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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===
[[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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*Muscularis externa (inner longitudinal, myenteric plexus (or Auerbach's plexus) outer circumferential).
*Muscularis externa (inner longitudinal, myenteric plexus (or Auerbach's plexus) outer circumferential).
*Adventitia (if retroperitoneal), serosa (if intraperitoneal).
*Adventitia (if retroperitoneal), serosa (if intraperitoneal).
===Cell types===
*Goblet cells.
**Secrete mucin.
*Enterochromaffin cells, [[AKA]] Kulchitsky cells.
**Subnuclear eosinophilic granules.
***Serotonin.
*[[Paneth cell]]s.
**Supranuclear eosinophilic granules.
Memory device:
*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===
[[Small bowel]]:
====[[Small bowel]]====
*Villi - should see three good ones in a normal biopsy.
*Villi - should see three good ones in a normal biopsy.
*Crypts.
*Crypts.
*Paneth cells.
*Paneth cells.
*Goblet cells.
**Few in proximal small bowel (duodenum).
**Abundant in distal small bowel (ileum).


[[Duodenum]]:
====[[Duodenum]]====
*Small bowel (as above).
*Small bowel (as above).
*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]] and IBD.
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===
{{main|Pancreas}}
An organ that is occasionally afflicted by cancer.  It is primarily seen in large centers where they do ERCPs and Whipples.
 
=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.


==See also==
==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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