Diffuse nodular duodenitis in a woman presenting with dyspepsia and weight loss.

Duodenal nodularity is an uncommon endoscopic finding charac-trized by numerous visible mucosal nodules in the duodenum. It is important to consider giardiasis in patients with symptoms include abdominal pain, nausea, anorexia, diarrhea, vomiting, weight loss and abdominal distension. It is also important to remind giardiasis in patients with duodenal nodularity.

High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects.

AIM: The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects. METHODS: Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired. RESULTS: Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed. CONCLUSION: B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.

Giardia lamblia infection diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

The protozoan Giardia lamblia is a major cause of gastrointestinal disease worldwide. We report the case of a 59-yr-old male who presented to his primary care physician with complaints of abdominal pain and weight loss. Imaging studies revealed a liver mass and a pancreatic head mass. Biopsy of the liver mass proved to be benign, and endoscopic ultrasound-guided fine-needle aspiration of the mass in the head of the pancreas showed no evidence of malignancy; however, numerous pear-shaped, binucleated, flagellated organisms morphologically consistent with trophozoites of Giardia lamblia were identified in the specimen. With the increasing use of endoscopic ultrasound-guided fine-needle aspiration for sampling of gastrointestinal, hepatobiliary, and pancreatic lesions, cytopathologists examining such specimens will need to be familiar with the diagnostic characteristics of this protozoal parasite.

[Filling of the lower segment of the large intestine with fluid to facilitate ultrasonic examination in diseases of the small pelvis]. / Wypelnienie plynem dolnego odcinka jelita grubego jako usprawnienie badania ultradzwiekowego w chorobach miednicy malej.

Small pelvis space is difficult to examine ultrasonographically as several important organs are localized in relatively small area. The most difficult is the interpretation of the standard USG examination of the abdomen in case of pathologies of the end of large intestine, when filled with feces. In such cases repeated ultrasonographic examination is recommended. Authors propose, that this segment of the colon should previously be filled with fluid. Such a technique improves the level of diagnosis or exclusion of any pathology. Forty two patients were examined with the above technique. Authors think, that it is a progress in ultrasonography of pelvic organs.

Intestinal giardiasis: the importance of serial filming.

Intestinal giardiasis is a common enteric pathogen. Conventional diagnostic screening studies are only 50% accurate. Although radiologic abnormalities in the small intestine have been described, barium studies are often normal. Symptoms may be chronic and debilitating but are effectively treated with appropriate therapy. Three cases were encountered in which recognition of subtle radiographic abnormalities in the small intestine was responsible for proper diagnosis. These findings consisted of a progression from relatively normal jejunum on initial films to dilution, segmentation, and apparent increased fold thickness in the proximal small intestine on delayed films. When this pattern is identified, the radiologist may suggest the possibility of giardiasis and thus direct the referring physician to use definitive diagnostic procedures.

The diagnosis of giardiasis.

Giardiasis is the most prevalent intestinal parasitic disease in the United States. Most cases can be diagnosed by a single stool examination. However, in periodic cyst excretors, cysts may not be detected unless repeated stool examinations are performed. In clinically highly suspected cases, duodenal fluid should be studies after three negative stool examinations. Scanning electron microscopy is probably superior to light microscopy in screening duodenal fluid if the parasite is scanty or degenerated. A small intestinal biopsy is a last resort for the diagnosis; a mucosal impression smear should be routinely performed on such specimens. The latter is the most sensitive and reliable technique in making the diagnosis.

Lymphoreticular disorders of the gastrointestinal tract: roentgenographic features.

Recent advances have permitted close correlation of characteristic roentgen signs with the pathophysiologic alterations in lymphoreticular disorders of the gastrointestinal tract. The background of primary and secondary immunoglobin disorders with gastrointestinal manifestations is reviewed. The roentgenographic alterations in the small bowel of the enteropathic immunoglobulin deficiency syndromes and in lymphoma of the small bowel, stomach, and colon are discussed and illustrated in detail.

Immunoglobulin deficiency diseases of the intestine.

Marshak has emphasized the role of the gastrointestinal tract as a major immunologic organ and described the radiologic findings of immunoglobulin deficiency diseases of the small intestine. According to his classification the radiologic findings include multiple nodular defects, edema and increased secretions associated with Giardiasis, a sprue-like pattern, and thickened folds. In this report, the role of the intestine in the immune response is briefly reviewed and several of the radiologic features of immune deficiency diseases and those of benign nodular lymphoid hyperplasia are illustrated.

Stenosis of the colon.

Seven cases of colonic stenosis due to an infectious, parasitic or ischemic origin are reported. Particular emphasis is laid on the need for an early differential diagnosis from Hirschsprung's disease.

Immunoglobulin disorders of the small bowel.

In this article the authors present a detailed classification of the various immunoglobulin deficiency states that have gastrointestinal manifestations, and describe the roentgenographic features of these disorders.