Colon, rectum and anusDr. sigid djuniawan,spB

AnatomyThe Bodys Digestive System Esophagus, Stomach, Small Intestine &Large Intestine 1st 6 feet = large bowel or colonLast 6 inches = rectum & anal canalThe anal canal ends at the anus

cancerColorectal polypsHyperthrophic lymph folicles, submucosal lesionCarcinoid tumor : at appendix (35-40%), rectum ( 15%), colon (10%)

Neoplastic mucosal lesion : tubular adenoma (60-80%), increase with age, tubulovilous adenoma , vilous adenoma,

ADENOCARCINOMA SEQUENCE

DISTINGUISHING FEATURES OF COLITIS-ASSOCIATED COLORECTAL CANCER

MULTIPLE POLYPOSIS SYNDROMEFamilial adenomatous polyposis : chromosome 5, rare, Age start :25 yo, clinical : abdominal pain, diare, hematochezia, anemia def iron

Signs & SymptomsChange in bowel habitsBlood in StoolBright red Very dark redBlack/Tarry StoolDiarrheaConstipation Does your bowel feel like it emptied completely?General abdominal discomfortGas painsBloatingFullnessCrampsWeight loss w/ no explained reasonConstant tirednessVomiting (coffee grounds)

Tests that examineRectum, Rectal Tissue, & Blood

Aids in diagnosing & preventing colon cancer

Physical ExamGeneral Medical HistoryIncludes self health habits Past self illnessesVarious treatments used for previous issuesFamily health historyIf patient reports problems with respect to signs and symptoms related to common bowel change habitsAre symptoms affecting your everyday life?

Fecal occult blood testCheck stool for evidence of blood MethodSmall samples of stool are placed on special cards and returned to the Dr. or Lab for testing under a microscopePotential harmsFalse-positive & false negative results (uncommonserious

Digital Rectal ExamThe doctor or nurse inserts a lubricated, GLOVED finger into the rectum to feel for lumps or abnormal areas.

Barium EnemaBarium is a liquid, that contains a silver-white compound, inserted into the rectumThe barium coats the lower GI tract and a series of x-rays are taken of the lower GI tract AKA = a lower GI series

What does a Barium Enema do?DetectsUlcersNarrowed areas (strictures)Growth of the lining (polyps)Small pouches in the wall of the intestineDiverticulaCancerabnormalities

How can one prepare for this test?Colon must be completely emptyPrescribed laxatives or enema (pre-exam)Special Diet to follow (2 days prior)Clear liquidsTea or coffee without milk or creamAny juice without pulp (NO OJ or Tomato)BrothCarbonated beverages

Types of Barium EnemasSingle ColumnLie on side on Xray tableEnema tube inserted into rectumBarium bag is delivered into colonMay feel urge to have a bowel movement.DONTThough, a small balloon will keep it inside youTake long deep breaths through mouthhelps relaxMay be asked to turn & rotate to evenly coat all colonThen the radiologist will take a number of X-ray images from various angles

Air Contrast (Double contrast)Similar to single-column Big differenceAir is inflated with air in addition to the barium to expand and improve the quality of the imagesPolyps can be seen easier, among other abnormalities

ResultsNegative = no abnormalities are foundPositive = abnormalities found, such as polyps.If positive you may be scheduled for further testing.

Cons of Barium Enemamiss small polyps or sometimes even small cancers Biopsy and polyp removal cannot be done during testing you may need to follow up with a colonoscopyPreparing for the procedure (emptying the colon) and the procedure itself can be unpleasant

SigmoidoscopyViews the rectum and sigmoid colon areas for polyps, abnormalities, or cancerA sigmoidoscope is a thin lighted tube is inserted into rectum & up through the sigmoid colonMay remove polyps or tissue samples for biopsy

Procedure DetectionThe cause of diarrhea, abdominal pain, or constipation Detect early signs of cancer in descending (sigmoid) colon and rectumcan see bleeding, inflammation, abnormal growths, and ulcers not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon).

