Difference between revisions of "Duodenum"

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Duodenum (view source)

Revision as of 04:03, 24 December 2013

3,342 bytes removed ,  04:03, 24 December 2013
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==Giardiasis==
==Giardiasis==
===General===
{{Main|Giardiasis}}
*Etiology:
**Flagellate protozoan ''Giardia lamblia''.
 
*Treatment
**Antibiotics, e.g. metronidazole (Flagyl).
 
===Gross===
*Diffuse changes.
*May have scattered white spots.<ref name=pmid19906109>{{Cite journal  | last1 = Biyikoğlu | first1 = I. | last2 = Babali | first2 = A. | last3 = Cakal | first3 = B. | last4 = Köklü | first4 = S. | last5 = Filik | first5 = L. | last6 = Astarci | first6 = MH. | last7 = Ustün | first7 = H. | last8 = Ustündağ | first8 = Y. | last9 = Akbal | first9 = E. | title = Do scattered white spots in the duodenum mark a specific gastrointestinal pathology? | journal = J Dig Dis | volume = 10 | issue = 4 | pages = 300-4 | month = Nov | year = 2009 | doi = 10.1111/j.1751-2980.2009.00399.x | PMID = 19906109 | URL = http://onlinelibrary.wiley.com/doi/10.1111/j.1751-2980.2009.00399.x/pdf }}</ref>
 
===Microscopic===
Features:
*+/-Loss of villi.
*Intraepithelial lymphocytes.
**+Other inflammatory cells, especially PMNs, close to the luminal surface.
*Flagellate protozoa -- '''diagnostic feature'''.
**Organisms often at site of bad inflammation.
**Pale/translucent on H&E.
**Size: 12-15 micrometers (long axis) x 6-10 micrometers (short axis) -- if seen completely.<ref>[http://www.water-research.net/Giardia.htm http://www.water-research.net/Giardia.htm]</ref>
***Often look like a crescent moon ([http://en.wikipedia.org/wiki/File:Crescent_Moon.JPG image of crescent moon]) or semicircular<ref>[http://en.wikipedia.org/wiki/Semicircle http://en.wikipedia.org/wiki/Semicircle]</ref> -- as the long axis of the organism is rarely in the plane of the (histologic) section.
 
Note:
*Changes are typically diffuse, i.e. if multiple biopsies are done the changes are present in all fragments.<ref name=pmid18354756>{{Cite journal  | last1 = Freeman | first1 = HJ. | title = Pearls and pitfalls in the diagnosis of adult celiac disease. | journal = Can J Gastroenterol | volume = 22 | issue = 3 | pages = 273-80 | month = Mar | year = 2008 | doi =  | PMID = 18354756 }}</ref>
 
DDx:
*[[Celiac disease]] - near perfect mimic; missing giardia organisms.
 
====Images====
<gallery>
Image:Giardiasis_duodenum_high.jpg | Giardiasis - high mag. (WC)
Image:Giardiasis_duodenum_low.jpg | Giardiasis - low mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case278.html Giardiasis - several crappy images (upmc.edu)].
 
===Stains===
*Methylene blue +ve.<ref name=pmid23285438>{{Cite journal  | last1 = Rajurkar | first1 = MN. | last2 = Lall | first2 = N. | last3 = Basak | first3 = S. | last4 = Mallick | first4 = SK. | title = A simple method for demonstrating the giardia lamblia trophozoite. | journal = J Clin Diagn Res | volume = 6 | issue = 9 | pages = 1492-4 | month = Nov | year = 2012 | doi = 10.7860/JCDR/2012/4358.2541 | PMID = 23285438 }}</ref>
 
===IHC===
*CD117 +ve.<ref name=pmid18835628>{{Cite journal  | last1 = Sinelnikov | first1 = I. | last2 = Sion-Vardy | first2 = N. | last3 = Shaco-Levy | first3 = R. | title = C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies. | journal = Hum Pathol | volume = 40 | issue = 3 | pages = 323-5 | month = Mar | year = 2009 | doi = 10.1016/j.humpath.2008.07.015 | PMID = 18835628 }}</ref>
 
===Sign out===
<pre>
DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLANDS AND MICROORGANISMS CONSISTENT WITH GIARDIA.
</pre>


==Acute duodenitis==
==Acute duodenitis==
Michael
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