Pneumatosis cystoides intestinalis

Bei der Pneumatosis cystoides intestinalis handelt es sich um Gascysten von Stecknadelkopf- bis Kirschgrose, die sich in der Wand des Dunndarms, des Coecums und im linksseitigen Dickdarm finden. Aber auch ein Befall des gesamten Colons ist beschrieben worden. Die Erkrankung kann in jeder Altersstufe auftreten. Histologisch lassen sich bei Serienschnitten kommunizierende Systeme von Gascysten nachweisen, die bei Jugendlichen submucos und im hoheren Alter subseros liegen. Die Zusammensetzung des Gases entspricht der der Atemluft.

Indikation zur proktologischen Untersuchung und Endoskopie

Klagen uber Misempfindungen im Analbereich sollten eine proktologische Untersuchung nach sich ziehen und nicht durch die Verordnung von „Hamorrhoiden-Zapfchen“ ubergangen werden.

Indikationen zur proktologischen Untersuchung und Endoskopie des Dickdarms

Das Colon ist ein oligo-symptomatisches Organ. Es reagiert auf unterschiedliche Noxen mit folgenden Symptomen: Schmerzen — Tenesmen; Obstipation/Diarrhoe; Abgang von Blut und Schleim.

Fistulae (Rectovaginal, Rectovesical)

The clinical manifestations of a fistula — stool from the vagina, air from the urethra — are often difficult to recognize because the fistulous opening is hidden by the edematous and swollen mucosa. Larger defects occur particularly after radiation therapy and with Crohn’s disease.

Digital-rectale Untersuchung

Beim Hantieren in der Analregion und vor der rectalen Untersuchung last sich die untersuchende Hand durch einen Plastikhandschuh schutzen. Es sind Plastikhandschuhe von verschiedener Starke fur den Einmalgebrauch auf dem Markt. Zusatzlich empfiehlt es sich, einen Fingerling uber den Zeigefinger zu ziehen, der nach der Untersuchung abgestreift wird. Die Untersuchung kann auch nur mit einem Fingerling erfolgen; man bohrt den Zeigefinger durch ein Stuck Zellstoff, der die ubrige Hand schutzt.

Anwendungsbereiche proktologischer Untersuchungsverfahren

Mit Inspektion und digital-rectaler Tastuntersuchung kann man sich begnugen bei: 1. Vorsorgeuntersuchungen ohne Beschwerdeangaben und negativem Test auf okkultes Blut im Stuhl (Haemoccult-Test, Fa. Rohm Pharma/Darmstadt, hemo FEC, Boehringer/Mannheim) 2. Juckreiz, Nassen, Feuchten in der Rima ani.

Inspection of the Perianal Region

During inspection of the perianal region and the anus, a portion of the anal canal may also be examined through stretching of the buttocks (Fig. 13). Good illumination is needed for an optimal examination.

Fecal Blood Loss in Patients With Colonic Polyps: A Comparison of Measurements With 51Chromium-Labeled Erythrocytes and With the Haemoccult Test

Abstract The quantitative determinations of fecal daily blood loss after intravenous administration of 51Cr-labeled erythrocytes in 44 patients with colonic polyps and in 11 controls were compared with the results of the daily performed Haemoccult test without dietary restrictions. A total of 642 stool specimens was analyzed for 51Cr loss and the Haemoccult test. The mean fecal daily blood loss in the 34 patients with adenomatous polyps of the descending colon and rectosigmoid was 1.36 ± 0.14 ml/day (mean ± SEM), in the 10 patients with polyps of the ascending and transverse colon it was 1.28 ± 0.31 ml/day, and in the 11 controls 0.62 ± 0.07 ml/day. There was no positive Haemoccult test in …

Gastric emptying of indigestible tablets in relation to composition and time of ingestion of meals studied by metal detector.

Enteric-coated tablets leave the stomach mainly during the interdigestive phase. Composition as well as time of ingestion of meals may influence their gastric emptying considerably. In 12 normal volunteers gastric emptying of a plastic tablet with a metal core was followed by a metal detector in relation to different compositions and various times of ingestion of meals. With an empty stomach and after ingestion of 250 ml water, the mean time for gastric emptying of the tablet was 38 +/- 11 min (mean +/- SEM) and 38 +/- 8 min. Two hundred fifty milliliters of milk (652 kJ) and a formula diet (1000 kJ) delayed gastric emptying time to 128 +/- 14 and 152 +/- 6 min, respectively (P less than 0.…

Anastomoses (Ileorectal; Colorectal)

With disease processes that involve the large bowel but leave the rectum free (Crohn’s disease, diverticulitis, neoplasms), a surgical procedure used for their treatment will result in an anastomosis that may be seen during rectoscopy. During the postoperative follow-up period, careful attention should be given to any recurrence, which in cases of Crohn’s disease is seen very early on rectoscopy.

