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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=
==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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{{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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Includes discussion of the [[rectum]]. The [[anus]] is a separate article.
Includes discussion of the [[rectum]]. The [[anus]] is a separate article.


===Appendix===
=Accessory organs of the gastrointestinal tract=
{{main|Appendix}}
Acute appendicitis and more...
 
=Accessory GI=
===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.


=Pathology=
=Pathology (detail articles)=
==Graft-versus-host disease==
==Inflammatory bowel disease==
*Abbreviated as ''GVHD''.
{{Main|Inflammatory bowel disease}}
===General===
The bread and butter of gastroenterology and GI pathology.
*Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT).
*Histology of GVHD the same rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref>


Clinical:
==Gastrointestinal stromal tumour==
*May present as diarrhea.
{{Main|Gastrointestinal stromal tumour}}
*Main DDx (clinical): infection.
The most common GI stromal tumour.


===Microscopic===
==Graft-versus-host disease==
Features:<ref name=pmid20953169>{{cite journal |author=Cogbill CH, Drobyski WR, Komorowski RA |title=Gastrointestinal pathology of autologous graft-versus-host disease following hematopoietic stem cell transplantation: a clinicopathological study of 17 cases |journal=Mod. Pathol. |volume=24 |issue=1 |pages=117–25 |year=2011 |month=January |pmid=20953169 |doi=10.1038/modpathol.2010.163 |url=http://www.nature.com/modpathol/journal/v24/n1/full/modpathol2010163a.htm}}</ref>
{{Main|Graft-versus-host disease}}
*Isolated epithelial cell apoptosis - '''key feature'''.
An uncommon thing that complicates [[bone marrow transplant]]s.
*+/-Crypt destruction (focal or extensive).
*+/-Loss of epithelium (denudation).
 
Notes:
*Neutrophils should not be present.


Images:
==Eosinophilic enterocolitis==
*[http://www.nature.com/modpathol/journal/v24/n1/fig_tab/modpathol2010163f1.html#figure-title GVHD grade 1-4 (nature.com)].
{{Main|Eosinophilic enterocolitis}}


====Grading<ref name=pmid20953169/>====
==Pneumatosis intestinalis==
*Grade 1 = isolated epithelial cell apoptosis.
{{Main|Pneumatosis intestinalis}}
**No crypt loss/destruction.
*Grade 2 = individual crypts are lost/scatter destruction of single crypts.
*Grade 3 = foci several adjacent crypts lost.
*Grade 4 = large number of adjacent crypts lost/loss of epithelium.


Notes:
==Pneumatosis cystoides intestinalis==
*Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle. 
{{Main|Pneumatosis cystoides intestinalis}}


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


=References=
=References=
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[[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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