Difference between revisions of "An introduction to gastrointestinal pathology"

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(→‎Colon: more)
(+GVHD)
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'''Gastrointestinal pathology''' is a large part of pathology as [[radiologist]]s can often describe the extent of disease... but don't get the diagnosis right all the time.
'''Gastrointestinal pathology''' is a large part of pathology as [[radiologist]]s can often describe the extent of disease... but don't get the diagnosis right all the time.


==Normal==
=Normal=
===Layers===
===Layers===
Layers of the alimentary canal:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Oral.htm http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Oral.htm].</ref><ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Images/gitplan.gif http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Images/gitplan.gif].</ref>
Layers of the alimentary canal:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Oral.htm http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Oral.htm].</ref><ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Images/gitplan.gif http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Images/gitplan.gif].</ref>
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**More lymphocytes usually.
**More lymphocytes usually.


==Luminal gastroenterology==
=Luminal gastroenterology=
===Intestinal polyps===
===Intestinal polyps===
{{main|Intestinal polyps}}
{{main|Intestinal polyps}}
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Acute appendicitis and more...
Acute appendicitis and more...


==Accessory GI==
=Accessory GI=
===Gallbladder===
===Gallbladder===
{{main|Gallbladder}}
{{main|Gallbladder}}
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An organ that is occasionally afflicted by cancer.  It is primarily seen in large centers where they do ERCPs and Whipples.
An organ that is occasionally afflicted by cancer.  It is primarily seen in large centers where they do ERCPs and Whipples.


==See also==
=Pathology=
==Graft-versus-host disease==
*Abbreviated as ''GVHD''.
===General===
*Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT).
*Histology of GVHD the same rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref>
 
Clinical:
*May present as diarrhea.
*Main DDx (clinical): infection.
 
===Microscopic===
Features:<ref name=pmid20953169>{{cite journal |author=Cogbill CH, Drobyski WR, Komorowski RA |title=Gastrointestinal pathology of autologous graft-versus-host disease following hematopoietic stem cell transplantation: a clinicopathological study of 17 cases |journal=Mod. Pathol. |volume=24 |issue=1 |pages=117–25 |year=2011 |month=January |pmid=20953169 |doi=10.1038/modpathol.2010.163 |url=http://www.nature.com/modpathol/journal/v24/n1/full/modpathol2010163a.htm}}</ref>
*Isolated epithelial cell apoptosis - '''key feature'''.
*+/-Crypt destruction (focal or extensive).
*+/-Loss of epithelium (denudation).
 
Notes:
*Neutrophils should not be present.
 
Images:
*[http://www.nature.com/modpathol/journal/v24/n1/fig_tab/modpathol2010163f1.html#figure-title GVHD grade 1-4 (nature.com)].
 
====Grading<ref name=pmid20953169/>====
*Grade 1 = isolated epithelial cell apoptosis.
**No crypt loss/destruction.
*Grade 2 = individual crypts are lost/scatter destruction of single crypts.
*Grade 3 = foci several adjacent crypts lost.
*Grade 4 = large number of adjacent crypts lost/loss of epithelium.
 
Notes:
*Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle. 
 
=See also=
*[[Introduction]].
*[[Introduction]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]

Revision as of 20:36, 16 January 2011

Gastrointestinal pathology is a large part of pathology as radiologists can often describe the extent of disease... but don't get the diagnosis right all the time.

Normal

Layers

Layers of the alimentary canal:[1][2]

  • Mucosa (epithelium, lamina propria, muscularis mucosa).
  • Submuscosa and submucosal plexus (or Meissner's plexus).
  • Muscularis externa (inner longitudinal, myenteric plexus (or Auerbach's plexus) outer circumferential).
  • Adventitia (if retroperitoneal), serosa (if intraperitoneal).

Cell types

  • Goblet cells.
    • Secrete mucin.
  • Enterochromaffin cells, AKA Kulchitsky cells.
    • Subnuclear eosinophilic granules.
      • Serotonin.
  • Paneth cells.
    • Supranuclear eosinophilic granules.

Memory device:

  • Supranuclear granules = paneth cell.

Bowel

Small bowel

  • Villi - should see three good ones in a normal biopsy.
  • Crypts.
  • Paneth cells.
  • Goblet cells.
    • Few in proximal small bowel (duodenum).
    • Abundant in distal small bowel (ileum).

Duodenum

  • Small bowel (as above).
  • Submucosal glands (Brunner's glands).

Large bowel vs. small bowel

  • Small intestine.
    • Villi (key feature).
    • Brunner's glands - duodenum only (key feature).
    • Paneth cells more common.
      • Paneth cells are in the base of the crypts and have eosinophilic granules. They are found (normally) in the small bowel and right colon. They may appear on the left side (i.e. descending colon) in pathologic states, e.g. IBD.
  • Large intestine
    • More goblet cells.
    • More lymphocytes usually.

Luminal gastroenterology

Intestinal polyps

Main article: Intestinal polyps

The bread and butter of gastrointestinal pathology.

Esophagus

Main article: Esophagus

Largely forgotten organ at SB... but no shortage of these at SMH.

Stomach

Main article: Stomach

H. pylori, cancer and more...

Small bowel

Main article: Small bowel

The part of the GI tract that pathology has mostly forgot. Crohn's disease is dealt with in a separate article.

Duodenum

Main article: Duodenum

Commonly biopsied. Celiac... cancer... giardia?

Colon

Main article: Colon

Colorectal tumours are dealt with in colorectal tumours. Crohn's disease and ulcerative colitis are dealt with in the inflammatory bowel disease article. Includes discussion of the rectum. The anus is a separate article.

Appendix

Main article: Appendix

Acute appendicitis and more...

Accessory GI

Gallbladder

Main article: Gallbladder

A growth industry... with the expanding waist lines in the (Western) world.

Liver

Main article: Liver

An organ that pathologists now sometimes forget. There are separate articles for the medical liver diseases and liver neoplasms.

Pancreas

Main article: Pancreas

An organ that is occasionally afflicted by cancer. It is primarily seen in large centers where they do ERCPs and Whipples.

Pathology

Graft-versus-host disease

  • Abbreviated as GVHD.

General

  • Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT).
  • Histology of GVHD the same rejection in bowel transplantation.[3]

Clinical:

  • May present as diarrhea.
  • Main DDx (clinical): infection.

Microscopic

Features:[4]

  • Isolated epithelial cell apoptosis - key feature.
  • +/-Crypt destruction (focal or extensive).
  • +/-Loss of epithelium (denudation).

Notes:

  • Neutrophils should not be present.

Images:

Grading[4]

  • Grade 1 = isolated epithelial cell apoptosis.
    • No crypt loss/destruction.
  • Grade 2 = individual crypts are lost/scatter destruction of single crypts.
  • Grade 3 = foci several adjacent crypts lost.
  • Grade 4 = large number of adjacent crypts lost/loss of epithelium.

Notes:

  • Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle.

See also

References

  1. ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Oral.htm.
  2. ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/Images/gitplan.gif.
  3. ↑ GT. 14 January 2011.
  4. ↑ 4.0 4.1 Cogbill CH, Drobyski WR, Komorowski RA (January 2011). "Gastrointestinal pathology of autologous graft-versus-host disease following hematopoietic stem cell transplantation: a clinicopathological study of 17 cases". Mod. Pathol. 24 (1): 117–25. doi:10.1038/modpathol.2010.163. PMID 20953169. http://www.nature.com/modpathol/journal/v24/n1/full/modpathol2010163a.htm.
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