Watch As Mucoid Cap Turns Into Mucoid Plaque

In my previous blog post I explained how mucoid cap looks something like tissue when it lines the mucosa. Not until it sloughs away from the mucosa does it look like the so-called mucoid plaque that cleansers remove. Now in this post I'm going to show it to you. Take a look at plate 81:


It's from a textbook called Clinical Gastroenterology.[1] It depicts "necrotic mucosa" of the descending colon with acute ischemic colitis. See that small blackish area? The gastroenterologist who commented about this photo called this "acute focal necrosis". Focal necrosis is associated with active inflammation and mucus depletion.[2]

As I explained in my previous blog post, what is actually going on is that the active inflammation is actually depleting the mucus. More precisely, enzymes produced during active inflammation is dissolving the mucus-exudate mixture that normally covers up the eschar component of the mucoid cap layer. To show you what I mean, here is a drawing of a cross section of the mucoid cap layer:


It's from page 85 of the textbook called "Gastric Cytoprotection: A Clinician’s Guide".[3] It's a very rough drawing and it's not to scale, but it shows how the necrotic cells are completely covered by a thin mucus (the necrotic cells is eschar and the "mucus" is actually a mucus-exudate mixture). As "mucus" degration continues, even more of the eschar component of the mucoid cap layer is revealed. You can see this happening in plate 74 [1] of the same textbook, which depicts Crohn's colitis of the sigmoid colon:


The Skeptical Raptor once described mucoid plaque as a "black tar goo" that adheres to the walls of the intestinal tract. Well there it is. Both Robert Gray and Benard Jensen thought it was feces.[4] But they were wrong. It's actually eschar.

Books on wound healing explain what happens when the enzymes then act on the eschar. The black/brown eschar rehydrates (and assumingly swells up) and turns toward a yellow or tan slough that is soft, loose, and that does not adhere to the wound bed.[5] This is precisely what you see in plate 83 of the same textbook. Plate 83 [1] is essentially slough mixed in with mucus:


Plate 83 of course looks like some of the types of mucoid plaque that cleansers remove. You never would have guessed that it originally looked something like plate 81. But it did. It originally looked something like tissue.

Now I submit to you that there are other areas of the gastrointestinal tract that look something like tissue but are not actually living tissue but rather a thick layer of mucoid cap. Look at plate 31 [1] from the same textbook for example:


This is somewhere in the jejunal. I believe this is exceptionally thick mucoid cap. Also look at plate 63 [1] from the same textbook:


This is the appendiceal orifice in the cecum. Notice that the texture of the "mucosa" of these two examples look very similiar to the texture of the "mucosa" of plate 81. The only difference is that there is no colitis and thus no "mucus" depletion.

I'm pretty sure that this is not what a normal mucosa is supposed to look like. With regards to plate 81 for example, it is supposed to look like plate 60 [1] from the same textbook:


A normal colon is supposed to have blood vessels and ridges.

References
[1] All photos in this post come from the fourth edition of "Clinical Gastroenterology" by Howard M. Spiro. The ISBN is 0-07-105434-0.

[2] See book called "Helicobacter pylori, Gastritis and Peptic Ulcer". It was published in 1990 and edited by P. Malfertheiner and H. Ditschuneit. The ISBN-13 is 978-3-642-75317-6. The e-ISBN-13 is 978-3-642-75315-2. The DOI is 10.1007/978-3-642-75315-2. On page 203 it suggests that active inflammation is associated with mucin depletion and "focal necrosis".

[3] The ISBN-13 is 978-1-4684-5699-8.

[4] Go to each of their books. Go to Robert Gray's book called "The Colon Health Handbook". On page 8 he says: "As layer after layer of gluey feces piles up in the colon, they often form into a tough, rubbery, nearly black substance". Go to Bernard Jensen's book called "Tissue Cleansing Through Bowel Management". He described it as "encrusted fecal material" that is hard and "black" like truck tire rubber.

[5] See the fourth edition of "Wound Care: A Collaborative Practice Manual for Health Professionals". It was written by Carrie Sussman & Barbara Bates-Jensen. The ISBN-10 is 1608317153. On page 447 it says: "When conservative methods of debridement are used, including mechanical, autolytic, and enzymatic techniques, the type of necrotic tissue should change as the wound improves. As the necrotic tissue is rehydrated, the appearance will change from a dry, desiccated eschar to soft slough and, finally, to a loose tissue that does not adhere to the wound bed. The color usually changes as well, the black/brown eschar giving way to yellow or tan slough."

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