Difference between revisions of "An introduction to gastrointestinal pathology"

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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.
[[Image:Tubular adenoma 4 low mag.jpg|thumb|right|250px|[[Micrograph]] of a [[Traditional adenoma|tubular adenoma]], a very common diagnosis in gastrointestinal pathology. [[H&E stain]].]]
'''Gastrointestinal pathology''', also '''gastrointestinal tract 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==
[[Cytopathology]] of the gastrointestinal tract is dealt with in the ''[[gastrointestinal cytopathology]]'' article.
 
=Normal=
===Layers===
[[Image:Illu stomach2.jpg|thumb|right|Layers of the stomach. (WC)]]
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>
*Mucosa (epithelium, lamina propria, muscularis mucosa).
*Mucosa (epithelium, lamina propria, muscularis mucosa).
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*Muscularis externa (inner longitudinal, myenteric plexus (or Auerbach's plexus) outer circumferential).
*Muscularis externa (inner longitudinal, myenteric plexus (or Auerbach's plexus) outer circumferential).
*Adventitia (if retroperitoneal), serosa (if intraperitoneal).
*Adventitia (if retroperitoneal), serosa (if intraperitoneal).
===Cell types===
*Goblet cells.
**Secrete mucin.
*Enterochromaffin cells, [[AKA]] Kulchitsky cells.
**Subnuclear eosinophilic granules.
***Serotonin.
*[[Paneth cell]]s.
**Supranuclear eosinophilic granules.
Memory device:
*Su'''p'''ranuclear granules = '''p'''aneth cell.
====Images====
www:
*[http://classconnection.s3.amazonaws.com/474/flashcards/538474/png/ne1307547591546.png Paneth cell versus neuroendocrine cell (amazonaws.com)].
*[http://www.pathology.washington.edu/about/education/barretts/Pseudogoblet.php Goblet cells versus pseudogoblet cells (washington.edu)].


===Bowel===
===Bowel===
[[Small bowel]]:
====[[Small bowel]]====
*Villi - should see three good ones in a normal biopsy.
*Villi - should see three good ones in a normal biopsy.
*Crypts.
*Crypts.
*Paneth cells.
*Paneth cells.
*Goblet cells.
**Few in proximal small bowel (duodenum).
**Abundant in distal small bowel (ileum).


[[Duodenum]]:
====[[Duodenum]]====
*Small bowel (as above).
*Small bowel (as above).
*Submucosal glands (Brunner's glands).
*Submucosal glands (Brunner's glands).


Large bowel vs. small bowel:
====Large bowel versus small bowel====
*Small intestine.
*Small intestine.
**Villi (key feature).
**Villi (key feature).
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**More lymphocytes usually.
**More lymphocytes usually.


==Intestinal polyps==
====Cecum versus rectum====
*[[Cecum]].
**Less goblet cells - more absorptive cells.<ref name=Ref_H4P3_633>{{Ref H4P3|633}}</ref>
**More inflammation ([[plasma cell]]s, eosinophils, lymphoid aggregates).<ref name=Ref_H4P3_633>{{Ref H4P3|633}}</ref>
**Paneth cells.
*Rectum.
**More goblet cells.
**No Paneth cells normally.
 
===DDx by location===
A short DDx for location of abnormality:
*Lumen:
**[[Giardiasis]], [[amebiasis]], [[enterobius]].
*Surface of epithelium:
**[[Cryptosporidiosis]], [[intestinal spirochetes]].
*Infiltration of epithelium:
**Intraepithelial lymphocytes - [[lymphocytic colitis]] & [[collagenous colitis]].
**Intraepithelial neutrophils - infection, IBD, ischemia.
*Epithelial architeture:
**Serration - [[SSA]], [[hyperplastic polyp]].
**Increased lamina propria/loss of crypts - IBD, [[juvenile polyp]]).
**Distortion - IBD, infection, ischemia.
**Crypt branching - IBD, ischemia, chronic infection, [[SSA]].
**Back-to-back glands - malignancy, dysplasia.
*Single cell infiltrates - lamina propria:
**Epithelial - signet ring cell carcinoma.
**Macrophages - MAI, [[TB]], [[Whipple disease]], Yersinia.
*Nuclear abnormalities:
**Pseudostratification - repair, dysplasia, malignancy.
**Nuclear enlargement - malignancy, viral cytopathic effect.
*Submucosal:
**Brunner's gland - [[duodenum]].
**Fibrosis - IBD, prolapse.
**Nests - neuroendocrine tumours.
 
=Luminal gastroenterology=
==Non-regional==
===Intestinal polyps===
{{main|Intestinal polyps}}
{{main|Intestinal polyps}}
The bread and butter of gastrointestinal pathology.
The bread and butter of gastrointestinal pathology.


==Esophagus==
==Regional==
===Esophagus===
{{main|Esophagus}}
{{main|Esophagus}}
Largely forgotten organ at SB... but no shortage of these at SMH.
Largely forgotten organ at SB... but no shortage of these at SMH.


==Stomach==
===Stomach===
{{main|Stomach}}
{{main|Stomach}}
H. pylori, cancer and more...
H. pylori, cancer and more...


==Small bowel==
===Small bowel===
{{main|Small bowel}}
{{main|Small bowel}}
The part of the GI tract that pathology has mostly forgot.
The part of the GI tract that pathology has mostly forgot.  Crohn's disease is dealt with in a [[Crohn's disease|separate article]].