PreparationComplicationsLiquid dietMost likely given an enema pre-procedureAir is pumped into colon to help expand and see more surface areaDuration is 10-20 minutes Though very uncommonIt is likely that bleeding or a puncture of the colon could result during procedure

Polyp...Removal

ColonoscopyProcedure to look into entire length of large intestine (colon) to detect abnormalitiesPreparation, procedure, & results same as sigmoidoscopyNew virtual colonoscopy as alternative procedure

Virtual or (CT) Colonographya series of x-rays called computed tomography to make a series of pictures of the colon Computer then puts these pictures together to create a detailed image that shows polyps, etc.

Prognosis (chances of recovery)Depends onStage : in the inner lining of colon only, whole colon? Spread to other places in bodyHas it blocked or created a hole in the colon?Blood levels of carcinoembryonic antigen (CEA); a substance in the blood that may be increased when cancer is present, before treatment begins.Has cancer recurred?Patients general health?

Treatment OptionsSurgery (main treatment)Radiation TherapyChemotherapyNewer targeted therapiesMonoclonal antibodiesDepending on stage of cancer, it is likely that 2-3 types of treatment may be utilized at the same time or one after the other

SurgeryRemoval of cancer and normal area of colon on either side, as well as nearby lymph nodesThen sewn back togetherColostomy (bag to catch the waste kept outside the body)If cancer is found early, a colonscope can be used without cutting the abdomen

Radiation Therapyhigh-energy rays (such as x-rays) to kill or shrink cancer cells external radiation internal or implant radiation; placed directly into tumorRadiation can also be used to ease symptoms of advanced cancer such as intestinal blockage, bleeding, or painMain uses is for those where cancer had attached to an internal organ or the lining of the abdomen can be aimed through the anus and reaches the rectum without passing through the skin of the abdomen

Chemotherapyuse of anticancer drugs injected into a vein or given by mouth treatment useful for cancers that have spread to distant organsincrease the survival rate for patients with some stages of colorectal cancer (will kill normal cells also)Side effects depend on amount, length, & type of drugs given (i.e. diarrhea, nausea, vomiting, loss of appetite & hair, mouth sores, increased chance of infections, bruising & bleeding after minor cuts or injuries & overall increased fatigue

Risk FactorsAge 50 or olderObesity (fat in waist area increases)30%-40% of smokers diagnosed with cancer will dieA family history of cancer of the colon or rectum. A personal history of cancer of the colon, rectum, ovary, endometrium, or breast. A history of polyps or ulcerative colitis (ulcers in the lining of the large intestine) or Crohns disease. Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome)Heavy use of Alcohol has been linked to this cancer

Dietary Risk Factorseat plenty of fruits, vegetables, and whole grain foods to limit high-fat foods (especially from animal sources) and limit excessive alcohol consumptionstudies suggest that taking a daily multivitamin containing folic acid or folate can lower riskOther studies suggest that getting more calcium with supplements or low-fat dairy products can help Getting enough exercise is important as well 30 min of physical activity on 5+ days per week.

Survival Rates9 of 10 people whose cancer is found & treated at early stage (before spreading) will live at least 5 yearsSpread to nearby organs/lymph nodes= 5years 66% survival rateSpread to lungs/liver= 5 year 9%(5 yr is based on percentage of patients that were alive 5 yrs after diagnosis. Leaving out those who died of other causes)

Modified Dukes Staging System for Colorectal Cancer

Modified Dukes A The tumor penetrates into the mucosa of the bowel wall but no further. Modified Dukes B B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall. B2: tumor penetrates into and through the muscularis propria of the bowel wall. Modified Dukes C C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes. C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes. Modified Dukes D The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).

Colitis

Ulcerative colitisDiffuse inflamatory disease of mucosa colon and rectumEtiology : unknown, autoimunne respon,microba (chlamydia, cytomegalovirus, yersinia), Endoscopy : granulars superficial ulcers, thickened mucosa, superficial fissures, small pseudopolypsClinical : bloody diarrhea, high fever, abdominal painTherapy : corticosteroids and immunosupresive agent (azathioprine, cyclosporine, 6-mercaptopurine), sulfasalazine is profilactic effect (prostaglandin synthesis), surgical : children, fulminating acute colitis, obstruction, (11%), acute toxic megacolon (6-13%) total proctocolectomy with ileostomy

