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| ===Sign out=== | | ===Sign out=== |
| | <pre> |
| | Small Bowel, Biopsy: |
| | - Small bowel mucosa within normal limits. |
| | </pre> |
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| | <pre> |
| | Terminal Ileum, Biopsy: |
| | - Small bowel mucosa within normal limits. |
| | </pre> |
| | |
| | <pre> |
| | Terminal Ileum, Biopsy: |
| | - Small bowel mucosa with morphologically benign lymphoid aggregates, negative for significant pathology. |
| | </pre> |
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| | ====Roux-en-Y gastric bypass==== |
| | {{Main|Obese}} |
| | {{Main|Roux-en-Y gastric bypass}} |
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| | ====Block letters==== |
| <pre> | | <pre> |
| SMALL BOWEL, BIOPSY: | | SMALL BOWEL, BIOPSY: |
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| **[[Crohn's disease]] and[[ulcerative colitis]] are discussed in their respective articles. | | **[[Crohn's disease]] and[[ulcerative colitis]] are discussed in their respective articles. |
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| =Specific conditions= | | =Specific diagnoses= |
| ==Small bowel obstruction== | | ==Ileitis== |
| *Abbreviated ''SBO''.
| | :''Active ileitis'' and ''acute ileitis'' redirect here. |
| :This section gives an overview of SBOs. Its primary focus is benign causes of SBO that have nonspecific pathologic findings. Specific causes definitively identified by pathology, e.g. [[adenocarcinoma]], are dealt with separately. | | :This deals with nonspecific ileitis. |
| ===General=== | | ===General=== |
| *Radiologic/[[clinical diagnosis]]. | | *Common. |
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| The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'':
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| *Strictures (think [[IBD]]).
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| *Hernias.
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| *Adhesions.
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| *[[Volvulus]].
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| *Intussusception.
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| *Neoplasia.
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| *Gallstone ileus.
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| The top three are:<ref>URL: [http://www.emedicine.com/EMERG/topic66.htm http://www.emedicine.com/EMERG/topic66.htm]. Accessed on: 19 April 2011.</ref><ref>{{Ref TN2007 |GS21}}</ref>
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| * Adhesions > hernias > neoplasms.
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| In the context of bowel obstructions and IBD, pathologists often see resected [[stoma]]s (that were put in place emergently). These specimens are usually fairly straight forward.
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| ===Radiology===
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| *Air-fluid levels.
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| ===Gross===
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| *+/-Adhesions.
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| *+/-Bowel contorted.
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| *+/-Luminal narrowing +/-proximal dilation.
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| *+/-Serosal exudate.
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| **Suggestive of perforation.
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *+/-Adhesions (serosal). | | *Intraepithelial [[neutrophil]]s. |
| **Dense fibrous tissue replaces the adipose tissue.
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| **+/-Increased vascularity.
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| *+/-Submucosal fibrosis.
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| *+/-[[Serositis]] - seen in small bowel perforation.
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| *+/-Foreign body-type granuloma - due to previous surgical intervention.
