Diseases of git
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Transcript of Diseases of git
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Diseases of GITPatho-B Lab
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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
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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
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• 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
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Congested sub epithelial and sub mucosal venous plexus
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Congested sub epithelial and sub mucosal venous plexus
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Congested sub epithelial and sub mucosal venous plexus
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Congested sub epithelial and sub mucosal venous plexus
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Congested sub epithelial and sub mucosal venous plexus
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Congested sub epithelial and sub mucosal venous plexus
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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
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• 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)
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Atrophied Mucosa due to Chronic inflammation
LPO
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Atrophied Mucosa due to Chronic inflammation
LPO
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Neutophilic infiltrates within lamina propriaIntraepithelia neutrophils and subepithelial plasma cells characteristic
LPO
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LPO
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Neutrophils
LPO
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LPO
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Plasma cell infiltrate
Gastric glands
HPO
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Lymphocyte & Plasma cell infiltrate
HPO
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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.
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• 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
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
Epithelial injury
LPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
HPO
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Morphology of PUD
** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis
LPO
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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
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• 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
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Bulky glandular structuresFormed from previous chronic inflammation
LPO
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Bulky glandular structuresFormed from previous chronic inflammation
LPO
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LPO
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LPO
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LPO
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LPO
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HPO
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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.
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LPO
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- LPO
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LPO
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HPO
Demonstrative Congestion
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HPO
Demonstrative Congestion
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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
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• 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.
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Ectopic Gastric mucosa
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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.
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• 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.
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LPO
Tunica muscularis
Wtih infiltrationOf neutrophils
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LPO
Congestion in subserosal vessel
LPO
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LPO
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LPO
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LPO
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LPO
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HPO
PMNs ---- Mostly Neutrophils inTunica muscularis layer
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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)
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• 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
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LPO
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HPO
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LPO
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HPO
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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.
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• 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
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LPO
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LPO
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HPO
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HPO
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HPO
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LPO
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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.
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• 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
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Invasive Adenocarcinoma of colon
LPO
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LPO
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LPO
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Malignant glands infilrating the surrounding tissue LPO
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Malignant glands infilrating the surrounding tissue
HPO
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Cytologic atypia
Pleomorphism
HPO
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Cytologic atypia
Pleomorphism
HPO
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Cytologic atypia
Pleomorphism
HPO
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HPO
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HPO
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Rectal Adenoma(not included in practical quiz)
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Thanking to the entire Universe