Polyps In Colitis

Chronic Ulcerative Colitis

Volvulus

Def : abnormal twisting or rotation about its mesenteryEtiologi : occlusion of lumen at each end segmen vascular compromiseLocation : sigmoid (50%), cecal (20-40%),transverse colon , splenic flexure (gastrocolic, splenocolic, phrenocolic ligaments)

Chrons disease

Crohn's disease, also known as inflammatory bowel disease, regional enteritis, and Granulomatous ileocolitis disease is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting, or weight loss,[1][2][3] but may also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.[1]Crohn's disease can lead to several mechanical complications within the intestines, including obstruction, fistulae, and abscesses

Diverticulitis

Definition : saclike protrusion of colonic wallCongenital , aquiredAge : 60 -65 yoEtiolofi : low fiber dietsLocation : caecum (2%), Colon descenden (94%)Clinical : bleedingComplication : abcess, fistula, obstructionIndication for surgery :Absolute : complication of disease , persistent pain, clinical deteoritation

Relative : chronis stricture, young patient, corticosteroid use, diverticulitis

Rectum

Surgery of rectum

Tumor at upper rectum V LAR, distal 2 cm, prox 5 cm 7-8 cm abdominoperineal resection > 12 cm LAR

Pathological staging (mod Astler and Collier) : TNMPost opertaive : monitoring CEA

Surgery for Rectal CancerSurgery is main treatment, along with a combination of radiation therapyPolypectomy, local excision, and local transanal resection) can be done with instruments placed into the anus, Stage I, II, & III rectal cancers, other types of surgery may be done A low anterior resection is used for cancers near the upper part of the rectum, close to where it connects with the colon. Abdominoperineal resection is done for cancers located close near the lower rectum-anal conjunction. After this surgery, a colostomy is needed

Pelvic Exenteration: the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (opening to collect urine) is needed

Anus

Symptoms : bleeding, pain, discharge, change of bowel habits

Disorders : incontinence disordes, prolapse of the rectum hemorroids, fissura in ano, abcess, fistulo in ano, chrons disease neoplastic disorders : Bowens disease ( SCC), Pagets disease (intraepithelial adenocarcinoma), BCC,

Hemorhoid

HEMORHOID adalah pelebaran Vena di dalam pleksus HEMORHOIDALIS yg tidak merupakan keadaan patologik , hanya apabila homorhoid ini menyebabkan keluhan atau penyulit diperlukan tindakan.

HEMORHOID DIBEDAKAN :HEMORHOID INTERNALPelebaran pleksus vena hemorhoidalis superior di atas garis mukokutan dan ditutupi oleh mukosa.Merupakan bantalan vaskuler di dalam jaringan sub mukosa pada rektum sebelah bawah.HEMORHOID EKSTERNALMerupakan pelebaran dan penonjolan pleksus hemorhoidalis inferior, terdapat di sebelah distal garis mukokutan di dalam jaringan di bawah epitel anus.

POSISI HEMORHOID YANG PALING SERING :

. Kanan Depan. Kanan Belakang. Kiri Lateral

PATOGENESISTiga Teori :TEORI MEKANIKAL : Dasar: Jaringan penunjang muskulo fibroelastik hemorhoid interna, Parks ligamen yang mengalami degeneratif kelemahan abnormal dari jaringan pergerakan hemorhoid peninggian tekanan intra rektal peningkatan ukuran hemorhoid.

2 TEORI HEMODINAMIK : Dasar: Mikrosirkuler anal kanal mengandung arterio venus shunt yang cenderung akibat reaksi hormonal atau rangsangan fisiologikal, berdasarkan pemeriksaan mikroskop elektron dan histologi.SPINCTER ABNORMAL:Dasar: Peningkatan aktivitas spincter, menyebabkan peningkatan tekanan jaringan dalam analkanal.

