Vdd

1,499 views

Published on

Published in: Health & Medicine, Education
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,499
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
20
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Vdd

  1. 1. Vieâm daï daøy Hoà Ñaêng Quyù Duõng
  2. 2. Ñaët vaán ñeà 1. Chaån ñoaùn vieâm daï daøy qua noäi soi? • Chaån ñoaùn ñaïi theå? • Chaån ñoaùn vi theå? 2. Moái töông quan giöõa chaån ñoaùn noäi soi vaø chaån ñoaùn moâ beänh hoïc. 3. Söï thoáng nhaát veà thuaät ngöõ vaø caùc heä thoáng phaân loaïi khaùc nhau. 4. YÙ nghóa laâm saøng.
  3. 3. Ñònh khu giaûi phaãu Antrum Corpus Fundus Ant Less Post Gre Cardia Pylorus
  4. 4. Ñònh khu veà moâ hoïc Tuyeán hang vò Antral Gland zone Tuyeán ñaùy vò Oxyntic Gland zone Tuyeán taâm vò Cardiac Gland zone
  5. 5. ÑÒNH KHU LOAÏI TEÁ BAØO CHAÁT BAØI TIEÁT Taâm vò Mucous Endocrine Mucus,Pepsinogen - Ñaùy vò Parietal Chief Enterochromaffin G Hydrochloride acid, IF Pepsinogen Histamine, Serotonin Gastrin Hang vò G D Enterochromaffin Gastrin Somatostatin Histamine, Serotonin
  6. 6. NIEÂM MAÏC VUØNG ÑAÙY VÒ
  7. 7. Caùc bieåu hieän vieâm qua noäi soi
  8. 8. Descriptive sheet of endoscopic findings Items Findings • 1. Surface Irregular Rugal hypertrophy • 2. Atrophy Border of atrophy Visibility of vascular pattern • 3. Intestinal metaplasia Elevated Type Flat type • 4. Redness measuring less than 2mm Spotted • Redness Patchy • Including linear redness on the folds Linear • 5. Edema • 6. Erosive changes Flat/Depressed Elevated • 7. Whitish exudate Presence/ Absence • 8. Hemorrhage Active • Blood pigment spot Old • Concomitant lesions Absence [ ] Presence [ ] Michiko Kaminishi et al., Endoscopic classification of chronic gastritis based on apilot study by the research society for gastritis. Digestive Endoscopy (2002),14: 138–151
  9. 9. Endoscopic Characteristics of Inflammation 1. Oedema 2. Erythema Punctate Confluent 3. Friability 4. Exudate 5. Flat erosion 6. Raised erosion 7. Rugal hyperplasia (hyperrugosity) 8. Rugal atrophy (hyporugosity) 9. Visibility of the vascular pattern 10. Intramural bleeding spots Punctate or petechial Confluent or ecchymotic 11. Nodularity Fine Coarse SYDNEY SYSTEM: ENDOSCOPIC DIVISION
  10. 10. 1. Phuø neà (Oedema) 1. Laø nhöõng vuøng nieâm maïc hôi nhôït nhaït vaø traéng hôn, coù caáu truùc hình ña giaùc (daáu hieäu da raén) 2. Coù theå coù keøm xuaát tieát.
  11. 11. 2. Sung huyeát (Erythema) 1. Laø nhöõng vuøng nieâm maïc coù maøu ñoû hôn moät caùch roõ reät so vôùi nieâm maïc gaàn keà. 2. Sung huyeát: daïng noát, töøng maûng, hoaëc daïng ñöôøng.
  12. 12. 3. Söôùt phaúng (Flat erosion) 1. Laø nhöõng vuøng toån thöông nieâm maïc ñaùy coù giaû maïc, phaúng hoaëc hôi loõm, bôø toån thöông coù theå coù nieâm maïc sung huyeát xung quanh (Red halo). 2. Kích thöôùc coù thay ñoåi, coù theå coù ÑK 1cm. 3. Phaân bieät vôùi loeùt.
  13. 13. 4. Söôùt nhoâ cao (Raised erosion) 1. Laø nhöõng vuøng toån thöông nieâm maïc nhoâ cao coù mieäng loõm ôû giöõa laø veát söôùt. 2. Coù theå ñöùng ñôn ñoäc hoaëc xeáp thaønh chuoãi .
  14. 14. 5. Noát xuaát huyeát (Bleeding spot) 1. Laø nhöõng vuøng toån thöông nieâm maïc ñaùy coù laø veät maùu ñoû hoaëc maùu ñen. 2. Kích thöôùc coù thay ñoåi, coù theå coù ÑK 1cm.
  15. 15. 6. Teo nieâm maïc (Atrophy) 1. Laø nhöõng vuøng nieâm maïc moûng, loä roõ nhöõng maïch maùu beân döôùi trong khi khoâng bôm hôi quaù caêng. 2. Caùc neáp nieâm maïc (thaân vò) bieán maát hoaëc teo nhoû.
  16. 16. 7. Dò saûn ruoät (Intestinal Metaplasia) 1. Laø nhöõng toån thöông nhoâ cao daïng noát hoaëc töøng maûng nhoû coù maøu traéng ngaø. 2. Thöôøng hay gaëp ôû hang vò.
  17. 17. 8. Phì ñaïi (Rugal hyperrugosity) 1. Laø nhöõng toån thöông maø caùc neáp nieâm maïc coù ñöôøng kính ≥ 5mm, khoâng thay ñoåi khi bôm hôi caêng. 2. Beà maët coù theå coù sung huyeát, söôùt hoaëc xuaát tieát.
  18. 18. 8. Phì ñaïi (Rugal hyperrugosity) • Representative upper gastrointestinal endoscopy of enlarged fold gastritis. (A) Before H. pylori eradication, • (B) After 1 year of H. pylori eradication, • (C) After 2 years of H. pylori eradication. (Arrows show enlarged fold.) Yoko Murayama., is helicobacter pylori-induced enlarged fold gastritis a high-risk factor for gastric carcinoma?. Digestive Endoscopy (2006),18: 98–104
