Difference between revisions of "An introduction to gastrointestinal pathology"

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An introduction to gastrointestinal pathology (view source)

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[[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.  
'''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.  


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=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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{{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]].


==Pneumatosis intestinalis==
==Pneumatosis intestinalis==
===General===
{{Main|Pneumatosis intestinalis}}
*Bad prognosis - esp. if diffuse.
 
===Gross===
*Small bubbles in the intestinal wall.
 
Image:
*[http://brighamrad.harvard.edu/Cases/bwh/images/349/path2.jpg Pneumatosis cystoides intestinalis (harvard.edu)].<ref>URL: [http://brighamrad.harvard.edu/Cases/bwh/hcache/349/full.html http://brighamrad.harvard.edu/Cases/bwh/hcache/349/full.html]. Accessed on: 3 April 2012.</ref>
 
===Microscope===
Features:
*Large submucosal pseudocysts.
 
Image:
*[http://www.wjes.org/content/6/1/15/figure/F4?highres=y Pneumatosis cystoides intestinalis (wjes.org)].<ref name=pmid21548980>{{Cite journal  | last1 = Takami | first1 = Y. | last2 = Koh | first2 = T. | last3 = Nishio | first3 = M. | last4 = Nakagawa | first4 = N. | title = Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report. | journal = World J Emerg Surg | volume = 6 | issue =  | pages = 15 | month =  | year = 2011 | doi = 10.1186/1749-7922-6-15 | PMID = 21548980 |PMC = PMC3108289}}</ref>


==Pneumatosis cystoides intestinalis==
==Pneumatosis cystoides intestinalis==
===General===
{{Main|Pneumatosis cystoides intestinalis}}
*Benign, generally asymptomatic subset of [[pneumatosis intestinalis]].<ref>URL: [http://emedicine.medscape.com/article/371955-overview http://emedicine.medscape.com/article/371955-overview]. Accessed on: 24 January 2012.</ref>
*Small or large bowel.<ref>{{Cite journal  | last1 = Micklefield | first1 = GH. | last2 = Kuntz | first2 = HD. | last3 = May | first3 = B. | title = Pneumatosis cystoides intestinalis: case reports and review of the literature. | journal = Mater Med Pol | volume = 22 | issue = 2 | pages = 70-2 | month =  | year =  | doi =  | PMID = 2102980 }}</ref>
 
Possible etiologies:<ref name=pmid21864163>{{Cite journal  | last1 = Wu | first1 = SS. | last2 = Yen | first2 = HH. | title = Images in clinical medicine. Pneumatosis cystoides intestinalis. | journal = N Engl J Med | volume = 365 | issue = 8 | pages = e16 | month = Aug | year = 2011 | doi = 10.1056/NEJMicm1013439 | PMID = 21864163 }}</ref>
*[[IBD]].
*Infection.
*Bowel necrosis.
*Malignancy.
*Drugs, e.g. alpha-glucosidase inhibitors.
*Idiopathic.
 
Others:
*[[Necrotizing enterocolitis]]. (???)
*[[Cystic fibrosis]]. (???)
 
===Gross===
*Polypoid lesions.
 
Images:
*www:
**[http://biblioteca.colmed5.org.ar/consultas/pneumatosis.htm Pneumatosis cystoides intestinalis - endoscopic image (colmed5.org.ar)].
**[http://brighamrad.harvard.edu/Cases/bwh/images/349/path2.jpg Pneumatosis cystoides intestinalis (harvard.edu)].<ref>URL: [http://brighamrad.harvard.edu/Cases/bwh/hcache/349/full.html http://brighamrad.harvard.edu/Cases/bwh/hcache/349/full.html]. Accessed on: 3 April 2012.</ref>
 
===Microscopic===
Features:
*Large submucosal pseudocysts lined by macrophages and multi-nucleated giant cells.
 
Images:
*www:
**[http://www.wjes.org/content/6/1/15/figure/F4?highres=y Pneumatosis cystoides intestinalis (wjes.org)].<ref name=pmid21548980>{{Cite journal  | last1 = Takami | first1 = Y. | last2 = Koh | first2 = T. | last3 = Nishio | first3 = M. | last4 = Nakagawa | first4 = N. | title = Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report. | journal = World J Emerg Surg | volume = 6 | issue =  | pages = 15 | month =  | year = 2011 | doi = 10.1186/1749-7922-6-15 | PMID = 21548980 |PMC = PMC3108289}}</ref>
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Pneumatosis_cystoides_intestinalis_-_low_mag.jpg Pneumatosis cystoides intestinalis - low mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Pneumatosis_cystoides_intestinalis_-_intermed_mag.jpg Pneumatosis cystoides intestinalis - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Pneumatosis_cystoides_intestinalis_-_high_mag.jpg Pneumatosis cystoides intestinalis - high mag. (WC)].


=See also=
=See also=
Michael
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