Duodenal Changes Associated with Diseases in

Adjacent Organs

■ Adjacent Organs

The duodenum is related in its course to the liver, gallbladder, pancreas, right colic flexure, and kidney (Fig. 3.156). Diseases of these organs can lead to endoscopically detectable changes in the duodenum.

Endoscopic features

Liver

- Metastases: indentation of the bulb

- Cysts: indentation of the bulb Gallbladder

- Hydrops: indentation of the duodenum

- Cholecystitis: edema of the duodenal wall Bile ducts

- Klatskin tumor: duodenal stenosis Pancreas (Figs. 3.157, 3.158)

- Chronic pancreatitis: lymphedema

- Acute pancreatitis: compression

- Tumor: infiltration

Liver

Gallbladder

Kidney

Colic flexure

Liver

Gallbladder

Kidney

Colic flexure

Pancreas

Fig. 3.156 Relations of the duodenum

Pancreas

Fig. 3.156 Relations of the duodenum

Fig. 3.157 Carcinoma of the pancreatic head infiltrating the duodenum

Fig. 3.158 Duodenum in necrotizing pancreatitis a Acute pancreatitis with inflammatory change and necrosis in the duodenum

Fig. 3.158 Duodenum in necrotizing pancreatitis a Acute pancreatitis with inflammatory change and necrosis in the duodenum

b Necrotizing pancreatitis with marked inflammatory changes and hemorrhages in the duodenum
c Necrotizing pancreatitis with infiltration of the duodenum

Overview of Interventional Endoscopy - 144

Bleeding

Upper Gastrointestinal Bleeding: Primary Treatment - 146

Bleeding Esophageal Varices and Fundic Varices: Medications and Tubes - 147

Bleeding Esophageal Varices: Sclerotherapy - 148

Bleeding Esophageal Varices: Banding - 149

Sclerotherapy of Fundic Varices, TIPS, and Operative Treatment - 150

Bleeding Ulcers: Nonoperative Therapies - 151

Bleeding Ulcers: Forrest Classification - 1S2

Bleeding Ulcers: Hemoclip Application and Thermal Methods - 1S4

Bleeding Ulcers: Management after Primary Hemostasis and in Special Cases - 155

Specimen Collection - 156

Endoscopic Treatment of Precancerous Lesions and Early Carcinoma - 157

Foreign Body Removal - 1S8

Foreign Body Removal: Types of Objects Swallowed - 159

PEG Placement: Principle, Indications, and Contraindications - 160

PEG Placement: Technique (1) - 161

PEG Placement: Technique (2) - 162

PEG Placement: Technique (3) - 163

PEG Placement: Technique (4) - 164

Bleeding Ulcers: Pharmacological Therapy and Injection Techniques - 153

Duodenal Tube: Insertion through a PEG - 165

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