Inspektion der äußeren Analregion

Der Inspektion zuganglich ist die perianale Region, der Anus und bei ausreichender Spreizung der Nates, Anteile des Analkanals (Abb. 13 s. S. 20). Voraussetzung fur eine optimale Beurteilung ist eine gute Beleuchtung der Analregion.

Influence of Senna, Fibre, and Fibre + Senna on Colonic Transit in Loperamide-induced Constipation

Retarded colonic transit and disturbed defecation are the most prominent pathophysiological mechanisms in constipation. Both may be influenced by bulking agents and by laxatives such as senna. Direct measurements of the influence of such substances on colonic transit are rare mainly because of technical problems. We measured gastric emptying, small and large intestinal transit in 24 healthy volunteers by a newly developed method employing a metal detector. Twelve persons taking a normal diet received loperamide in a dose sufficient to double the individual transit time. All subjects measured gastrointestinal transit time under normal conditions and with Sennatin containing purified sennosid…

Vorbereitung zur endoskopischen Untersuchung

Die Inspektion der auseren Analregion, die digitale Untersuchung und die Proktoskopie sind ohne Vorbereitung des Patienten durchzufuhren.

Anitis — Cryptitis — Papillitis

Inflammatory processes within this transitional zone cannot be separated from one another and often occur together. The source of the infection will usually be found in the crypts of Morgagni, originating in the dorsal crypts and spreading to the adjacent papillae. The area of involvement appears erythematous and edematous, and pus occasionally exudes from the crypts. An association exists between cryptitis and the development of anal fissures, and between anal fissures and hemorrhoidal diseases. The anal canal is for the most part also involved in the inflammatory process. One encounters an anitis, which because of an increased secretion produces a perianitis and perpetuates a perianal ecz…

Antibodies to cytoskeletal proteins in patients with Crohn's disease

. The immunologic basis of inflammatory bowel disease has been the focus of interest of a series of studies on Crohn's disease and the process of immune sensitization at the gastrointestinal mucosal level is functionally poorly understood. To date only few contradictory reports concerning the incidence of autoantibodies in patients with this disease exist. The aim of this study was to investigate the sera drawn from 60 patients suffering from biopsy-proven Crohn's disease to evaluate the prevalence of autoantibodies against nuclear antigens and cytoskeletal proteins. Using standard methods, no anti-nuclear antibodies or antibodies to extractable nuclear antigens could be detected. All sera …

Calcium transport in rat small intestine in vitro and in vivo

Intestinal calcium (Ca) transport was studied in the rat jejunum by the in vitro perfusion technique of Fisher and Parsons and in the tied loop in vivo. Mucosal uptake and absorption of Ca was examined under the following conditions: rising intraluminal Ca-concentrations (0.5–128 meq/l); inhibition of energy dependent metabolism (2,4-dinitrophenol, N2, low temperature); net water flow, out of or into the intestinal lumen; addition of strontium (Sr); pretreatment with low Ca-diet and with 6-methyl-prednisolone. The concentration-dependent Ca absorption curve rose steeply at low Ca-concentrations but changed to a slowly rising straight line above 16 meq/l Ca++. In contrast, Ca uptake into the…

Tolerance exists towards resident intestinal flora but is broken in active inflammatory bowel disease (IBD)

SUMMARY Hyporesponsiveness to a universe of bacterial and dietary antigens from the gut lumen is a hallmark of the intestinal immune system. Since hyperresponsiveness against these antigens might be associated with inflammation, we studied the immune response to the indigenous intestinal microflora in peripheral blood, inflamed and non-inflamed human intestine. Lamina propria monocuclear cells (LPMC) isolated from inflamed intestine but not peripheral blood mononuclear cells (PBMC) of IBD patients with active inflammatory disease strongly proliferated after co-culture with sonicates of bacteria from autologous intestine (BsA), Proliferation was inhibitable by anti-MHC class II MoAb, suggest…

Solitary Rectal Ulcer

Solitary ulcers of the rectum may be traumatic in origin and caused by thermometers, occasionally by digital removal of a fecal impaction, or by deviate sexual behavior. Solitary rectal ulcers may also be a manifestation of Crohn’s disease. Very rarely, ectopic gastric mucosa is their cause. For the vast majority of solitary rectal ulcers, the explanation remains unknown. Occasionally, the ulcers are accompanied by localized inflammation of the mucosa within the distal segment of the rectum with edema, erythema, and circumscribed whitish flecks in a thickened bowel wall covered by excessive secretions. The changes are found predominantly in the ventral portion of the rectum, and in contrast…

Preparation for Endoscopic Examination

Inspection of the perianal area, the digital rectal examination, and the proctoscopic examination may be done without special preparation.

