Diseases of GIT<br />Patho-B Lab<br />
Esophagealvarices<br />Chronic gastritis<br />Chronic peptic ulcer<br />Adenocarcinoma<br />of rectum<br />Adenocarcinoma ...
EsophagealVarices<br />Tortuos dilated veins lying within the submucosa of the distal esophagus.<br />Congested sub epithe...
Diagnosis<br />Often asymptomatic utill there is a rupture<br />Endoscopy<br />Clinical Manifestation<br />Increased vascu...
Congested sub epithelial and sub mucosal venous plexus <br />
Congested sub epithelial and sub mucosal venous plexus <br />
Congested sub epithelial and sub mucosal venous plexus <br />
Congested sub epithelial and sub mucosal venous plexus <br />
Congested sub epithelial and sub mucosal venous plexus <br />
Congested sub epithelial and sub mucosal venous plexus <br />
Chronic Gastritis<br />Defined by presence of chronic inflammatory changes in the mucosa leading eventually to mucosal atr...
Complication:-<br />Peptic ulcer Disease<br />Dysplasia and Intestinal Metaplasia<br />Gastritis cystica<br />Diagnosis<br...
Atrophied Mucosa due to Chronic inflammation<br />LPO<br />
Atrophied Mucosa due to Chronic inflammation<br />LPO<br />
LPO<br />Neutophilic infiltrates within lamina propria<br />Intraepithelianeutrophils and subepithelial plasma cells chara...
LPO<br />
LPO<br />Neutrophils<br />
LPO<br />
HPO<br />Plasma cell infiltrate<br />Gastric glands<br />
HPO<br />Lymphocyte & Plasma cell infiltrate<br />
Chronic peptic Ulcer<br />Peptic ulcers are chronic most often solitary lesions that occur in any portion of the GIT expos...
Diagnosis<br />Endoscopy<br />Gastric ulcers may occasionalybe malignant and therefore must always be biopsied and followe...
LPO<br />Epithelial injury<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />    predominant n...
LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br />     predominant neutrophils<br />**Gran...
Adenocarcinoma of Stomach<br />Most common malignancy of stomach<br />Classification is according to the location in stoma...
Diagnosis<br />There are no laboratory markers<br />Upper GI Endoscopy remains the choice.<br />Multiple biopsies from bas...
Bulky glandular structures<br />Formed from previous chronic inflammation<br />LPO<br />
Bulky glandular structures<br />Formed from previous chronic inflammation<br />LPO<br />
LPO<br />
LPO<br />
LPO<br />
LPO<br />
HPO<br />
Hemorrhoids<br />They arise from congestion of the internal and/or external venous plexuses around the anal canal.<br />Al...
LPO<br />
-<br />LPO<br />
LPO<br />
HPO<br />Demonstrative Congestion<br />
HPO<br />Demonstrative Congestion<br />
Meckel’sDiverticulum<br />Most common congenital anomaly of GIT<br />Diverticulum results from the failure of the closure ...
Diagnosis<br />Scanning the abdomen by gamma counter following an IV injection of pertechnate.<br />Clinical manifestation...
Ectopic Gastric mucosa<br />
Acute Appendicitis<br />Appendiceal inflammation is associated with obstruction in 50-80% of cases usually in the form of ...
Diagnosis<br />Until the localization of pain occurs diagnosis is not made.<br />CBC counts are taken if pain is manifeste...
LPO<br />Tunica<br />muscularis<br />Wtih infiltration<br />Of neutrophils<br />
LPO<br />Congestion in subserosal vessel<br />LPO<br />
LPO<br />
LPO<br />
LPO<br />
LPO<br />
HPO<br />PMNs ---- Mostly Neutrophils in<br />Tunica muscularis layer<br />
TB of intestines<br />Extrapulmonary TB <br />Upper GI involvement is rare and is usually an unexpected findings in endosc...
Diagnosis<br />Diagnosis rest on obtaining histology by either colonoscopy or minilaparotomy.<br />Cultures from obtained ...
LPO<br />
HPO<br />
LPO<br />
HPO<br />
Schistosoma Appendix<br />As the worm produces more eggs the lesion tends to be more extensive and widespread.<br />Clinic...
Diagnosis<br />Diagnosis depends on demonstrating eggs or serological evidence of infection.<br />Stool examination<br />E...