PATOGENESIS

Current etiologic, pathogenic, and paathophysiological concepts of hemorrhoidal disease

Pathophysiology of hemorrhoids: hemorrhoids in place but mobile

Pathophysiolohy of hemorrhoids: Prolapsed hemorrhoids

Normal arteriovenous shunt function: Arteriovenous shunts closed, precapillary sphincter opened

Arteriovenous shunt dysfunction:opening of arteriovenous shunts, contraction of precapillary sphincter

FAKTOR RESIKO YANG DAPAT MENYEBABKAN HEMORHOID :

Gangguan fungsi usus halus mis: diare, konstipasiGangguan pengosongan rektumKehamilan dan melahirkanPemakaian obat-obat lokal mis: enema, supositoria, penggunaan laksan yang berlebihanOral kontraseptifIritasi mukosa anal kanalDiet yang rendah seratAlkohol

GAMBARAN KLINIK:NyeriPerdarahanProlap hemorhoidDischarge / MucusPruritus

Examination in knee-elbow position

Examination in left lateral position

PEMERIKSAAN

Terdapat mucus pada hemorhoid yang prolap Colok dubur Anuskopi Proktosigmoidoscopy

DIAGNOSA BANDING:

Karsinoma KolorektumPenyakit DivertikelProlap RectumKolitis UlserativaKondiloma PerianalLipatan kulit Sentinel pada garis tengah dorsal

Macam Haemorhoid

Kelainan Anorektal

KOMPLIKASI

Trombosis melingkar nyeri hebat nekrose mukosa dan kulit penutup (jarang) Emboli septik melalui sistem portal abses hati Anemia

Paska Haemorhoidektomi (komplikasi)

KLASIFIKASI Hemorhoid interna dikelompokkan dlm 4 derajat:DERAJAT I :Perdarahan segar tanpa nyeri pada waktudefekasi. Tidak ada prolap, padapemeriksaan anuskopi terlihat hemorhoidyang menonjol ke dalam lumen.DERAJAT II :Menonjol melalui anal kanal saat mengedan ringan, tetapi dapat masuk kembali secara spontan.

KLASIFIKASI

DERAJAT III :Menonjol saat mengedan dan harus didorong kembali sesudah defekasi.DERAJAT IV :Menonjol keluar dan tidak dapat didorong masuk, biasanya timbul gejala nyeri.

Staging of hemorrhoids

PENANGGULANGAN. Secara umum. Terapi obat-obatan. Skeleroterapi. Ligasi dengan gelang karet. Bedah beku. Infrared coagulasi. Metode lain. Hemorhoidektomi

Sclerotherapy equipment

Injection sclerotherapy

Sclerotherapy technique

Rubber and ligator with its cone engabling fitting of a rubber band

Cryode with its nitrous oxid cylindeerand pressure adjuster

Infrared coagulation apparatus

Indikasi metode pengobatan berbagai derajat hemorhoid

SURGICALMEDICALMEDICALOFFICE PRACTICESURGICALTRADITIONALMODERNI0III0IV0II0I0II0IV0III0PILIHAN TERAPI

PARADIGMA BARU1.DIAGNOSA HEMORRHOID INTERNA HARUS DILENGKAPI PEMERIKSAAN PROKTOSKOPI

2.TENTUKAN : LETAK, JUMLAH DAN BESARNYA MASING- MASING BENJOLAN (PENTING UNTUK EVALUASI PROKTOSKOPI)

3. DERAJAT 3: BISA DIBAGI MENJADI 3A DAN 3B

PARADIGMA BARUDERAJAT 3A: SEPERTI KRITERIA 3 TETAPI BILA BENJOLAN 2

DERAJAT 3B: SEPERTI KRITERIA 3 BILA BENJOLANNYA >2 ATAU SIRKULER

DERAJAT 3B: BIASANYA AKAN TURUN KE DERAJAT 4.

PARADIGMA BARU : KONSERVATIF ----> TRIO1. PENGATURAN DIET --> BAB LUNAK 2. OBAT-OBAT PER-ORAL

3. SUPPOSITORIA.

PARADIGMA BARU : PENGATURAN DIET1. MINUM AIR PUTIH 1 - 1 LITER/HARI

2. BUAH-BUAHAN : PEPAYA, PISANG

3. SAYURAN

4. LARANGAN MAKAN.

LARANGAN MAKAN1. DAGING KAMBING2. PEDAS3. DURIAN4. NANAS5. CUKAK6. SALAK7. NANGKALAMANYA SAMPAI 6 MINGGU (1 BULAN)

PARADIGMA BARU1.PENGOBATAN KONSERVATIF SELAMA 6 MINGGU

2.GEJALA HILANG TIDAK BERARTI SEMBUH.

