ulcers were found.

Video Endoscopic Sequence 1 of 7.

This video endoscopic sequence shows two ulcers in a cirrhotic patient.

 This 82 year old woman who had had severe ascites and
 previously in the paracentesis procedure had drained 6
 liters of ascites liquid, at endoscopy two giant ulcers were
 found.

 
One of the two big ulcers was fount at lesser curvature at the pre-piloric antrum.

Video Endoscopic Sequence 2 of 7.

 One of the two big ulcers was fount at lesser curvature at
 the pre-piloric antrum.

 Liver cirrhosis is frequently associated with complicated
 peptic ulcer disease. It has been showed that peptic ulcer is
 more frequent in patients with liver cirrhosis, is associated
 with the severity of cirrhosis, and occurs without upper
 abdominal pain in up to 70% of patients and with
 complications in 29%.

 
This giant ulcer is found at the lesser curvature of the gastric body, macroscopically has suspected, some parameters of malign but the biopsies were negative, however in six week will need a new follow up endoscopy.

Video Endoscopic Sequence 3 of 7.

 This giant ulcer is found at the lesser curvature of the
 gastric body, macroscopically has suspected, some
 parameters of malign but the biopsies were negative,
 however in six week will need a new follow up endoscopy.
Retroflexed view.

Video Endoscopic Sequence 4 of 7.

Retroflexed view.

 Peptic ulcer in these patients is very often asymptomatic
 and associated with concurrent complications, especially
 in those with more severe liver disease. The complication
 rate in recurrent ulcers was 20%-25%. However, due to
 the retrospective nature of this study, after ulcer healing
 the endoscopic follow-up was irregular. Regularly repeated
 endoscopy should be carried out in patients with liver
 cirrhosis and peptic ulcer to diagnose new and recurrent
 ulcers and to prevent related complications.
More images and video clips of this video endoscopic sequence.

Video Endoscopic Sequence 5 of 7.

More images and video clips of this video endoscopic sequence.
A follow up endoscopy Six week after. The ulcer of the antrum is in the scar fase, a six week with PPI treatment.

Video Endoscopic Sequence 6 of 7.

A follow up endoscopy Six week after.

 The ulcer of the antrum is in the scar phase, a six week
 with proton pump inhibitor (PPI) treatment.
This image displays the scar of the ulcer of the body.

Video Endoscopic Sequence 7 of 7.

A follow up endoscopy Six week after.

This image displays the scar of the ulcer of the body.
Multiple Gastric Ulcers. This Sequence of images and videos display multiple ulcers That are observed in all parts of the stomach, fundus, corpus, and the antrum. A 86 year-old female was hospitalized due to an upper gastrointestinal hemorrhage presenting with melena and hypotension. Her Hb was 8.1 gr.

Video Endoscopic Sequence 1 of 3.

Multiple Gastric Ulcers.

 This Sequence of images and videos display multiple ulcers
 That are observed in all parts of the stomach, fundus,
 corpus, and the antrum.
 An 86 year-old female, was hospitalized due to an upper
 gastrointestinal hemorrhage presenting with melena and
 hypotension. Her Hb was 8.1 gr/dl. 

 
Multiple Gastric Ulcers. Same case displays above, eleven ulcers are observed in retroflexed view, the video clip displays many more ulcers until the fundus.

Video Endoscopic Sequence 2 of 3.

 Same case displays above, eleven ulcers are observed in
 retroflexed view, the video clip displays many more
 ulcers until the fundus.
 
Multiple Gastric Ulcers. The antrum is observed with multiple ulcers, no ulcer was found in the duodenum.

 Video Endoscopic Sequence 3 of 3.

 The antrum is observed with multiple ulcers, no ulcer
 was found in the duodenum.
 
Gastric Ulcer at the prepiloric antrum of great size and depth which contains a fistolous biliary tract at the small curvature. You can observe in the video clip the biliar secretion emerging from the fistolous tract.

Gastric Ulcer with Fistolous Biliary Tract.

 Gastric Ulcer at the prepiloric antrum of great size and
 depth which contains a fistolous biliary tract at the small
 curvature.

 You can observe in the video clip the biliar secretion
 emerging from the fistolous tract.
 
Multiple acute erosions of the antrum.

Video Endoscopic Sequence 1 of 7.

 Multiple acute erosions of the antrum.

 
magnifying endoscopy. This acute erosion is appreciated with magnifying endoscope.

Video Endoscopic Sequence 2 of 7.


 This acute erosion is appreciated with magnifying
 endoscope.
 
magnifying endoscopy. Another erosion seen with magnifying endoscope.