Digital Rectal Examination (Fig. 2a and 2b)

During examination of the anal region and before doing the rectal examination, the hand is protected by a plastic glove. A number of disposable gloves of varying strengths are on the market. One may additionally use a finger cot on the forefinger, which is removed after the examination. The examination can also be done using a finger cot alone with the finger stuck through a piece of gauze that protects the rest of the hand. Right-handed examiners often elect to use the forefinger of the left hand for the rectal examination and keep the right hand uncontaminated for handling instruments.

Technique for Performing Rectoscopy

After positioning of the patient (Figs. 1 and 11), the instrument is introduced into the anus. The anal canal runs diagonally toward the navel. This distance must be passed blindly. The instrument is therefore guided through this area with the help of the obturator, which is promptly removed after passage of the instrument through the anal canal.

Instrumente zur Endoskopie des Analkanals und Rectums

In der Besprechung des endoskopischen Instrumentariums und der Zusatzgerate wird auf allgemeine Merkmale und die wesentlichen Prinzipien eingegangen, weil die Instrumente von Firma zu Firma leicht variieren und uberdies standig modifiziert werden. Einzelheiten konnen aus Firmenprospekten entnommen werden (Wolf/Knittlingen ; Storz/Tuttlingen).

Fisteln (recto-vaginale, -vesicale)

Klinisch manifeste Fisteln — Stuhl aus der Vagina, Luft aus der Hanrohre — sind endoskopisch oftmals nur schwer nachzuweisen, weil der Fistelgang in odematos geschwollener Schleimhaut verborgen liegt. Grosere Defekte finden sich besonders nach Bestrahlungen und bei Morbus Crohn.

NITROGLYCERINE DILATATION OF SPHINCTER OF ODDI FOR ENDOSCOPIC REMOVAL OF BILEDUCT STONES

Diseases of the External Anal Area

Diseases of the external anal area may be diagnosed during inspection using good lighting. Because of the variable responses to treatment, the individual diseases should be diagnostically distinguished from one another.

PENTAZOCINE HAMPERS BILE FLOW

Instruments Used for Endoscopy of Anus and Rectum

In the discussion of endoscopic instruments and additional tools, we have referred only to the general features and important principles since instruments from individual firms not only vary in details but are also being continuously modified. The characteristics of any specific instrument may be obtained from its manufacturer.

Calcium Absorption in Health and Disease

Calcium (Ca) metabolism and intestinal Ca absorption have attracted special attention ever since the discovery of vitamin D and the definition of the clinical entities of disturbances of Ca homeostasis in the first three decades of this century. Since then, many details of Ca transport and vitamin D metabolism have accumulated, but only in very recent years have new ideas and findings brought about rapid progress in this field. There is now a startling activity in the investigation of the physiology and pathogenesis of vitamin D and Ca metabolism.

Anitis — Kryptitis — Papillitis

Die entzundlichen Prozesse in dieser Ubergangsregion konnen nicht isoliert gesehen werden und kommen oft gemeinsam vor. Die Morgagnischen Krypten sind meist der Ausgangspunkt der Entzundungen.

Antiinflammatory treatment and intestinal alpha 1-antitrypsin clearance in active Crohn's disease.

Intestinal alpha 1-antitrypsin clearance was quantified in 17 patients with clinically active Crohn's disease before and after a six-week period of treatment with sulfasalazine and methylprednisolone. Before the study, alpha 1-antitrypsin clearance and, hence, enteric protein loss was elevated as being above control values in 16 patients. After therapy, clearance values decreased in 11 and were normalized in five patients. Serum albumin level was normalized in 11 of 12 patients who had hypoalbuminemia before the study. Clinical condition was improved in all but 1 patient after treatment. There was no close correlation between alpha 1-antitrypsin clearance and disease activity index. These r…

Erkrankungen der äußeren Analregion

Erkrankungen der auseren Analregion lassen sich wahrend der auseren Inspektion bei ausreichender Beleuchtung diagnostizieren. Wegen der unterschiedlichen therapeutischen Konsequenz sollen die einzelnen Krankheitsbilder differentialdiagnostisch voneinander abgegrenzt werden.

