Alicam, a picture is worth a thousand words

Nothing is more compelling than being able to show a client an abnormality. Clients tend to be more compliant with treatments and more willing to pursue additional tests or therapies when they can see the problem. Alternatively, normal images provide peace of mind. ALICAM® is a win-win proposition for clients.

Clinical History:

1.Chronic mixed bowel diarrhea (suspect small bowel is primary component) with severe weight loss (BCS 2/9) 

2.Decreased cobalamin and folate levels

3.Pan-hypoproteinaemia

4.Mild non-regenerative anaemia

5. Appetite waxes and wanes. occasional haematochezia

6. No vomiting

Chemistry panel: T.P. 3.7, Alb 2.0, Glob 1.7 (low end normal), Creat 0.5, Mg 1.6, ALP 15

CBC: 13.50 WBC, RBC 4.47, 10.4 HGB, HCT 29.8, RDW 14.3, PP 4.8, Mono 2.160, Eosin 1.89, Baso 0.810, absolute retic 36,000 

Cobalamin level decreased 194 ng/l, Folate level decreased 7 ug/l, cTLI- normal Vitamin b12 injections 500mg/ul once weekly

Past medications include 1. Multiple rounds of metronidazole 500mg q12h 2. Tylosin unknown dose. 3. Vitamn B12 injections 500mg/ul weekly injections. 4. Panacur 800mg q24 x 10 days for empiric deworming 5. Prednisone 6/8/15 20mg q12hr.

The capsule acquired 35,082 images during 15h 48m of imaging.

There are patchy areas of mild erythema and irregularity of the gastric mucosa, and a single area with a few pinpoint erosions is seen. Gastric transit is somewhat prolonged at 230 minutes (normal transit is typically 30-90 minutes).

The small intestinal mucosa is moderate-markedly irregular, most severe in the proximal half of the small intestine. There are several small polypoid/nodular lesions with depressed, ulcerated centers identified. A number of focal erosions are seen, and there are several locations throughout the small intestine that have linear hemorrhagic lesions. A few dilated lacteals are identified in the distal small intestine.

The majority of the colonic mucosa is obscured by liquid feces, but a hemorrhagic lesion is identified in the proximal colon.

Recommendations:

The most severe gross GI lesions seen in this case are in the proximal half of the small intestine. Primary diagnostic considerations for this patient's PLE include inflammatory bowel disease, lymphangiectasia, lymphoma (or other GI neoplasia) and fungal infection.

Given the severity of the macroscopic lesions, clinical signs and biochemical abnormalities, histopathology is strongly recommended for further identification of the underlying etiology. Gastroduodenoscopy and ileocolonoscopy would allow for access to many of the visualized lesions, but most of the nodular lesions and dilated lacteals would likely be beyond the length of the endoscope.