diseases of git

Diseases of GITPatho-B Lab

Esophageal varices

Chronic gastritis

Chronic peptic ulcer

Adenocarcinoma of Stomach

Hemorrhoids

Meckel’s diverticulum

Acute appendicitis

TB of intestine

Schistosoma Appendix

Adenocarcinoma of colon

Adenocarcinoma of rectum

Esophageal Varices• Tortuos dilated veins lying within the submucosa of the distal

esophagus.

• Congested sub epithelial and sub mucosal venous plexus within the distal esophagus

• Due to diseases that impede venous blood flow from GIT to the liver via portal vein before reaching Inferior vena cava

– Alcoholic Liver disease – In 90% of cirrhotic patients– Schistosomiasis-2nd most common cause worldwide

• Complication- Hemorrhage & Internal bleeding

• Diagnosis– Often asymptomatic utill there is a rupture– Endoscopy

• Clinical Manifestation– Increased vascular hydrostatic pressure is associated with

vomiting– Rupture can cause massive hematemesis

• Management– Medical emergency

• Sclerotherapy• Endoscopic ballon tamponade• Endoscopic rubber band ligation

Congested sub epithelial and sub mucosal venous plexus

Congested sub epithelial and sub mucosal venous plexus

Congested sub epithelial and sub mucosal venous plexus

Congested sub epithelial and sub mucosal venous plexus

Congested sub epithelial and sub mucosal venous plexus

Congested sub epithelial and sub mucosal venous plexus

Chronic Gastritis

• Defined by presence of chronic inflammatory changes in the mucosa leading eventually to mucosal atrophy and epithelial metaplasia.

• Etiology:- Most common is H. Pylori infection(typically found in the antrum)

• Most common cause of duodenal ulcer

• Morphology:-– Antral mucosa usually erythematous with coarse or nodular appearance.– Neutophilic infiltrates within lamina propria– Intraepithelia neutrophils and subepithelial plasma cells characteristic

• Complication:-– Peptic ulcer Disease– Dysplasia and Intestinal Metaplasia– Gastritis cystica

• Diagnosis– Gastroscopy

• Clinical Manifestation– Nausea and abdominal discomfort

• Management:- – H.pylori eradication if that’s the cause

– Primary therapy for 7 days which includes proton pump inibitor along with antibiotic(Clarithromycin, metronidazole,amoxicillin)

Atrophied Mucosa due to Chronic inflammation

LPO

Atrophied Mucosa due to Chronic inflammation

LPO

Neutophilic infiltrates within lamina propriaIntraepithelia neutrophils and subepithelial plasma cells characteristic

LPO

LPO

Neutrophils

LPO

LPO

Plasma cell infiltrate

Gastric glands

HPO

Lymphocyte & Plasma cell infiltrate

HPO

Chronic peptic Ulcer• Peptic ulcers are chronic most often solitary lesions that occur in any

portion of the GIT exposed to the aggressive action of acidic peptic juices.

• 98% of the peptic ulcers are either in the first portion of the duodenum or in the stomach(4:1 ratio)

• 2 conditions leading to Peptic ulcers

– H.pylori infection which has a strong causal relationship with peptic ulcer development. (in person with no H.pylori infection NSAIDs are the major cause of peptic ulcers)

– Mucosal exposure to gastric acid and pepsin.

• Diagnosis– Endoscopy– Gastric ulcers may occasionaly be malignant and therefore must always be

biopsied and followed up to ensure healing.

• Clinical manifestation – Recurrent epigastric pain- most common– Occasional vomiting– Anorexia– Anemia in some patients with silent undetected blood loss

• Management– Relive symptoms– Induce healing– Prevent recurrence– H.pylori eradication

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

Epithelial injury

LPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

LPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

LPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

LPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

HPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

HPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

HPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

HPO

Morphology of PUD

** Necrotic debris** Inflammation with predominant neutrophils**Granulation tissue**Fibrosis

LPO

Adenocarcinoma of Stomach

• Most common malignancy of stomach

• Classification is according to the location in stomach,gross and histologic morphology.

• Intestinal Adenocarcinoma- Bulky and composed of glandular structures. (slide shown in lab)

• Diffuse Adenocarcinoma- Infiltrative pattern composed of signet ring cells that do not form glands

• Diagnosis– There are no laboratory markers– Upper GI Endoscopy remains the choice.– Multiple biopsies from base and edge of ulcer

• Clinical manifestation – Early stage is asymptomatic– Weight loss(most common)– Epigastric pain with vomiting– Virchow’s node– Sister Mary Joseph sign

• Management– Surgical resection(Partial gastrectomy common)– For unrectable tumors palliative measures are taken– Over all prognosis of patients with Adenocarcinoma of stomach is poor with <30%

survival rate of 5 years

Bulky glandular structuresFormed from previous chronic inflammation

LPO

Bulky glandular structuresFormed from previous chronic inflammation

LPO

LPO

LPO

LPO

LPO

HPO

Hemorrhoids• They arise from congestion of the internal and/or external venous plexuses around the

anal canal.

