Endoscopic signs of duodenitis

Duodenitis - inflammatory-dystrophic changes in the mucous membrane of the duodenum. The most common pathological process is located in the bulb.

By the nature of the distribution:

1. Total duodenitis.
2. Limited duodenitis:
   1. distal,
   2. proximal.

Etiology and pathogenesis are different: total duodenitis occurs due to diffuse diseases of the mucous membrane of the small intestine, proximal (bulbit) - as a result of peptic ulcer, except follicular; distal, including papillitis, accompanies the diseases of the pancreas and the biliary system.

Forms of duodenitis.

1. Superficial (moderately pronounced).
2. Expressed.
3. Very pronounced.
4. Atrophic duodenitis.

Separately, follicular duodenitis is considered.

Superficial duodenitis. The mucous membrane is unevenly edematous, the areas of the inflamed mucosa alternate with unchanged external areas. On the areas of pronounced edema, a sharp hyperemia is seen in the form of separate spots (a mottled appearance). The diameter of patches of spotted hyperemia usually does not exceed 0.2-0.3 cm, they protrude slightly over the rest of the edematous mucosa. There is a slight thickening of the folds of the mucosa.

With pronounced duodenitis, the mucous membrane of the duodenum is diffusively edematous, the patches of spotted hyperemia are larger, they often merge into fields with a diameter of 1.5-2.0 cm. On sites of spotted hyperemia, small-dotted hemorrhages occur. Slime a lot, in addition, in the lumen of the gut appears a transparent light yellow opalescent liquid. When manipulating the endoscope, the mucous membrane of the duodenum bleeds easily.

Endoscopic picture of pronounced duodenitis is the same as with pronounced duodenitis, but sharper. Sites of spotted hyperemia merge into fields of 2,0-4,0 cm or diffuse lesion, there are small-scale hemorrhages, mucous membranes are easily injured, bleeds. In some areas, erosion occurs. In addition, in areas of the most pronounced edema, multiple whitish grains are detected, sharply differing in color from the surrounding edema-hyperemic mucosa of the duodenum and protruding above its surface, whose diameter is 0.5-0.8 mm. Such an endoscopic picture is described as a phenomenon of "semolina". In the lumen of the duodenum, a large amount of liquid content is accumulated with a significant admixture of bile and mucus.

Atrophic duodenitis. Along with edema and hyperemia, more or less extensive areas of thinned, pale mucosa are identified. A shell with a translucent mesh of numerous small branchlets of vessels. The mucous membrane is often clean, without clumps of mucus.

Follicular duodenitis. Against the background of a pale pink mucous membrane, numerous, rarely single, pale, small bulging of a rounded form 0.2-0.3 cm on a broad base of a whitish color are seen more often. Often there are multiple: they can be located in heap, or they can be at a distance. Usually localized in a bulb. Often there are parasitic infestations: lamblia, helminths.

Papillites.

1. Moderately pronounced.
2. Expressed.

There are 2 variants of the norm of the large duodenal papilla (BDS):

1. BDS does not differ in color from the surrounding mucosa.
2. Part of the OBD is covered with a protocol epithelium of whitish, brilliant, "radiant" species.

Moderate papillitis. Mucous in the area of the nipple is edematous, the nipple is pale, there is no gloss, chances of hyperemia are possible, nails can be a whitish shade.

Pronounced papillitis. A sharp hyperemia, edema, the radiant pattern disappears, the surface is uneven, bumpy, the size of the nipple can be increased to 1.5-2.0 cm.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11],