  19. 19. CHAÅN ÑOAÙN NOÄI SOI
  20. 20. Overview of Gastritis and Gastropathy • Erosive and hemorrhagic • Nonerosive • Distinctive Wilfred M. Weinstein, Gastritis and Gastropathy, Gastroenterologic Endoscopy; Vol 1 (2002)
  21. 21. Endoscopic findings and diagnostic criteria Fundamental types Definition according to endoscopic findings 1. Superficial gastritis Findings including edema and redness (spotted, patchy, linear) are observed 2. Hemorrhagic gastritis Hemorrhage is evidenced 3. Erosive gastritis Erosive changes including flat or depressed types 4. Verrucous gastritis Erosive changes including elevated type 5. Atrophic gastritis Findings such as color change of mucosa, visible vascular pattern and thinning are observed Metaplastic gastritis Intestinal metaplasia is noted Hyperplastic gastritis Remarkable irregularity of mucosa or rugal hypertrophy of greater curvature in corpus 6. Special gastritis (Refer to the appendix) Michiko Kaminishi et al., Endoscopic classification of chronic gastritis based on apilot study by the research society for gastritis. Digestive Endoscopy(2002),14: 138–151
  22. 22. Sydney System
  23. 23. Updated Sydney Classification
  24. 24. Endoscopic gastritis: Sydney system 1. Endoscopic erythematous/exudativc gastritis 2. Endoscopic flat erosive gastritis 3. Endoscopic raised erosive gastritis 4. Endoscopic atrophic gastritis 5. Endoscopic haemorrhagic gastritis 6. Endoscopic rugal hyperplastic gastritis 7. Endoscopic enterogastric reflux gastritis * Endoscopic congestive gastroenteropathy
  25. 25. Distinctive Types of Gastritis INFECTIONS AND INFESTATIONS - Bacterial infections: - Tuberculosis - Syphilis - Phlegmonous and Emphysematous Gastritis - Viral infections: - Cytomegalovirus infection - Herpesvirus infections - Fungal infections: - Candidiasis (Candida albicans) - Histoplasmosis - Other: zygomycosis (mucormycosis), aspergillosis - Nematosis and other parasitoses: - Cryptosporidosis - Anisakidosis - Other GASTROINTESTINAL TRACT DISEASES - Crohn's disease - Eosinophilic gastritis SYSTEMIC DISEASE - Sarcoidosis CONFINED TO THE STOMACH - Menetrier's disease - Isolated unexplained granulomas Wilfred M. Weinstein, Gastritis and Gastropathy, Gastroenterologic Endoscopy; Vol 1 (2002)
  26. 26. Special forms of gastritis 1. Chemical or Reactive Gastritis 2. Lymphocytic Gastritis 3. Granulomatous Gastritis 4. Eosinophilic Gastritis 5. Collagenous Gastritis 6. Radiation Gastritis 7. Infectious Gastritis 8. Bacterial 9. Viral 10. Fungal 11. Parasitic Updated Sydney Classfication
  27. 27. Eosinophilic gastritis 1. Laâm saøng: Ñau thöôïng vò, noân sau aên, suït caân, thieáu maùu thieáu saét, giaûm protid maùu. 2. Tieàn söû dò öùng moät soá loaïi thöùc aên 6 naêm.
  28. 28. Eosinophilic gastritis (a) Low-power microscopic view of a biopsy specimen from the gastric lesion showing foveolar dilatation and denseinfiltration of inflammatory cells (x 20). (b) High-power view of the specimen showing that most of the infiltrating cells are eosinophils (x100).
  29. 29. Eosinophilic gastritis Endoscopic findings of the gastric antrum after steroid therapy
  30. 30. Nodular gastritis 1. Laâm saøng: Thöôøng gaëp ôû nöõ, treû, hình aûnh noäi soi hang vò laø toån thöông daïng noát (haït): daáu hieäu da ngoãng (Goose skin). 2. Coù Hp (+).
  31. 31. Nodular gastritis Note also the intense inflammatory cell infiltration with large and superficial lymphoid follicle formation in the lamina propria of the mucosal specimens
  32. 32. Endoscopic Gastric syphilis
  33. 33. Gastric syphilis: histology
  34. 34. Gastric syphilis: posttherapy
  35. 35. Menetrier’s disease
  36. 36. Menetrier’s disease
  37. 37. Menetrier’s disease: histologic characteristics
  38. 38. MALT Lymphoma Cytokeratin stain: Normal gastric mucosa
  39. 39. MALT Lymphoma
  40. 40. Helicobacter pylori to gastric cancer

×