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Diseases of GITPatho-B Lab
Esophageal varices
Chronic gastritis
Chronic peptic ulcer
Adenocarcinoma of Stomach
Hemorrhoids
Meckel’s diverticulum
Acute appendicitis
TB of intestine
Schistosoma Appendix
Adenocarcinoma of colon
Adenocarcinoma of rectum
Esophageal Varices• Tortuos dilated veins lying within the submucosa of the distal
esophagus.
• Congested sub epithelial and sub mucosal venous plexus within the distal esophagus
• Due to diseases that impede venous blood flow from GIT to the liver via portal vein before reaching Inferior vena cava
– Alcoholic Liver disease – In 90% of cirrhotic patients– Schistosomiasis-2nd most common cause worldwide
• Complication- Hemorrhage & Internal bleeding
• Diagnosis– Often asymptomatic utill there is a rupture– Endoscopy
• Clinical Manifestation– Increased vascular hydrostatic pressure is associated with
vomiting– Rupture can cause massive hematemesis
• Management– Medical emergency
• Sclerotherapy• Endoscopic ballon tamponade• Endoscopic rubber band ligation
Congested sub epithelial and sub mucosal venous plexus
Congested sub epithelial and sub mucosal venous plexus
Congested sub epithelial and sub mucosal venous plexus
Congested sub epithelial and sub mucosal venous plexus
Congested sub epithelial and sub mucosal venous plexus
Congested sub epithelial and sub mucosal venous plexus
Chronic Gastritis
• Defined by presence of chronic inflammatory changes in the mucosa leading eventually to mucosal atrophy and epithelial metaplasia.
• Etiology:- Most common is H. Pylori infection(typically found in the antrum)
• Most common cause of duodenal ulcer
• Morphology:-– Antral mucosa usually erythematous with coarse or nodular appearance.– Neutophilic infiltrates within lamina propria– Intraepithelia neutrophils and subepithelial plasma cells characteristic
• Complication:-– Peptic ulcer Disease– Dysplasia and Intestinal Metaplasia– Gastritis cystica
• Diagnosis– Gastroscopy
• Clinical Manifestation– Nausea and abdominal discomfort
• Management:- – H.pylori eradication if that’s the cause
– Primary therapy for 7 days which includes proton pump inibitor along with antibiotic(Clarithromycin, metronidazole,amoxicillin)
Atrophied Mucosa due to Chronic inflammation
LPO
Atrophied Mucosa due to Chronic inflammation
LPO
Neutophilic infiltrates within lamina propriaIntraepithelia neutrophils and subepithelial plasma cells characteristic
LPO
LPO
Neutrophils
LPO
LPO
Plasma cell infiltrate
Gastric glands
HPO
Lymphocyte & Plasma cell infiltrate
HPO
Chronic peptic Ulcer• Peptic ulcers are chronic most often solitary lesions that occur in any
portion of the GIT exposed to the aggressive action of acidic peptic juices.
• 98% of the peptic ulcers are either in the first portion of the duodenum or in the stomach(4:1 ratio)
• 2 conditions leading to Peptic ulcers
– H.pylori infection which has a strong causal relationship with peptic ulcer development. (in person with no H.pylori infection NSAIDs are the major cause of peptic ulcers)
– Mucosal exposure to gastric acid and pepsin.
• Diagnosis– Endoscopy– Gastric ulcers may occasionaly be malignant and therefore must always be
biopsied and followed up to ensure healing.
• Clinical manifestation – Recurrent epigastric pain- most common– Occasional vomiting– Anorexia– Anemia in some patients with silent undetected blood loss
• Management– Relive symptoms– Induce healing– Prevent recurrence– H.pylori eradication
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
Epithelial injury
LPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
Adenocarcinoma of Stomach
• Most common malignancy of stomach
• Classification is according to the location in stomach,gross and histologic morphology.
• Intestinal Adenocarcinoma- Bulky and composed of glandular structures. (slide shown in lab)
• Diffuse Adenocarcinoma- Infiltrative pattern composed of signet ring cells that do not form glands
• Diagnosis– There are no laboratory markers– Upper GI Endoscopy remains the choice.– Multiple biopsies from base and edge of ulcer
• Clinical manifestation – Early stage is asymptomatic– Weight loss(most common)– Epigastric pain with vomiting– Virchow’s node– Sister Mary Joseph sign
• Management– Surgical resection(Partial gastrectomy common)– For unrectable tumors palliative measures are taken– Over all prognosis of patients with Adenocarcinoma of stomach is poor with <30%
survival rate of 5 years
Bulky glandular structuresFormed from previous chronic inflammation
LPO
Bulky glandular structuresFormed from previous chronic inflammation
LPO
LPO
LPO
LPO
LPO
HPO
Hemorrhoids• They arise from congestion of the internal and/or external venous plexuses around the
anal canal.