Influence of loperamide and loperamide oxide on the anal sphincter

The objective of this study was to investigate the effects of the opioid loperamide and its recently synthesized pharmacologically inactive prodrug loperamide oxide on the anal sphincter. In a double-blind, placebo-controlled crossover study, anorectal manometry was performed in 12 healthy volunteers five hours after oral bolus application of 10 mg of loperamide, loperamide oxide, or placebo. Loperamide significantly increased the threshold volumes for minimal perception and urgency to defecate (P less than 0.05) and raised the volume required to abolish recovery of the rectoanal inhibitory reflex (P less than 0.05). These findings suggest that loperamide has a specific continence-improving…

Enteropathische Spondarthritiden bei chronisch entzündlichen Darmerkrankungen: Prävalenz, Befallsmuster und HLA-Assoziation

Enteropathische Spondarthritiden stellen die haufigste extraintestinale Manifestation der chronisch entzundlichen Darmerkrankungen (CED), Morbus Crohn (MC) und Colitis ulcerosa (CU), dar. Ziel der vorliegenden Studie war es daher, ein groses Patientengut mit chronisch entzundlichen Darmerkrankungen auf die Pravalenz und das Befallsmuster von Spondarthritiden (SpA) sowie auf eine Assoziation der Spondarthritiden mit der Ausdehnung der Darmerkrankung und dem HLA-Typ des Patienten hin zu untersuchen. 521 Patienten (409 mit Morbus Crohn, 112 mit Colitis, ulcerosa) wurden prospektiv uber den Zeitraum eines Jahres untersucht. Bei der Diagnose einer Spondarthritis wurden anamnestische, klinische, …

Anastomosen (ileo-rectale; colo-rectale)

Bei Dickdarmprozessen, die das Rectum freilassen und eine Resektion erfordern (Morbus Crohn, Diverticulitis, Neoplasien) ist die Anastomose rectoskopisch einsehbar (Tafeln XV/1 ; XX/4). Bei Kontrolluntersuchungen mus besonders auf Rezidive geachtet werden, die im Fall des Morbus Crohn bereits sehr fruhzeitig rectoskopisch sichtbar sind.

Effect of lactose, lactulose and bisacodyl on gastrointestinal transit studied by metal detector.

SUMMARY Aim and methods: To study the effect of 45 g lactose, 30 g lactulose and 10 mg bisacodyl on gastrointestinal transit in 30 healthy volunteers by metal detector and Hinton marker method. The first set of measurements were performed under standard conditions. In a second stage, transit was slowed to twice the original value by loperamide to simulate constipation conditions. Results: Bisacodyl drastically accelerated small and large intestinal transit. Colonic transit was shortened to 23 % and to 31% of control values, without and with loperamide. Bisacodyl increased stool weight and decreased stool consistency in all persons. Lactulose marginally shortened small intestinal transit (P=…

Low-dose budesonide treatment for prevention of postoperative recurrence of Crohnʼs disease

Summary and ConclusionAlthough the effect of budesonide was altogether positive in almost all variables studied in this train (e.g. endoscopic and histopathological score, time-to-failure, CDAI, patients' global judgement and rate of side effects), this increase in efficacy was small and the power f

Azathioprine combined with prednisolone or monotherapy with prednisolone in active Crohn's disease

Abstract Background: The role of azathioprine (AZA) in the treatment of active Crohn's disease (CD) is still controversial. This study examined whether AZA combined with standard prednisolone therapy improved the therapeutic outcome compared with monotherapy with prednisolone. Methods: Forty-two patients with a Crohn's Disease Activity Index (CDAI) of > 150 were randomized into two groups. Both received 60 mg of prednisolone daily in a tapering regimen to a maintenance dose of 10 mg. In addition, group 1 received 2.5 mg AZA/kg body wt and group 2 received a placebo over the whole study period of 4 months. Results: At the end of the trial, 16 of 21 patients (76%) in group 1 were in remission…

Inflammatory Bowel Diseases

The endoscopic aspects of an inflammatory colon disease do not permit the differentiation of a nonspecific proctitis from a bacterial enterocolitis and an ulcerative proctitis.

Indications for Performing a Proctologic Examination and Endoscopy

Complaints from the patient about discomfort in the anal region, rectal bleeding, and change in bowel habits — especially recent occurrence of constipation or diarrhea or a change in either symptom — as well as tenesmus are obligatory reasons for conducting a proctologic examination. These symptoms should never be ignored or treated by prescription of hemorrhoid suppositories, antispasmodics, analgesics, or laxatives.