3.SEMUA GEJALA RATA-RATA HILANG DALAM SEMINGGU PERTAMA BEROBAT.

4.EVALUASI HARUS DENGAN PROKTOSKOPI MINIMAL 2 MINGGU SEKALI 3 X BERTURUT-TURUT.

HEMORHOID EKSTERNAL YANG MENGALAMI TROMBOSIS : 1. Rendam duduk menggunakan larutan hangat, salep yang mengandung analgetik. 2. Istirahat di tempat tidur, untuk mempercepat berkurangnya pembengkakan.3. Kurang dari 48 jam dapat ditolong : segera mengeluarkan trombus atau eksisi lengkap dengan anastesi lokal.

KESIMPULANHemorhoid suatu keadaan normal dari anatomi manusia, jika mengalami perubahan diperlukan tindakan.Dengan bertambahnya usia terjadi perubahan hemorhoid yang membesar dan turun dalam lumen anal kanal.Vena-vena menjadi tegang dan perubahan ini meningkat setelah dekade ke-3 dalam kehidupan.Dengan meningkatnya pengetahuan struktur anatomi dan prevalensi penyakit, akan memudahkan cara pencegahan dan pengobatan simptomatis penyakit ini.

PERIANAL FISTULALAB/SMF BEDAH SEKSI BEDAH DIGESTIV

PENDAHULUAN

~ FISTULA ANI / FISTULA IN ANO~ CHRONIS RESIDIF.~ FISTULA : PENGHUBUNG ANORECTAL - LUAR~ Th/ TIDAK ADEKUAT~ PEMBEDAHAN~ MEMAHAMI ANATOMI, KLASSIFIKASI & TEKNIK

ANATOMI ANORECTUM

PATHOGENESIS

KLASSIFIKASI :1. MILLIGAN MORGAN (1934)2. PARKS (1976)

TUJUAN : ARAH & LETAK FISTULA

TINDAKAN PEMBEDAHAN

MILLIGAN-MORGAN 1934Subcutan

Low Anal

High AnalAnorectal

High InterMuscular

KLASIFIKASI PARK (1976)INTERSPHINCTERICSIMPLE LOW HIGH BLIND - OPEN RECTUM NO PERINEALSUPRALEVATOR ABSCESS PELVIC EXTENSION

UNCOMPLICATED HIGH BLIND TRACKTRANSSPHINCTERICSUPRASPHINCTERICEXTRASPHINCTERIC

GOODSALS RULEANAL ORIFICEANORECTAL RINGLINEA DENTATA126

GAMBARAN KLINIS :

~ RIWAYAT PERIANAL ABSCESS~ CHRONIS RESIDIF~ TERASA BASAH, PUS / CAIRAN~ PRURITUS

PEMERIKSAAN FISIK~ INSPEKSI LUBANG LUAR

PEMERIKSAAN FISIK~ PALPASI (PERKIRAKAN ARAH)

PEMERIKSAAN FISIK~ RT & SONDAGE

PEMERIKSAAN FISIK~ RECTOSCOPYPEMERIKSAAN PENUNJANG~ ZAT WARNA , PERHIDROL~ FISTULOGRAFI~ ENDORECTAL SONOGRAFI~ CT SCAN FISTULOGRAFI~ THORAX PA~ BARIUM ENEMA~ LABORATORIUM

PEMBEDAHAN~ SATU-SATUNYA TERAPI KARENA :~ RISIKO SEPSIS OK ANORECTAL ABSCESS~ PERLUASAN TIDAK TERDETEKSI SECARA FISIK~ RECURENT (CHRONIS RESIDIF)

~ PRINSIP : MEMBUANG FISTEL BESERTA CABANGNYA TANPA MENIMBULKAN INCONTINENSIA.

~ PREOPERATIF :

TEKNIK OPERASI1. LAYING OPEN TECHNIQUE~ UNTUK FISTEL LETAK RENDAH~ BUKA SAL.FISTEL DARI LUBANG LUAR S/D DALAM LALU FISTULOTOMY / FISTULECTOMY / DGN SKIN GRAFT.

