Atlas of Colonoscopy Techniques - Diagnosis - Interventional Procedures Bearbeitet von Maximilian Bittinger, Helmut Messmann 1. Auflage 2005. Buch. 248 S. Hardcover ISBN 978 3 13 140571 5 Format (B x L): 23 x 31 cm Weitere Fachgebiete > Medizin > Klinische und Innere Medizin > Gastroenterologie, Proktologie Zu Leseprobe schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, ebooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte.
I General Information 1 General Information Regarding Examination... 2 G. Jechart Introduction... 2 Complications and Risks... 3 Indications and Contraindications... 2 Preparing for the Examination... 3 General Principles... 4 Anatomy of the Colon... 5 2 Basic Examination Technique and Colonoscopy Workstation... 7 G. Jechart Learning Examination Technique... 7 Instrument Features... 7 Operating the Endoscope... 8 Simulators... 11 Training on a Patient... 12 The Colonoscopy Workstation... 12 Examination Room Set-up... 12 Hygiene Standards for Reprocessing Equipment... 13 Radiography Equipment Regulations... 13 3 Modern Endoscopic Techniques... 15 Digital Structure Enhancement... 15 Chromoendoscopy... 16 Magnifying or Zoom Endoscopy... 15 Fluorescence Endoscopy... 16 II Normal Examination Procedure and Non-pathological Findings 4 Before the Examination... 22 A. Probst Informing the Patient... 22 Sedation and Medication... 22 Sedation and Analgesics... 22 Other Medications/Endocarditis Prophylaxis... 22 Patients with Pacemakers or Metal Implants... 23 Positioning the Patient... 23 Safety of the Patient and Monitoring... 24 5 Inserting the Endoscope and Advancing It in the Colon... 25 A. Probst Inspection and Palpation... 25 Passing the Anal Sphincter... 25 Endoscope Insertion in Postoperative Patients (Colostomy/Ileostomy)... 26 Advancing the Endoscope in the Sigmoid Colon (Sigmoidoscopy)... 27 Advancing Further to the Hepatic Flexure... 29 Proximal Colon... 31 Intubating the Ileocecal Valve and Terminal Ileum... 33 Looping and Using External Compression Techniques.. 34 Applying Simple Pressure over the Sigmoid Colon in the Left Lateral Position... 36 Simple and Combined Pressure with Patient in the Supine Position... 36 Transverse Pressure... 36 Pressure on the Right Flank... 36 Pressure over the Cecum... 36 Localizing the Endoscope... 37 Withdrawing the Endoscope and Blind Spots... 37 Retroflexion in the Rectum... 38 VII
6 Normal Appearance of the Intestinal Segments... 40 Normal Rectum... 40 Normal Sigmoid Colon... 42 Normal Descending Colon... 43 Normal Transverse Colon... 44 Normal Ascending Colon... 45 Normal Cecum and Ileocecal Valve... 46 Normal Terminal Ileum... 48 7 Normal Postoperative Appearances... 50 Restoring Intestinal Continuity... 50 III Pathological Findings 8 Diverticulosis and Diverticulitis... 56 Definitions... 56 Diverticulosis... 56 Clinical Picture... 56 Diagnosis... 56 Complications... 61 Differential Diagnosis... 61 Treatment... 61 Diverticulitis... 62 Clinical Picture... 62 Diagnosis... 62 Complications... 64 Differential Diagnosis... 64 Treatment... 64 9 Polyps and Polyposis Syndromes... 66 Polyps... 66 Definition... 66 Clinical Picture and Clinical Significance... 66 Diagnosis... 67 Epithelial Polyps... 68 Nonepithelial Polyps... 76 Surveillance... 76 Polyposis Syndromes... 76 Definition... 76 Clinical Picture and Clinical Significance... 76 Endoscopic Diagnosis... 77 Familial Adenomatous Polyposis (FAP)... 77 Peutz Jeghers Syndrome... 78 Juvenile Polyposis... 79 Differential Diagnosis... 79 10 Malignant Tumors... 81 Definition and Classification... 81 Clinical Picture and Clinical Significance... 81 Diagnosis... 81 Epithelial Tumors... 82 Malignant Nonepithelial Tumors... 86 Surveillance... 87 11 Submucosal Tumors... 89 Definition and Classification... 89 Clinical Picture and Clinical Significance... 89 Diagnosis... 89 Nonepithelial Tumors... 89 Carcinoids... 91 Treatment... 92 12 Colitis Inflammatory Bowel Diseases and Other Forms of Colitis... 93 R. Scheubel Definition... 93 Clinical Significance of Chronic Inflammatory Bowel Disease (IBD)... 93 Diagnosis... 93 Inflammatory Bowel Disease Indications for Ileocolonoscopy:... 94 VIII
