Ulcers of Intestine

SLOs

• Classification

• Salient features – Pathogenesis – Gross – Histology – Complications

Ulcer

“Ulcer is a breach in the continuity of skin,

epithelium or mucous membrane caused by

sloughing out of inflammed necrotic

tissue”

Intestinal Ulcers

Peptic

• Duodenal

Infection

• Bacterial • Virus • Protozoa

Immune

• GVHD• Crohn• Ulcerative

Malignant

• Carcinoma

Duodenal Peptic Ulcer

Pathogenesis

Gross

Necrotic slough

Rounded edge

Sharp edge

Histopathology

Necrotic slough

Non-specific inflammtion

Granulation tissue

Fibrosis

Complications

Bleeding Perforation

Penetration Stenosis

Malignancy

Typhoid ulcer

Salmonella typhimurium Salmonella paratyphi

Pathogenesis

Gross

Peyer’s patches

Oval ulcers

Long axis

Histopathology

Aggregates of macrophages

Typhoid nodules

Complications

Bleeding Perforation

Tuberculosis ulcer

Mycobacterium tuberculosis Mycobacterium bovis

Pathogenesis

Gross

Transverse ulcers

Short axis

Direction of lymphatics

Histopathology

Epithelioid cell granuloma

Complications

Bleeding Stenosis

Amoebic ulcer

Entamoeba histolytica

Pathogenesis

Gross

Pin –point ulcers

Nodules

Histopathology

Flask shaped ulcer

Complications

Bleeding Perforation

Obstruction

Pseudmembranous colitis

Clostridium difficile

Pathogenesis

Gross

Cap lesion

Pseudomembrane

Histopathology

Mushroom / Volcanic eruption

Complications

Malabsorption Toxic megacolon

CMV Colitis

Pathogenesis

Gross

Erythematous base

Haemorrhagic

Histopathology

Inflammation

CMV inclusion

Complications

Malabsorption

Ulcerative colitis

Pathogenesis

Gross

Continuous

Wide ulcers

Pseudopolyps

Histopathology

Blunting and distortion of

villi

Cryptitis

Crypt abscess

Complications

Malabsorption Toxic megacolon

Carcinoma

Crohn’s disease

Pathogenesis

Gross

Skip lesions

Serpengious ulcers

Cobblestone

Histopathology

Transmural

Fissure

Granuloma

Complications

Malabsorption Fistula

Strictures Carcinoma

Graft versus host disease

Pathogenesis

Gross

Pin point

Haemorrhagic

Histopathology

Apoptosis

Intra-epithelial lymphocytes

Complications

Malabsorption Haemorrhage

Carcinoma

Pathogenesis

Gross

Ulceroproliferative

Rolled up indurated

Histopathology

Irregular glands

Dysplasia

Complications

Obstruction Metastases

Summarise

Questions