TEKNIK OPERASI2. KOMBINASI LAYING OPEN + SETON~ UNTUK FISTEL LETAK TINGGI DGN INTERNAL OPENING~ SETELAH FISTULOTOMY, PASANG SETON~ > 1 MINGGU BUKA SBG GUIDE

TEKNIK OPERASI3. EKSISI FISTEL + MUCOSAL ADVANCEMENT FLAP4. RE-ROUTING TECHNIQUE POST OPERASI~ CEGAH PENYEMBUHAN PREMATUR DARI LUKA KULIT LUAR SEBELUM LUKA DALAM SEMBUH (DARI DALAM KELUAR)~ WAKTU CUKUP LAMA

KOMPLIKASI POST OPERASI ~ RETENSIO URINE, PERDARAHAN, INCONTINEN FISTEL REKUREN, ANAL STENOSIS~ SEPSISKEKAMBUHAN~ TIDAK SELURUHNYA TERANGKAT~ SALAH DIAGNOSIS (TBC FISTULA)~ PERAWATAN POST OP KURANG BAIK

KESIMPULAN1. SANGAT PENTING UNTUK MENGETAHUI TIPE FISTEL DAN MEMAHAMI ANATOMI SEBELUM TINDAKAN PEMBEDAHAN.2. PRINSIP PEMBEDAHAN FISTEL.3. CARA PEMBEDAHAN SESUAIKAN DENGAN LETAK FISTEL (TINGGI / RENDAH).4. PERAWATAN POST OP MEMEGANG PERANAN SANGAT PENTING.

39. DISTINGUISHING FEATURES OF COLITIS-ASSOCIATED COLORECTAL CANCERWhile spontaneous colorectal cancers are synchronously multiple in only about 3% of cases, in ulcerative colitis this figure has been reported as high as 12%. Spontaneous colorectal cancers generally arise from pre-existing adenomatous polyps, but colitis-associated cancers tend to emerge directly from flat mucosa. More extensive infiltration along the bowel wall and a higher frequency of mucinous cytology also characterize colitis-associated cancers. A particularly striking feature of colitis-associated cancer is its occurrence at a mean age two or three decades younger than colorectal cancer in the non-colitis population. All these features suggest that colitis-associated colorectal cancer is a distinct pathogenetic entity, probably attributable to the effects of chronic inflammation and epithelial regeneration. Whatever the biological distinctions may be, however, the disturbing clinical fact remains that colorectal cancer in colitis patients cannot be reliably detected by standard population-based screening methods, and its usual signs and symptoms are likely to be masked by the underlying disease, which leads to a more advanced stage of tumor with resultant poorer prognosis than sporadic colon cancer in the absence of screening for dysplasia.

Greenstein AJ, Sachar DB, Pucillo A et al. Cancer in universal and left-sided ulcerative colitis: clinical and pathological features. Mt. Sinai J Med 1979;46:25-32.46. ADENOMATOUS-LIKE POLYP IN ULCERATIVE COLITISThe polyp in this colonoscopic photograph from an ulcerative colitis patient will show unmistakable dysplasia on histology, but both grossly and microscopically there is nothing to distinguish it from an ordinary adenomatous polyp that might be found in someone without colitis. So long as the polyp is entirely excised endoscopically, and there is no dysplasia anywhere else in the coloneither adjacent or at a distance on extensive multiple biopsiesrecent evidence suggests that the patient can safely be followed with close and continuous surveillance, without automatic resort to colectomy.

Engelsgjerd M, Farraye FA, Odze RD. Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis. Gastroenterology 1999;117:1288-94.Rubin PH, Friedman S, Harpaz N et al. Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps. Gastroenterology 1999;117:1295-1300.Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol 1999;94:1746-50.Slide 33.Chronic Ulcerative Colitis

As this term indicates, chronic ulcerative colitis is a lesion with histological evidence of ongoing chronic inflammation without active crypt injury. This may be a manifestation of the natural course of disease in some patients, as active episodes ebb, or it may be the result of treatment, with suppression of the active crypt inflammation. As this slide emphasizes, typical chronic disease exhibits several, if not all, of the features of chronic injury, including atrophy, crypt architecture distortion and a persistent basal or diffuse mucosal lymphoplasmacytic inflammatory infiltrate.