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| DDx: | | DDx: |
| *Small bowel [[adenocarcinoma]] - most important differential diagnosis. | | *[[Crohn's disease]]. |
| *Metastatic adenocarcinoma - classically on the serosal aspect. | | *Infectious ileitis. |
| *[[Signet ring cell carcinoma]]. | | **[[Tuberculosis]]. |
| | *Benign ileum - may have focal intra-epithelial lymphocytes associated with lamina propria lymphoid nodules. |
| | *[[NSAID enteropathy]].<ref name=pmid20532706>{{Cite journal | last1 = Dilauro | first1 = S. | last2 = Crum-Cianflone | first2 = NF. | title = Ileitis: when it is not Crohn's disease. | journal = Curr Gastroenterol Rep | volume = 12 | issue = 4 | pages = 249-58 | month = Aug | year = 2010 | doi = 10.1007/s11894-010-0112-5 | PMID = 20532706 }}</ref> |
| | |
| | ====Images==== |
| | <gallery> |
| | Image: Mild ileitis -- very low mag.jpg | Ileitis - very low mag. (WC) |
| | Image: Mild ileitis -- low mag.jpg | Ileitis - low mag. (WC) |
| | Image: Mild ileitis -- intermed mag.jpg | Ileitis - intermed. mag. (WC) |
| | Image: Mild ileitis -- high mag.jpg | Ileitis - high mag. (WC) |
| | </gallery> |
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| ===Sign out=== | | ===Sign out=== |
| <pre> | | <pre> |
| SMALL BOWEL, RESECTION:
| | Terminal Ileum, Biopsy: |
| - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL | | - Small bowel with moderate active inflammation, marked villous blunting, basal plasmacytosis |
| NARROWING. | | and prominent eosinophils, see comment. |
| - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | | - NEGATIVE for granulomas. |
| </pre>
| | - NEGATIVE for dysplasia. |
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| <pre>
| | Comment: |
| SMALL BOWEL, RESECTION:
| | The inflammation is nonspecific; it could be due to infection, inflammatory bowel disease (especially Crohn's disease), ischemia, or therapy/drugs. Clinical correlation is required. |
| - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE), FOCAL LUMINAL NARROWING AND A
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| FOREIGN BODY-TYPE GRANULOMA.
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| - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
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| </pre> | | </pre> |
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| ====Ischemic changes==== | | ==Small bowel obstruction== |
| <pre>
| | *Abbreviated ''SBO''. |
| SMALL BOWEL, RESECTION:
| | {{Main|Small bowel obstruction}} |
| - SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL
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| MICROABSCESS FORMATION.
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| - NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==Small bowel neoplasms== | | ==Small bowel neoplasms== |
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| ===IHC=== | | ===IHC=== |
| *CD20 and CD3 - mixed population of lymphocytes. | | *[[CD20]] and CD3 - mixed population of lymphocytes. |
| *[[CD23]] - follicular dendritic cells. | | *[[CD23]] - follicular dendritic cells. |
| *Cyclin D1 -ve. | | *Cyclin D1 -ve. |
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| DDx: | | DDx: |
| | *Cryptogenic multifocal ulcerous stenosing enteritis.<ref>{{Cite journal | last1 = Chung | first1 = SH. | last2 = Jo | first2 = Y. | last3 = Ryu | first3 = SR. | last4 = Ahn | first4 = SB. | last5 = Son | first5 = BK. | last6 = Kim | first6 = SH. | last7 = Park | first7 = YS. | last8 = Hong | first8 = YO. | title = Diaphragm disease compared with cryptogenic multifocal ulcerous stenosing enteritis. | journal = World J Gastroenterol | volume = 17 | issue = 23 | pages = 2873-6 | month = Jun | year = 2011 | doi = 10.3748/wjg.v17.i23.2873 | PMID = 21734797 }}</ref> (???) |
| *[[Crohn's disease]]. | | *[[Crohn's disease]]. |
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| ==Meckel diverticulum== | | ==Meckel diverticulum== |
| ===General===
| | {{Main|Meckel diverticulum}} |
| *Most common congenital anomaly of the gastrointestinal tract.<ref name=pmid15026601>{{Cite journal | last1 = Levy | first1 = AD. | last2 = Hobbs | first2 = CM. | title = From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation. | journal = Radiographics | volume = 24 | issue = 2 | pages = 565-87 | month = | year = | doi = 10.1148/rg.242035187 | PMID = 15026601 }}</ref>
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| **Remnant of the ''omphalomesenteric duct'' - a connection of the yolk sac and midgut.
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| The rule of 2s:
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| *2 feet from the terminal ileum
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| *2% of the population
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| *2% symptomatic.
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| *2 inches long.
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| *2 year old.
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| *2 types of epithelium - gastric and pancreatic.
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| Main clinical DDx of a symptomatic Meckel diverticulum:
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| *[[Appendicitis]].
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| ===Gross===
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| *Antimesenteric attachement, i.e. a ''Meckel's diverticulum'' hangs off the side opposite of the mesentery.
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Meckel%27s_Diverticulum_AFIP.jpg Meckel diverticulum - (AFIP/WC)].
