Download e-book for iPad: Atlas of coloscopy by Francesco Paolo Rossini M.D. (auth.)

By Francesco Paolo Rossini M.D. (auth.)

ISBN-10: 1461596505

ISBN-13: 9781461596509

ISBN-10: 1461596521

ISBN-13: 9781461596523

by Mario Banche, M.D. IX The neologism "coloscopy" (colonscopy, colonoscopy) is the newest addition to the vocabulary of endoscopy of the big gut. simply because the time period "duodenoscopy" used to be in endoscopy of the higher digestive tract many years in the past. With the appearance of the coloscope it truly is now attainable to check the big bowel extra largely and successfully than was once previously attainable with using its inflexible forerunner, the rectosigmoidoscope. The earliest rectoscopes, eleven endoscopes" brought throughout the nineteenth century by means of Segales and Desormeaux (1826, 1853), have been conceived for lots of uses-inspection of the urethra, bladder, uterus, rectum. Successive advancements finally ended in the development of an device designed solely for endoscopy of the rectum and sigmoid colon (Bensaude, 1907). Over the next years the rectoscope underwent no big switch and therefore an ample and homogeneous literature amassed within which the on hand tools and their use have been defined whereas the endoscopic pathologic nosography and corresponding endoscopic images of the rectum and sigmoid colon have been codified, illustrated first through basic sketches and later via nonetheless and movement images. The literature comprises many fantastic courses, a few in monograph form.

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The coloscope is in the middle third of the transverse colon. Its progression is slowed down by the upward displacement of the splenic flexure and by a loop in the sigmoid colon. Fig. 53. The tip of the coloscope is hooked upwards. The instrument can thus be withdrawn and rotated clockwise to straighten out the alpha loop, lower the splenic flexure and raise the transverse colon. Fig. 54. The tip has reached the hepatic flexure. Fig. 56. Fig. 55. The coloscope has passed the hepatic flexure and is bent down facing the ascending colon.

Parietal and intramural diverticulum. Part of the diverticular sac extends into the bowel wall. 44 Coloscopic form Gastrointestinal endoscopy Coloscopy n. --~----------------------------------Diathermy snare type Polyp retrieved by: Control after polypectomy Complications Notes Diagnosis forceps or basket 0 suction 0 natural route 0 lost 0 45 c: I:: 0_ 8J~ "Ct: Oc. - 0 Cl'" OO=: 1 ) faeces 2) blood 3) mucus 1 2 3 c: 0_c: 00 CJ;e "Co '0 a. Q "'0 u " U 1 2 4 4 4 1 2 1 2 1 2 1 2 1 2 1 2 3 4 4 4 4 4 Progression of the fibrescope 1 2 1 2 1 2 1 2 1 2 3 1 2 3 3 3 Bowel walls 1) distensible 1 1 2 1 2 1 2 1 2 1 2 1 2 4 4 Mucosa (colour) 2) stiff 1) pink 2) bright red Blood vessels Erosions Pseudopolyps Size 1 2 4 4 1 2 4) granular 5) oedematous 6) brittle 7) cobblestone 4 5 1) normal 2) high 3) pseudopolypoid 4) low 5) absent 1 2 3 1 2 1 2 3 4 1 2 3 3 3 6 6 6 1 2 7 3 4 5 7 4 5 2 1 2 3 4 1 2 3 1 2 3 4 1 2 4 1 2 1 2 3 1 2 1 2 1 '2 7 7 6 6 7 1 2 1 2 1 2 1 2 1 2 7 1 2 1 2 6 6 4 5 4 5 3 3 4 5 4 5 3 3 4 5 4 5 3 3 4 5 4 5 3 3 4 5 1) enhanced vascular networks 1 2 2) vascular networks 3) dilated veins 3 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 3 3 3 3 3 1 3 3 3 3 3 2 1 2 3 3 3 3 1 ) linear 2) serpiginous 3) punched-out 4) furrow-like 5) aphtha-like 6) mUltiple, bleeding 7) deep 8) shallow 1 2 1 1 2 1 2 1 2 1 2 1 2 1 2 1 2 4 5 4 5 1) multiple 2) diffuse 2 3 3 6 7 8 6 4 5 1 2 3) brittle 3 4 1 ) single 2) multiple 3) diffuse 1 2 4 5 7 3 3 6 6 7 8 4 5 7 8 8 1 2 1 2 3 1 2 6 6 6 8 8 1 2 1 2 1 2 4 4 4 4 1 2 1 2 1 2 1 2 6 7 8 3 7 4 5 7 7 8 1 2 4 5 6 7 8 1 2 4 4 4 4 1 2 1 2 3 1 2 3 1 2 3 3 ,3 3 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 4 4 1 ) sessile 2) pedunculated 1) smooth 3 3 1 2 1 2 1 2 1 2 4 5 4 5 3 4 3 4 3 4 4 1 2 1 1 2 1 2 3 3 4 5 3 1 2 1 ) 0-5 mm.

The mucosa is distended and becomes pale. The insufflated air rebounds from the bowel wall. If the coloscope is now inserted further the bowel wall may be torn. Any complaint of pain by the patient should receive immediate attention. Fluoroscopy must be performed at once and should distension of the colon be observed the coloscope must be withdrawn until the pain subsides. Should pain persist coloscopy must be interrupted and a surgeon consulted. Perforation may also occur during biopsy especially when the mucosa is brittle, or when there is a bleeding growth or even when the mucosa is normal but the forceps is inserted deeply.

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Atlas of coloscopy by Francesco Paolo Rossini M.D. (auth.)


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