Interactive Transcript
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So for this case, we're going to talk about
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strictures in Crohn's disease and how to identify
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them and what we need to talk about when we see them.
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And so this is a patient who has multiple
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segments of bowel that are hyperenhancing.
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If you look at this area here, this
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is a proximal jejunal segment.
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So when we compare it to other proximal jejunal
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segments, we see it's clearly more enhancing than
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the surrounding bowel, but it extends for quite
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a long period here up into the upper abdomen.
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As we come into the upper abdomen, we see this kind
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of transition where it goes from, you know, fairly
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normal or slightly smaller caliber to a larger caliber.
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I mean, whenever we see that transition, when
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we see a larger caliber segment, we need to
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decide, is there a stricture there?
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And if so, how do we describe that?
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And so when we look on our axial plane, we see that
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that area really is quite narrowed as it comes into
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this more proximal segment that's quite distended.
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And so this is a slam dunk case where there's
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clearly a stricture in the segment of bowel.
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And so anytime you see upstream dilation that's
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greater than three centimeters, and you see
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narrowing downstream from that, you should call
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a stricture, and you should call it confidently.
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Sometimes you'll have cases where there's
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a persistent narrowing, but you don't
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really see that upstream dilation.
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And for those cases, you should raise the
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possibility of stricture, but it's not as much of a
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clear slam dunk case, and it may not be as clinically significant
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as these cases where we clearly see upstream dilation.
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So you can call it a probable stricture if there's
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a fixed narrowing, but when we see the upstream
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dilation as we do in this case, along with the
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area of narrowing, we call it a clear stricture.
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Now these happen as a mix of acute and
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chronic processes from the Crohn's disease.
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However, oftentimes it's a marker of
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a more chronic fibrotic process.
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And so in addition to the degree of
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stricturing, we need to talk about the degree
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of inflammation that's associated with that,
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and we'll talk a little bit more about that
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in subsequent cases.
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But in this case, we have a pretty
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substantial upstream narrowing and we have
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upstream dilation and downstream narrowing.
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It's a slam dunk Crohn's stricture.
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There are other causes of strictures,
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of course, in the small ball, including
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NSAID use and radiation enteropathy.
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So strictures aren't specific for Crohn's disease,
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but there are common...an important finding on imaging
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studies and the surgeons and
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gastroenterologists really need to know when they're present.
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