Gastric Ulcers III -The Gastrointestinalatlas

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Video Endoscopic Sequence 2 of 5.

Endoscopy of Gastric Ulcer

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

Video Endoscopic Sequence 3 of 5.

Endoscopy of Gastric Ulcer

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.

Video Endoscopic Sequence 4 of 5.

Esophageal Varices are seen

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.

Video Endoscopic Sequence 5 of 5.

The Larynx is yellowish (Jaundice).

Gastric Ulcer with Fistolous Biliary Tract.

Ectopic opening of the CBD into various sites of the upper digestive 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.

An ectopic opening of the common bile duct in the upper digestive tract is an extremely rare anomaly and one that should not be dismissed as just a benign congenital variant.

Video Endoscopic Sequence 1 of 2.

Pyloric and pre-pyloric antrum ulcer

This is a 72 year-old lady, has suffered from anorexia, and anemia. She was referred to our unit for endoscopic study finding this ulcer

Video Endoscopic Sequence 2 of 2.

Pyloric and pre-pyloric antrum ulcer

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.

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%.

Video Endoscopic Sequence 3 of 7.

Endoscopic Image of Gastric Ulcer

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 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.

Video Endoscopic Sequence 5 of 7.

More images and video clips of this video endoscopic sequence.

Video Endoscopic Sequence 6 of 7.

A follow up endoscopy Six week after.

The ulcer of the antrum is in the scar phase after six week with proton pump inhibitor (PPI) treatment.

Video Endoscopic Sequence 7 of 7.

A follow up endoscopy Six week after.

This image displays the scar of the ulcer of the body.

Video Endoscopic Sequence 1 of 3.

Multiple Gastric Ulcers.

This Sequence of images and videos clips 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.

Video Endoscopic Sequence 2 of 3.

Same case displays above, eleven ulcers are seen in retroflexed view, the video clip displays many more ulcers until the fundus.

Video Endoscopic Sequence 3 of 3.

The antrum is observed with multiple ulcers, no ulcer was found in the duodenum.

This is a 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.

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.

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.

Video Endoscopic Sequence 2 of 5.

The video clip displays multiple ulcer of the gastric body.

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.

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.

Video Endoscopic Sequence 5 of 5.

Another picture and video of this case.

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.