Video Endoscopic Sequence 3 of 7.


 Another erosion seen with magnifying endoscope.
magnifying endoscopy. This acute erosion is observed with magnifying endoscope.

Video Endoscopic Sequence 4 of 7.

 This acute erosion is observed with magnifying endoscope.

 
Chromoendoscopy. The image and the video display the methylene blue. Chromoendoscopy, one erosion is seen with this method.

Video Endoscopic Sequence 5 of 7.

 The image and the video display the methylene blue. 
 Chromoendoscopy, one erosion is seen with this method.
 
Chromoendoscopy. Multiple erosions of the gastric antrum.

Video Endoscopic Sequence 6 of 7.

 Multiple erosions of the gastric antrum.
Chromoendoscopy. Another image and video of the gastric erosions.

Video Endoscopic Sequence 7 of 7.

 Another image and video of the gastric erosions.
This 57 year-old woman with hepatic cirrhosis. The image and the video display a gastric ulcer at the antrum..

      
 This 57 year-old woman with hepatic cirrhosis.
 The image and the video display a gastric ulcer at the
 antrum.

Perforated Gastric Ulcer. A 25 year-old otherwise healthy man presented to the emergency department with the sudden onset of severe, sharp mid-epigastric pain approximately 3 hours earlier. Intraoperative photograph of the stomach showing the perforation on the anterior pre-pyloric region. Patient had no history of Alcoholism or NSAIDS.

Perforated Gastric Ulcer.

 A 25 year-old otherwise healthy man presented to the
 emergency department with the sudden onset of severe,
 sharp mid-epigastric pain approximately 3 hours earlier.
 Intraoperative photograph of the stomach showing the
 perforation on the anterior pre-pyloric region.
 Patient had no history of Alcoholism or NSAIDS.
 
Gastric ulcer with irregular aspect. A 63 year-old male. An upper endoscopy was performed due to epigastric pain. An irregular ulcer was found, the biopsies were negatives. A 63 year-old male. An upper endoscopy was performed due to epigastric pain. An irregular ulcer was found, the biopsies were negatives.

Gastric ulcer with irregular aspect.

 A 63 year-old male. An upper endoscopy was performed
 due to epigastric pain. An irregular ulcer was found, the
 biopsies were negatives.

 
Endoscopy revealed multiple ulcers and erosions of the gastric corpus, fundus and the antrum. An 82 year-old male, taking NSAIDs who presented with acute bleeding. Endoscopy revealed multiple ulcers and erosions of the gastric corpus, fundus and the antrum. The endoscopic image displays an ulcer with a blood clot that cover the vessel.

Video Endoscopic Sequence 1 of 5.

 An 82 year-old male, taking NSAIDs who presented with
 acute bleeding.
 Endoscopy revealed multiple ulcers and erosions of the
 gastric corpus, fundus and the antrum.
 The endoscopic image displays an ulcer with a blood clot
 that cover the vessel.
 
The video clip displays multiple ulcer of the gastric body.

Video Endoscopic Sequence 2 of 5.

 The video clip displays multiple ulcer of the gastric body.
Multiple ulcers and erosions are observed through the gastric body, fundus, antrum and a deformed pylorus was observed; the patient also had duodenal ulcers.

Video Endoscopic Sequence 3 of 5.

 Multiple ulcers and erosions are observed through the
 gastric body, fundus, antrum and a deformed pylorus was
 observed; the patient also had duodenal ulcers.
 

 
A close up of the ulcer that iniciate the hemorrhage a blood clot which has been covered by a clot.

Video Endoscopic Sequence 4 of 5.

 A close up of the ulcer that iniciate the hemorrhage a blood
 clot which has been covered by a blood clot.
 
Another picture and video of this case.

Video Endoscopic Sequence 5 of 5.

 Another picture and video of this case.

A 92 year-old male that has been hospitalized due weight loss and anemia his hemoglobin was 10 mg./dl. An irregular ulcer was found at the corpus, 10 fragment of biopsies were obtain no evidence of malignancy were found neither the Hematoxilin-eosin staining nor immunohistochemical studies.

Video Endoscopic Sequence 1 of 2.

 A 92 year-old male that has been hospitalized due weight
 loss and anemia his hemoglobin was 10 mg./dl.
 An irregular ulcer was found at the corpus, 10 fragment of
 biopsies were obtain no evidence of malignancy were found
 neither the Hematoxilin-eosin staining nor
 immunohistochemical studies.
The image and the video clip display the forceps of the biopsy.

Video Endoscopic Sequence 2 of 2.

 The image and the video clip display the forceps of the
 biopsy.