LPO<br />
LPO<br />
HPO<br />
HPO<br />
HPO<br />
LPO<br />
Adenocarcinoma of colon<br />98% of cancers in large intestine are adenocarcinomas.<br />Tumors in the proximal colon tend...
Diagnosis<br />Barium enema<br />Colonoscopy<br />Confirmatory biopsy<br />Digital rectal examination and fecal testing fo...
LPO<br />Invasive Adenocarcinoma<br />of colon<br />
LPO<br />
LPO<br />
Malignant glands infilrating<br /> the surrounding tissue<br />LPO<br />
HPO<br />Malignant glands infilrating<br /> the surrounding tissue<br />
HPO<br />Cytologicatypia<br />Pleomorphism<br />
HPO<br />Cytologicatypia<br />Pleomorphism<br />
HPO<br />Cytologicatypia<br />Pleomorphism<br />
HPO<br />
HPO<br />
Rectal Adenoma(not included in practical quiz)<br />
Thanking to the entire Universe<br />
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Diseases of git

  1. 1. Diseases of GIT<br />Patho-B Lab<br />
  2. 2. Esophagealvarices<br />Chronic gastritis<br />Chronic peptic ulcer<br />Adenocarcinoma<br />of rectum<br />Adenocarcinoma of Stomach<br />Hemorrhoids<br />Meckel’sdiverticulum<br />Acute appendicitis<br />TB of intestine<br />Schistosoma Appendix<br />Adenocarcinoma of colon<br />
  3. 3. EsophagealVarices<br />Tortuos dilated veins lying within the submucosa of the distal esophagus.<br />Congested sub epithelial and sub mucosal venous plexus within the distal esophagus<br />Due to diseases that impede venous blood flow from GIT to the liver via portal vein before reaching Inferior vena cava<br />Alcoholic Liver disease – In 90% of cirrhotic patients<br />Schistosomiasis-2nd most common cause worldwide<br />Complication- Hemorrhage & Internal bleeding<br />
  4. 4. Diagnosis<br />Often asymptomatic utill there is a rupture<br />Endoscopy<br />Clinical Manifestation<br />Increased vascular hydrostatic pressure is associated with vomiting<br />Rupture can cause massive hematemesis<br />Management<br />Medical emergency<br />Sclerotherapy<br />Endoscopic ballontamponade<br />Endoscopic rubber band ligation<br />
  5. 5. Congested sub epithelial and sub mucosal venous plexus <br />
  6. 6. Congested sub epithelial and sub mucosal venous plexus <br />
  7. 7. Congested sub epithelial and sub mucosal venous plexus <br />
  8. 8. Congested sub epithelial and sub mucosal venous plexus <br />
  9. 9. Congested sub epithelial and sub mucosal venous plexus <br />
  10. 10. Congested sub epithelial and sub mucosal venous plexus <br />
  11. 11. Chronic Gastritis<br />Defined by presence of chronic inflammatory changes in the mucosa leading eventually to mucosal atrophy and epithelial metaplasia.<br />Etiology:- Most common is H. Pylori infection(typically found in the antrum)<br />Most common cause of duodenal ulcer<br />Morphology:-<br />Antral mucosa usually erythematous with coarse or nodular appearance.<br />Neutophilic infiltrates within lamina propria<br />Intraepithelianeutrophils and subepithelial plasma cells characteristic<br />
  12. 12. Complication:-<br />Peptic ulcer Disease<br />Dysplasia and Intestinal Metaplasia<br />Gastritis cystica<br />Diagnosis<br />Gastroscopy<br />Clinical Manifestation<br />Nausea and abdominal discomfort<br />Management:- <br />H.pylori eradication if that’s the cause<br />Primary therapy for 7 days which includes proton pump inibitor along with antibiotic(Clarithromycin, metronidazole,amoxicillin)<br />
  13. 13. Atrophied Mucosa due to Chronic inflammation<br />LPO<br />
  14. 14. Atrophied Mucosa due to Chronic inflammation<br />LPO<br />
  15. 15. LPO<br />Neutophilic infiltrates within lamina propria<br />Intraepithelianeutrophils and subepithelial plasma cells characteristic<br />
  16. 16. LPO<br />
  17. 17. LPO<br />Neutrophils<br />
  18. 18. LPO<br />
  19. 19. HPO<br />Plasma cell infiltrate<br />Gastric glands<br />
  20. 20. HPO<br />Lymphocyte & Plasma cell infiltrate<br />
  21. 21. Chronic peptic Ulcer<br />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.<br />98% of the peptic ulcers are either in the first portion of the duodenum or in the stomach(4:1 ratio)<br />2 conditions leading to Peptic ulcers<br />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)<br />Mucosal exposure to gastric acid and pepsin.<br />