• Also Known as Piles– First Degree Piles - Bleed– Second Degree Piles – Prolapse but retract spontaneously– Third Degree Piles– Require manual replacement after prolapse

• Associated with constipation and straining

• Manifestation –– Bright red rectal bleeding after defeacation– Pain– Pruritis ani– Mucus discharge

• Management – – Injection sclerotherapy or band ligation is effective in most patients– Some patients require haemorrhoidectomy.

LPO

- LPO

LPO

HPO

Demonstrative Congestion

HPO

Demonstrative Congestion

Meckel’s Diverticulum

• Most common congenital anomaly of GIT

• Diverticulum results from the failure of the closure of the vitelline duct.

• Small out pouching extending from the anti mesenteric side of the bowel.

• Normal mucosal lining resembling small intestine

• Diagnosis– Scanning the abdomen by gamma counter following an IV injection

of pertechnate.

• Clinical manifestation– Bleeding results from ulceration of the ileal mucosa(Present as

Recurrent Melena)– Abdominal pain

• Management– Some are present with no complication and may be left as it is.– The ones with complications like perforation require Surgery.

Ectopic Gastric mucosa

Acute Appendicitis

• Appendiceal inflammation is associated with obstruction in 50-80% of cases usually in the form of a fecalth and less commonly gall stone tumor or ball of worm(Oxyuriasis vermicularis)

• At earliest stages only scanty of neutrophilic exudate may be found throughout the mucosa,submucosa and muscularis propria.

• Diagnosis– Until the localization of pain occurs diagnosis is not made.– CBC counts are taken if pain is manifested in RLQ, to confirm

inflammation in appendix.

• Clinical manifestation – Epigastric pain is the initial symptom– Later classically nausea,vomiting then pain becomes

generalized which finally shifts to Right lower Quadrant.

• Management– Non surgical treatment can be approached but there are

chances of recurrence and perforation.– Conventional Appendectomy is performed in most cases.

LPO

Tunica muscularis

Wtih infiltrationOf neutrophils

LPO

Congestion in subserosal vessel

LPO

LPO

LPO

LPO

LPO

HPO

PMNs ---- Mostly Neutrophils inTunica muscularis layer

TB of intestines

• Extrapulmonary TB

• Upper GI involvement is rare and is usually an unexpected findings in endoscopy or laparotomy specimen

• Ileocecal disease accounts for approximately half of the abdominal TB cases.

• Commonly found in immunocompromised patients(HIV patients)

• Diagnosis– Diagnosis rest on obtaining histology by either colonoscopy or minilaparotomy.– Cultures from obtained specimens– Ultrasound/Ct may reveal thickened bowel wall,mesenteric thickening or ascites.

• Clinical manifestation – Exudative ascites– Intestinal obstruction– Fever– Night sweats– Anorexia – Weight loss

• Management– Classical 4 drug therapy for TB

LPO

HPO

LPO

HPO

Schistosoma Appendix

• As the worm produces more eggs the lesion tends to be more extensive and widespread.

• Clinical feature resemble those of severe infection.

• Small as well as large bowel can be affected.

• Diagnosis– Diagnosis depends on demonstrating eggs or serological evidence of

infection.– Stool examination– Eosinophilia

• Clinical manifestation – Initially itching at the site of penetration– Later 5-6 weeks Acute schistosomiasis(Katayama syndrome) may

develop with allergic presentation such as urticaria,fever,Muscle aches,abdominal pain,cough,sweating.

• Management– Objective is to kill the adult schistosome so that it stop producing

eggs. (Praziquantel is the drug of choice)– Surgery may be required

LPO

LPO

HPO

HPO

HPO

LPO

Adenocarcinoma of colon• 98% of cancers in large intestine are adenocarcinomas.

• Tumors in the proximal colon tend to grow as polyp.Obstruction is uncommon

• When the carcinomas in distal colon are discovered the tend to be annular encircling lesions that produce so called napkin ring constrictions of the bowel and narrowing of the lumen.

• Almost all cancers of colon are adenocarcinomas which range from well differentiated to Undifferentiated, frankly anaplastic masses.

• Many tumors produce mucin which is secreted into the gland lumina/interstitium of gut wall which facilitate the extension of this cancer and worsen the prognosis.

• Diagnosis– Barium enema– Colonoscopy– Confirmatory biopsy– Digital rectal examination and fecal testing for occult blood loss

• Clinical manifestation – Fatigue– Weakmess– Weight loss– Changes in bowel habits– Left lower quadrant discomfort

• Management– Chemotherapy determined on the basic of the cancer classification.– Prognosis for T1 stage in 97% of patients is 5 year survival rate– Palliative surgical segmental resection

Invasive Adenocarcinoma of colon

LPO

LPO

LPO

Malignant glands infilrating the surrounding tissue LPO

Malignant glands infilrating the surrounding tissue

HPO

Cytologic atypia

Pleomorphism

HPO

Cytologic atypia

Pleomorphism

HPO

Cytologic atypia

Pleomorphism

HPO

HPO

HPO

Rectal Adenoma(not included in practical quiz)

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Thanking to the entire Universe