GI Pathology. CONGENITAL ABNORMALITIES Atresia – development is incomplete Stenosis – incomplete...
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Transcript of GI Pathology. CONGENITAL ABNORMALITIES Atresia – development is incomplete Stenosis – incomplete...
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GI Pathology
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CONGENITAL ABNORMALITIES• Atresia– development is incomplete
• Stenosis– incomplete form of atresia in which the lumen is
markedly reduced in caliber as a result of fibrous thickening of the wall
– Imperforate anus - most common form of congenital intestinal atresia
• Congenital duplication cysts– saccular or elongated cystic masses that contain
redundant smooth muscle layers
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Barrett Esophagus
• complication of chronic GERD • intestinal metaplasia within the esophageal
squamous mucosa• it confers an increased risk of esophageal
adenocarcinoma• Goblet cells, define intestinal metaplasia and
are necessary for diagnosis
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Barrett Esophagus
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ESOPHAGEAL VARICES
• congested subepithelial and submucosal venous plexus within the distal esophagus
• develop in 90% of cirrhotic patients• most commonly in association with alcoholic
liver disease• hepatic schistosomiasis is the second most
common cause of varices
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Acute Gastritis• transient mucosal inflammatory process that may be
asymptomatic or cause variable degrees of epigastric pain, nausea, and vomiting
• can occur following disruption of the protective mechanisms– Nonsteroidal anti-inflammatory drugs (NSAIDs)• interfere with prostaglandins or reduce
bicarbonate secretion– reduced mucin synthesis in the elderly – H. pylori - may be due to inhibition of gastric
bicarbonate transporters by ammonium ions
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Chronic Gastritis
• symptoms associated are typically less severe but more persistent
• most common cause is infection with the bacillus Helicobacter pylori
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Gastric Polyps and Tumors
• 75% of all gastric polyps are inflammatory or hyperplastic polyps
• common in individuals between 50 and 60 years of age
• usually develop in association with chronic gastritis
• Because the risk of dysplasia correlates with size, polyps larger than 1.5 cm should be resected and examined histologically
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GASTRIC ADENOCARCINOMA
• most common malignancy of the stomach• comprising over 90% of all gastric cancers• more common in lower socioeconomic
groups • mean age of presentation is 55 years• male-to-female ratio is 2 : 1
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GASTRIC ADENOCARCINOMA
• The depth of invasion and the extent of nodal and distant metastasis at the time of diagnosis remain the most powerful prognostic indicators for gastric cancer
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HERNIAS
• Any weakness or defect in the wall of the peritoneal cavity may permit protrusion of a serosa-lined pouch of peritoneum called a hernia sac
• most commonly occur anteriorly, via the inguinal and femoral canals or umbilicus, or at sites of surgical scars
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ADHESIONS
• Surgical procedures, infection, or other causes of peritoneal inflammation, such as endometriosis
• fibrous bridges can create closed loops resulting in internal herniation
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VOLVULUS
• Complete twisting of a loop of bowel about its mesenteric base of attachment
• produces both luminal and vascular compromise
• occurs most often in large redundant loops of sigmoid colon
• volvulus is often missed clinically
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INTUSSUSCEPTION
• occurs when a segment of the intestine, constricted by a wave of peristalsis, telescopes into the immediately distal segment
• the invaginated segment is propelled by peristalsis and pulls the mesentery along
• Untreated intussusception may progress to intestinal obstruction
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Inflammatory Bowel Disease
• Crohn disease – which has also been referred to as regional
enteritis (because of frequent ileal involvement) may involve any area of the GI tract and is typically transmural
• Ulcerative colitis– severe ulcerating inflammatory disease that is
limited to the colon and rectum and extends only into the mucosa and submucosa
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Feature Crohn Disease Ulcerative ColitisMACROSCOPICBowel region Ileum ± colon Colon onlyDistribution Skip lesions DiffuseStricture Yes RareWall appearance Thick ThinMICROSCOPICInflammation Transmural Limited to mucosaPseudopolyps Moderate MarkedUlcers Deep, knife-like Superficial, broad-based
Lymphoid reaction Marked ModerateFibrosis Marked Mild to noneSerositis Marked Mild to noneGranulomas Yes ( 35%)∼ NoFistulae/sinuses Yes NoCLINICALPerianal fistula Yes (in colonic disease) No
Fat/vitamin malabsorption Yes No
Malignant potential With colonic involvement Yes
Recurrence after surgery Common No
Toxic megacolon No Yes
Features That Differ between Crohn Disease and Ulcerative Colitis
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Polyps
• most common in the colon • Sessile - small elevations of the mucosa• Pedunculated - Polyps with stalks• most common neoplastic polyp is the
adenoma• non-neoplastic polyps can be further classified
as inflammatory, hamartomatous, or hyperplastic
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• Adenomas can be classified as – Tubular• tend to be small, pedunculated polyps composed of
small rounded, or tubular, glands
– Tubulovillous • have a mixture of tubular and villous elements
– Villous• which are often larger and sessile, are covered by
slender villi
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• Adenocarcinoma of the colon is the most common malignancy of the GI tract
• the small intestine, which accounts for 75% of the overall length of the GI tract, is an uncommon site for benign and malignant tumors
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Hemorrhoids
• affect about 5% of the general population • develop secondary to persistently elevated
venous pressure within the hemorrhoidal plexus
• predisposing influences are straining at stool because of constipation and the venous stasis of pregnancy
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Acute Appendicitis
• most common in adolescents and young adults• lifetime risk for appendicitis is 7%• males are affected slightly more often than
females• 50% to 80% of cases, acute appendicitis is
associated with overt luminal obstruction, usually caused by a small stone-like mass of stool, or fecalith, or, less commonly, a gallstone, tumor, or mass of worms
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Acute Appendicitis
• A classic physical finding is McBurney's sign, deep tenderness located two thirds of the distance from the umbilicus to the right anterior superior iliac spine (McBurney's point).
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Acute Appendicitis