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| ===Microscopic===
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| Features:<ref name=pmid15026601/>
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| *Small bowel mucosa.
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| *+/-Gastric mucosa:
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| **Foveolar epithelium: champagne flute-like columnar epithelium.
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| **Oxyntic mucosa: parietal cells (pink) and chief cells (purple).
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| *+/-Pancreatic epithelium:
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| **Pancreatic acini.
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| Images:
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| *[http://radiographics.rsna.org/content/24/2/565/F12.expansion.html Gastric foveolar epithelium in a MD (radiographics.rsna.org)].
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| *[http://radiographics.rsna.org/content/24/2/565/F15.expansion.html Gastric glands in a MD (radiographics.rsna.org)].
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| *[http://radiographics.rsna.org/content/24/2/565.long Pancreatic glands in a MD (radiographics.rsna.org)].
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| ==Ischemic enteritis== | | ==Ischemic enteritis== |
| ===General===
| | {{Main|Ischemic enteritis}} |
| *Typically elderly and due to [[atherosclerosis]].
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| *Rare.
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| *High mortality.<ref name=pmid18616124>{{Cite journal | last1 = Nakase | first1 = H. | title = [Ischemic enteritis]. | journal = Nihon Rinsho | volume = 66 | issue = 7 | pages = 1330-4 | month = Jul | year = 2008 | doi = | PMID = 18616124 }}</ref>
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| *May occur together with ischemia of the colon, i.e. ''[[ischemic colitis]]'', in which case it is known as ''ischemic enterocolitis''.
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| Etiologies:
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| *[[Atherosclerosis]].
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| *[[Vasculitis]].
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| *Embolism.
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| *Thrombosis.
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| ===Microscopic===
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| Features:
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| *See ''[[ischemic colitis]]''.
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| DDx:
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| *Infection.
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| *[[Crohn's disease]].
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| *[[Radiation changes]].
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| *Drugs/toxins.
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| =Weird stuff= | | =Weird stuff= |
| ==Autoimmune enteropathy== | | ==Autoimmune enteropathy== |
| *Abbreviated as ''AIE''. | | *Abbreviated as ''AIE''. |
| ===General===
| | {{Main|Autoimmune enteropathy}} |
| *Considered a pediatric disease.
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| *Super rare in adults - there are only ~11 reported cases in the literature.<ref name=pmid17683994>{{Cite journal | last1 = Akram | first1 = S. | last2 = Murray | first2 = JA. | last3 = Pardi | first3 = DS. | last4 = Alexander | first4 = GL. | last5 = Schaffner | first5 = JA. | last6 = Russo | first6 = PA. | last7 = Abraham | first7 = SC. | title = Adult autoimmune enteropathy: Mayo Clinic Rochester experience. | journal = Clin Gastroenterol Hepatol | volume = 5 | issue = 11 | pages = 1282-90; quiz 1245 | month = Nov | year = 2007 | doi = 10.1016/j.cgh.2007.05.013 | PMID = 17683994 | PMC = 2128725 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128725/ }}</ref>
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| *May be a component of the IPEX syndrome.<ref>{{Cite journal | last1 = Gentile | first1 = NM. | last2 = Murray | first2 = JA. | last3 = Pardi | first3 = DS. | title = Autoimmune enteropathy: a review and update of clinical management. | journal = Curr Gastroenterol Rep | volume = 14 | issue = 5 | pages = 380-5 | month = Oct | year = 2012 | doi = 10.1007/s11894-012-0276-2 | PMID = 22810979 }}</ref>
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| Diagnosis is clinico-pathologic:<ref name=pmid17683994/>
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| #Intact immune system.
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| #Autoantibodies.
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| #*Anti-enterocyte antibody.
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| #*Anti-goblet antibody.
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| #Lack of response to gluten-free diet.
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| ===Microscopic===
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| Features:<ref name=pmid17683994/>
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| *+/-Loss of goblet cells.
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| *+/-Loss of paneth cells.
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| *Villous blunting.
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| DDx:
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| *[[Celiac disease]].
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| =See also= | | =See also= |