• Also Known as Piles– First Degree Piles - Bleed– Second Degree Piles – Prolapse but retract spontaneously– Third Degree Piles– Require manual replacement after prolapse
• Associated with constipation and straining
• Manifestation –– Bright red rectal bleeding after defeacation– Pain– Pruritis ani– Mucus discharge
• Management – – Injection sclerotherapy or band ligation is effective in most patients– Some patients require haemorrhoidectomy.
LPO
- LPO
LPO
HPO
Demonstrative Congestion
HPO
Demonstrative Congestion
Meckel’s Diverticulum
• Most common congenital anomaly of GIT
• Diverticulum results from the failure of the closure of the vitelline duct.
• Small out pouching extending from the anti mesenteric side of the bowel.
• Normal mucosal lining resembling small intestine
• Diagnosis– Scanning the abdomen by gamma counter following an IV injection
of pertechnate.
• Clinical manifestation– Bleeding results from ulceration of the ileal mucosa(Present as
Recurrent Melena)– Abdominal pain
• Management– Some are present with no complication and may be left as it is.– The ones with complications like perforation require Surgery.
Ectopic Gastric mucosa
Acute Appendicitis
• Appendiceal inflammation is associated with obstruction in 50-80% of cases usually in the form of a fecalth and less commonly gall stone tumor or ball of worm(Oxyuriasis vermicularis)
• At earliest stages only scanty of neutrophilic exudate may be found throughout the mucosa,submucosa and muscularis propria.
• Diagnosis– Until the localization of pain occurs diagnosis is not made.– CBC counts are taken if pain is manifested in RLQ, to confirm
inflammation in appendix.
• Clinical manifestation – Epigastric pain is the initial symptom– Later classically nausea,vomiting then pain becomes
generalized which finally shifts to Right lower Quadrant.
• Management– Non surgical treatment can be approached but there are
chances of recurrence and perforation.– Conventional Appendectomy is performed in most cases.
LPO
Tunica muscularis
Wtih infiltrationOf neutrophils
LPO
Congestion in subserosal vessel
LPO
LPO
LPO
LPO
LPO
HPO
PMNs ---- Mostly Neutrophils inTunica muscularis layer
TB of intestines
• Extrapulmonary TB
• Upper GI involvement is rare and is usually an unexpected findings in endoscopy or laparotomy specimen
• Ileocecal disease accounts for approximately half of the abdominal TB cases.
• Commonly found in immunocompromised patients(HIV patients)
• Diagnosis– Diagnosis rest on obtaining histology by either colonoscopy or minilaparotomy.– Cultures from obtained specimens– Ultrasound/Ct may reveal thickened bowel wall,mesenteric thickening or ascites.
• Clinical manifestation – Exudative ascites– Intestinal obstruction– Fever– Night sweats– Anorexia – Weight loss
• Management– Classical 4 drug therapy for TB
LPO
HPO
LPO
HPO
Schistosoma Appendix
• As the worm produces more eggs the lesion tends to be more extensive and widespread.
• Clinical feature resemble those of severe infection.
• Small as well as large bowel can be affected.
• Diagnosis– Diagnosis depends on demonstrating eggs or serological evidence of
infection.– Stool examination– Eosinophilia
• Clinical manifestation – Initially itching at the site of penetration– Later 5-6 weeks Acute schistosomiasis(Katayama syndrome) may
develop with allergic presentation such as urticaria,fever,Muscle aches,abdominal pain,cough,sweating.
• Management– Objective is to kill the adult schistosome so that it stop producing
eggs. (Praziquantel is the drug of choice)– Surgery may be required
LPO
LPO
HPO
HPO
HPO
LPO
Adenocarcinoma of colon• 98% of cancers in large intestine are adenocarcinomas.
• Tumors in the proximal colon tend to grow as polyp.Obstruction is uncommon
• When the carcinomas in distal colon are discovered the tend to be annular encircling lesions that produce so called napkin ring constrictions of the bowel and narrowing of the lumen.
• Almost all cancers of colon are adenocarcinomas which range from well differentiated to Undifferentiated, frankly anaplastic masses.
• Many tumors produce mucin which is secreted into the gland lumina/interstitium of gut wall which facilitate the extension of this cancer and worsen the prognosis.
• Diagnosis– Barium enema– Colonoscopy– Confirmatory biopsy– Digital rectal examination and fecal testing for occult blood loss
• Clinical manifestation – Fatigue– Weakmess– Weight loss– Changes in bowel habits– Left lower quadrant discomfort
• Management– Chemotherapy determined on the basic of the cancer classification.– Prognosis for T1 stage in 97% of patients is 5 year survival rate– Palliative surgical segmental resection
Invasive Adenocarcinoma of colon
LPO
LPO
LPO
Malignant glands infilrating the surrounding tissue LPO
Malignant glands infilrating the surrounding tissue
HPO
Cytologic atypia
Pleomorphism
HPO
Cytologic atypia
Pleomorphism
HPO
Cytologic atypia
Pleomorphism
HPO
HPO
HPO
Rectal Adenoma(not included in practical quiz)
•
Thanking to the entire Universe