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Uc colonoscopy findings8/18/2023 ![]() ![]() They develop in patients with more severe and extensive periods of inflammation. Pseudopolyps are also often seen in UC and develop as a result of regenerating epithelium but can be seen in CD as well. Because the inflammation is continuous, the mucosa surrounding ulcerations will usually at a minimum have a diminished vascular pattern but more commonly will show more obvious signs of inflammation. As the severity of inflammation progresses the ulcerations become confluent, friability worsens, and spontaneous bleeding may develop ( Figure 2a and 2b). ![]() Moderate UC has a “wet sand-paper” appearance due to changes in light reflection, erosions, superficial ulcers, and friability. Early and mild inflammation appears as erythema, edema, and abnormal vascularity. On colonoscopy the inflammation in UC is circumferential and continuous. The proximal extent of inflammation varies-about 46% of patients with UC have proctosigmoiditis, 37% have left sided colitis, and 17% have pancolitis. Ulcerative colitis always involves the rectum, but if treatment has been started prior to colonoscopy the rectum may be spared or there may be patchy rectal inflammation. The inflammation seen in ulcerative colitis begins at the anal verge and extends proximally. Because of the discontinuous inflammation in CD, the area immediately surrounding inflammatory patches or ulcers are more likely to have an intact vascular pattern and absent or minimal inflammation on biopsy. Strictures, perianal disease, and isolated ileitis are also indicative of but not 100% specific for CD. Endoscopically, fistula openings may be visible as small openings in the colon or ileal mucosa. In perianal disease fistulas may be apparent on physical exam, and perianal fistulas are more commonly seen in patients with rectal inflammation. About one-third of patients with CD will develop a fistula over their lifetime. As the inflammation progresses, deep, serpiginous, and linear ulcerations and cobblestoning develop ( Figure 1). Mild inflammation presents endoscopically with erythema, granularity, altered vascular pattern, friability, and small discrete superficial and aphthous ulcers. The inflammation is patchy and circumferential inflammation is uncommon. Rectal sparing occurs in at least 50% of patients. įindings on index ileocolonoscopy at the time of CD diagnosis vary depending on the severity of inflammation, but the distribution and pattern can be helpful in diagnosing CD. Skip lesions, areas of inflamed mucosa separated by normal appearing mucosa, is characteristic of CD. This distribution can evolve over time during a patient’s disease course and so these proportions may not stay static in a population with CD over time. ![]() About 29% of patients with CD have involvement of both the ileum and colon, 35% have isolated ileitis, 36% of patients have colitis, and 4% have upper gastrointestinal tract involvement at the time of diagnosis. CD can affect any part of the alimentary tract from the mouth to the anus, but the terminal ileum and colon are most commonly affected. Since then, the endoscopic features and distribution of CD has been extensively elucidated. Crohn’s disease was initially described as regional ileitis in 1932 in which a new entity was described as being similar to UC but affecting the small intestine and leading to luminal stenosis. ![]()
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