Difference between revisions of "An introduction to gastrointestinal pathology"

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An introduction to gastrointestinal pathology (view source)

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


=Normal=
=Normal=
===Layers===
===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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**Subnuclear eosinophilic granules.
**Subnuclear eosinophilic granules.
***Serotonin.
***Serotonin.
*Paneth cells.
*[[Paneth cell]]s.
**Supranuclear eosinophilic granules.
**Supranuclear eosinophilic granules.


Memory device:
Memory device:
*Su'''p'''ranuclear granules = '''p'''aneth cell.
*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===
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*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 goblet cells.
**More goblet cells.
**More lymphocytes usually.
**More lymphocytes usually.
====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=
=Luminal gastroenterology=
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{{main|Duodenum}}
{{main|Duodenum}}
Commonly biopsied. Celiac... cancer... giardia?
Commonly biopsied. Celiac... cancer... giardia?
===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===
===Colon===
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Colorectal tumours are dealt with in ''[[colorectal tumours]]''.  Crohn's disease and ulcerative colitis are dealt with in the ''[[inflammatory bowel disease]]'' article.
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.
Includes discussion of the [[rectum]]. The [[anus]] is a separate article.
===Appendix===
{{main|Appendix}}
[[Acute appendicitis]] and more...


=Accessory organs of the gastrointestinal tract=
=Accessory organs of the gastrointestinal tract=
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==Eosinophilic enterocolitis==
==Eosinophilic enterocolitis==
:For the esophageal disease see: ''[[Eosinophilic esophagitis]]''.
{{Main|Eosinophilic enterocolitis}}
===General===
*Uncommon.
*Associated with food allergies, esp. in children.<ref>{{cite journal |author=Lucendo AJ |title=Eosinophilic diseases of the gastrointestinal tract |journal=Scand. J. Gastroenterol. |volume=45 |issue=9 |pages=1013–21 |year=2010 |month=September |pmid=20509820 |doi=10.3109/00365521003690251 |url=}}</ref>
 
===Microscopic===
Features:
*Eosinophilia.
*Eosinophilic abscesses.
 
DDx:
*[[IBD]].
*Infection.
*Drug reaction.
 
==Meckel diverticulum==
===General===
*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>
 
The rule of 2s:
*2 feet from the terminal ileum
*2% of the population
*2% symptomatic.
*2 inches long.
*2 year old.
*2 types of epithelium - gastric and pancreatic.
 
===Gross===
*Antimesenteric attachement.


Image:
==Pneumatosis intestinalis==
*[http://commons.wikimedia.org/wiki/File:Meckel%27s_Diverticulum_AFIP.jpg MD - (AFIP/WC)].
{{Main|Pneumatosis intestinalis}}


===Microscopic===
==Pneumatosis cystoides intestinalis==
Features:
{{Main|Pneumatosis cystoides intestinalis}}
*Gastric foveolar epithelium:
**Champagne flute-like columnar epithelium.
*Pancreatic epithelium:
**Pancreatic acini.


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


=References=
=References=
Michael
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