Ulcerative Colitis... 94 Pouchitis... 101 Toxic Megacolon... 101 Carcinoma in Ulcerative Colitis... 101 Crohn Disease... 101 Differential Diagnosis of Chronic IBD Types and Other Forms of Inflammatory Bowel Diseases... 106 Differential Diagnosis: Ulcerative Colitis vs. Crohn Disease... 106 Other Differential Diagnoses... 107 Indeterminate Colitis... 107 Infectious Colitis... 108 Radiation Colitis... 111 Ischemic Colitis... 113 NSAID Colitis... 115 Diversion Colitis... 115 Pseudomembranous Colitis... 116 Other Rare Forms of Colitis... 116 Nonclassifiable Types of Colitis... 116 13 Acute and Chronic Lower Gastrointestinal Bleeding... 118 Definitions... 118 Epidemiology... 118 Prognosis and Clinical Course... 118 Diagnosis... 118 Endoscopic Diagnosis... 119 Chronic Lower Gastrointestinal Bleeding... 119 Acute Lower Gastrointestinal Bleeding... 119 Differential Diagnosis of Acute Lower Gastrointestinal Bleeding... 123 Diverticula... 123 Vascular Causes... 125 Dieulafoy Ulcer... 128 Ischemia... 129 Colitis... 130 Neoplasias... 134 Anorectal Diseases... 136 14 Vascular Malformations and Other Vascular Lesions... 143 Definitions... 143 Angiodysplasia (Telangiectasia)... 143 Epidemiology and Pathogenesis... 143 Histology... 143 Clinical Course and Prognosis... 143 Diagnosis... 143 Differential Diagnosis... 146 Syndromes/Vascular Malformations in Other Diseases... 146 Hemangiomas... 147 Epidemiology... 147 Histology... 147 Course and Prognosis... 147 Diagnosis... 147 Syndromes/Vascular Malformations in Other Diseases... 148 15 Melanosis Coli... 151 Definition... 151 Clinical Picture... 151 Diagnosis... 151 Therapy... 151 Surveillance... 151 16 Solitary Rectal Ulcer Syndrome... 152 Definition... 152 Clinical Picture... 152 Diagnosis... 152 Treatment... 152 17 Rare Diseases and Disorders... 154 Extrinsic Compression (Stenosis)... 154 Postoperative Strictures and Suture Granulomas... 154 Lumen Dilation and Pseudo-obstruction... 154 Definition... 154 Clinical Picture... 154 Diagnosis... 155 Treatment... 155 Surveillance... 156 Acute Segmental Hemorrhagic Colitis... 156 Definition... 156 Clinical Picture... 156 Diagnosis... 156 Treatment... 156 Surveillance... 156 IX
Pneumatosis Cystoides Intestinalis... 156 Definition... 156 Clinical Picture... 156 Diagnosis... 157 Treatment... 157 Surveillance... 157 Kaposi Sarcoma... 157 Definition... 157 Diagnosis... 157 Treatment... 158 Surveillance... 158 HIV-Related Lymphoma... 158 Ileitis... 158 Colon Varices and Portal Colopathy... 158 Rectal Varices... 159 Iatrogenic Lesions... 159 Lipomas and Carcinoid Tumors... 159 Endometriosis... 160 Amyloidosis... 160 Collagenous Colitis and Microscopic Colitis... 160 Colon Involvement in Non-Hodgkin Lymphoma... 161 IV Endoscopic Intervention 18 Polypectomy and Mucosectomy... 164 Indications and Contraindications... 164 Preparing for Polypectomy and Mucosectomy... 164 Instrumentation... 164 Polypectomy... 165 Small Polyps... 167 Stalked Polyps... 167 Sessile Polyps... 169 Malignant Polyps... 173 Mucosectomy... 173 Recovering Resected Polyps... 176 Complications following Polypectomy or Mucosectomy... 176 Follow-up Surveillance after Polypectomy... 178 19 Interventional Tumor Therapy... 179 Pathology of Malignant Colon Tumors... 179 Indications for Endoscopic Tumor Therapy... 179 Hemostasis Methods and Relief of Obstruction... 179 Palliative Tumor Therapy in Inoperable Patients... 179 Laser... 179 APC (Argon Plasma Coagulation)... 180 Metallic Mesh Stents... 180 20 Hemostasis... 185 Thermocoagulation... 185 Monopolar and Biopolar Electrocoagulation... 185 Argon Plasma Coagulation (APC)... 186 Laser... 189 Heater Probe... 191 Injection Therapy... 191 Mechanical Methods... 194 Hemoclips... 194 Band Ligation... 194 Endoloop... 197 21 Management of Benign Strictures... 200 R. Scheubel Definition and Causes... 200 Diagnosis and Therapy... 201 22 Fistulas and Postoperative Leakages... 203 W. Schmidbaur Fistulas... 203 Anastomotic Leakage... 204 Diagnosis... 206 Endoscopic Interventions... 206 Fistula Closure and Management of Dehiscence Using Fibrin Sealant... 207 Fistula Closure and Management of Dehiscence Using Clips... 208 Differential Therapy Using Fibrin Sealant/Clips... 210 Stents... 210 Endoscopic Suturing... 212 EndoVAC... 212 X
23 Removal of Foreign Bodies... 216 W. Schmidbaur Principles of Endoscopic Foreign Body Removal... 216 Removal of Foreign Bodies in the Colon... 216 Ingested Foreign Bodies... 217 Iatrogenic Foreign Bodies... 217 Foreign Bodies Introduced Per Rectum... 218 Removal of Foreign Bodies in the Rectum... 218 24 Decompression Tube Placement... 221 Definitions... 221 Acute Pseudo-obstruction of the Colon... 221 Definition and Pathogenesis... 221 Clinical Picture and Course... 222 Therapy... 222 Mechanical Obstruction... 224 Volvulus... 224 Malignant and Benign Stenoses... 227 Index... 229 XI