===Duodenum===
====Duodenum====
{{main|Duodenum}}
{{main|Duodenum}}
Commonly biopsied. Celiac... cancer... giardia?
Commonly biopsied. Celiac... cancer... giardia?


==Gallbladder==
===Cecum===
{{Main|Cecum}}
The first part of the large intestine. Technically, it is not part of the colon.
 
===Appendix===
{{main|Appendix}}
It hangs off the [[cecum]].  Commonly, it comes to the pathologist because of [[acute appendicitis]].
 
===Colon===
{{main|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.
 
=Accessory organs of the gastrointestinal tract=
===Gallbladder===
{{main|Gallbladder}}
{{main|Gallbladder}}
A growth industry... with the expanding waist lines in the (Western) world.
A growth industry... with the expanding waist lines in the (Western) world.


==Liver==
===Liver===
{{main|Liver}}
{{main|Liver}}
An organ that pathologists now sometimes forget.
An organ that pathologists now sometimes forget.  There are separate articles for the [[medical liver disease]]s,  [[liver neoplasms]] and [[liver transplantation pathology]].
 
===Pancreas===
{{main|Pancreas}}
An organ that is occasionally afflicted by cancer.  It is primarily seen in large centers where they do ERCPs and Whipples.
 
=Pathology (detail articles)=
==Inflammatory bowel disease==
{{Main|Inflammatory bowel disease}}
The bread and butter of gastroenterology and GI pathology.
 
==Gastrointestinal stromal tumour==
{{Main|Gastrointestinal stromal tumour}}
The most common GI stromal tumour.
 
==Graft-versus-host disease==
{{Main|Graft-versus-host disease}}
An uncommon thing that complicates [[bone marrow transplant]]s.


==Colon==
==Eosinophilic enterocolitis==
{{main|Colon}}
{{Main|Eosinophilic enterocolitis}}
Includes discussion of the [[rectum]] and IBD.
 
==Pneumatosis intestinalis==
{{Main|Pneumatosis intestinalis}}


==Appendix==
==Pneumatosis cystoides intestinalis==
{{main|Appendix}}
{{Main|Pneumatosis cystoides intestinalis}}
Acute appendicitis and more...


==See also==
=See also=
*[[Introduction]].
*[[Introduction]].
*[[Pediatric gastrointestinal pathology]].
*[[Gastrointestinal cytopathology]].


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


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
=External links=
*[http://www.pathology.med.umich.edu/greensonlab/unknown.html Unknown GI pathology cases (pathology.med.umich.edu)].

Latest revision as of 05:55, 3 February 2016

Micrograph of a tubular adenoma, a very common diagnosis in gastrointestinal pathology. H&E stain.

Gastrointestinal pathology, also gastrointestinal tract 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.

Cytopathology of the gastrointestinal tract is dealt with in the gastrointestinal cytopathology article.

Normal

Layers

Layers of the stomach. (WC)

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.

Images

www:

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 versus 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.

Cecum versus rectum

  • Cecum.
    • Less goblet cells - more absorptive cells.[3]
    • More inflammation (plasma cells, eosinophils, lymphoid aggregates).[3]
    • Paneth cells.
  • Rectum.
    • More goblet cells.
    • No Paneth cells normally.

DDx by location

A short DDx for location of abnormality:

  • Lumen:
  • Surface of epithelium:
  • Infiltration of epithelium:
  • Epithelial architeture:
    • Serration - SSA, hyperplastic polyp.
    • Increased lamina propria/loss of crypts - IBD, juvenile polyp).
    • Distortion - IBD, infection, ischemia.
    • Crypt branching - IBD, ischemia, chronic infection, SSA.
    • Back-to-back glands - malignancy, dysplasia.
  • Single cell infiltrates - lamina propria:
    • Epithelial - signet ring cell carcinoma.
    • Macrophages - MAI, TB, Whipple disease, Yersinia.
  • Nuclear abnormalities:
    • Pseudostratification - repair, dysplasia, malignancy.
    • Nuclear enlargement - malignancy, viral cytopathic effect.
  • Submucosal:
    • Brunner's gland - duodenum.
    • Fibrosis - IBD, prolapse.
    • Nests - neuroendocrine tumours.

Luminal gastroenterology

Non-regional

Intestinal polyps

Main article: Intestinal polyps

The bread and butter of gastrointestinal pathology.

Regional

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?

Cecum

Main article: Cecum

The first part of the large intestine. Technically, it is not part of the colon.

Appendix

Main article: Appendix

It hangs off the cecum. Commonly, it comes to the pathologist because of acute appendicitis.

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.

Accessory organs of the gastrointestinal tract

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, liver neoplasms and liver transplantation pathology.

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 (detail articles)

Inflammatory bowel disease

Main article: Inflammatory bowel disease

The bread and butter of gastroenterology and GI pathology.

Gastrointestinal stromal tumour

Main article: Gastrointestinal stromal tumour

The most common GI stromal tumour.

Graft-versus-host disease

Main article: Graft-versus-host disease

An uncommon thing that complicates bone marrow transplants.

Eosinophilic enterocolitis

Main article: Eosinophilic enterocolitis

Pneumatosis intestinalis

Main article: Pneumatosis intestinalis

Pneumatosis cystoides intestinalis

Main article: Pneumatosis cystoides intestinalis

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. ↑ 3.0 3.1 Mills, Stacey E. (2006). Histology for Pathologists (3rd ed.). Lippincott Williams & Wilkins. pp. 633. ISBN 9780781762410.

External links

Retrieved from "https://librepathology.org/w/index.php?title=An_introduction_to_gastrointestinal_pathology&oldid=42411"