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.  


==Normal==
[[Cytopathology]] of the gastrointestinal tract is dealt with in the ''[[gastrointestinal cytopathology]]'' article.
 
=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 lymphocytes usually.
**More lymphocytes usually.


==Luminal gastroenterology==
====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===
===Intestinal polyps===
{{main|Intestinal polyps}}
{{main|Intestinal polyps}}
The bread and butter of gastrointestinal pathology.
The bread and butter of gastrointestinal pathology.


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


===Colon===
===Cecum===
{{main|Colon}}
{{Main|Cecum}}
Includes discussion of the [[rectum]]. Colorectal tumours are dealt with in ''[[colorectal tumours]]''.  Crohn's disease and ulcerative colitis are dealt with in the ''[[inflammatory bowel disease]]'' article.
The first part of the large intestine. Technically, it is not part of the colon.


===Appendix===
===Appendix===
{{main|Appendix}}
{{main|Appendix}}
Acute appendicitis and more...
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 GI==
=Accessory organs of the gastrointestinal tract=
===Gallbladder===
===Gallbladder===
{{main|Gallbladder}}
{{main|Gallbladder}}
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===Liver===
===Liver===
{{main|Liver}}
{{main|Liver}}
An organ that pathologists now sometimes forget.  There are separate articles for the [[medical liver disease]]s and [[liver neoplasms]].
An organ that pathologists now sometimes forget.  There are separate articles for the [[medical liver disease]]s,  [[liver neoplasms]] and [[liver transplantation pathology]].


===Pancreas===
===Pancreas===
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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 (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.
 
==Eosinophilic enterocolitis==
{{Main|Eosinophilic enterocolitis}}
 
==Pneumatosis intestinalis==
{{Main|Pneumatosis intestinalis}}
 
==Pneumatosis cystoides intestinalis==
{{Main|Pneumatosis cystoides intestinalis}}
 
=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)].
Michael
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