  22. 22. Diagnosis<br />Endoscopy<br />Gastric ulcers may occasionalybe malignant and therefore must always be biopsied and followed up to ensure healing.<br />Clinical manifestation <br />Recurrent epigastric pain- most common<br />Occasional vomiting<br />Anorexia<br />Anemia in some patients with silent undetected blood loss<br />Management<br />Relive symptoms<br />Induce healing<br />Prevent recurrence<br />H.pylori eradication<br />
  23. 23. LPO<br />Epithelial injury<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  24. 24. LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  25. 25. LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  26. 26. LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  27. 27. HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  28. 28. HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  29. 29. HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  30. 30. HPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  31. 31. LPO<br />Morphology of PUD<br />** Necrotic debris<br />** Inflammation with<br /> predominant neutrophils<br />**Granulation tissue<br />**Fibrosis<br />
  32. 32. Adenocarcinoma of Stomach<br />Most common malignancy of stomach<br />Classification is according to the location in stomach,gross and histologic morphology.<br />Intestinal Adenocarcinoma- Bulky and composed of glandular structures. (slide shown in lab)<br />Diffuse Adenocarcinoma- Infiltrative pattern composed of signet ring cells that do not form glands<br />
  33. 33. Diagnosis<br />There are no laboratory markers<br />Upper GI Endoscopy remains the choice.<br />Multiple biopsies from base and edge of ulcer<br />Clinical manifestation <br />Early stage is asymptomatic<br />Weight loss(most common)<br />Epigastric pain with vomiting<br />Virchow’s node<br />Sister Mary Joseph sign<br />Management<br />Surgical resection(Partial gastrectomy common)<br />For unrectable tumors palliative measures are taken<br />Over all prognosis of patients with Adenocarcinoma of stomach is poor with <30% survival rate of 5 years<br />
  34. 34. Bulky glandular structures<br />Formed from previous chronic inflammation<br />LPO<br />
  35. 35. Bulky glandular structures<br />Formed from previous chronic inflammation<br />LPO<br />
  36. 36. LPO<br />
  37. 37. LPO<br />
  38. 38. LPO<br />
  39. 39. LPO<br />
  40. 40. HPO<br />
  41. 41. Hemorrhoids<br />They arise from congestion of the internal and/or external venous plexuses around the anal canal.<br />Also Known as Piles<br />First Degree Piles - Bleed<br />Second Degree Piles – Prolapse but retract spontaneously<br />Third Degree Piles– Require manual replacement after prolapse<br />Associated with constipation and straining<br />Manifestation –<br />Bright red rectal bleeding after defeacation<br />Pain<br />Pruritisani<br />Mucus discharge<br />Management – <br />Injection sclerotherapyor band ligation is effective in most patients<br />Some patients require haemorrhoidectomy.<br />
  42. 42. LPO<br />
  43. 43. -<br />LPO<br />
  44. 44. LPO<br />
  45. 45. HPO<br />Demonstrative Congestion<br />
  46. 46. HPO<br />Demonstrative Congestion<br />
  47. 47. Meckel’sDiverticulum<br />Most common congenital anomaly of GIT<br />Diverticulum results from the failure of the closure of the vitelline duct.<br />Small out pouching extending from the anti mesenteric side of the bowel.<br />Normal mucosal lining resembling small intestine<br />
  48. 48. Diagnosis<br />Scanning the abdomen by gamma counter following an IV injection of pertechnate.<br />Clinical manifestation<br />Bleeding results from ulceration of the ileal mucosa(Present as Recurrent Melena)<br />Abdominal pain <br />Management<br />Some are present with no complication and may be left as it is.<br />The ones with complications like perforation require Surgery.<br />
  49. 49. Ectopic Gastric mucosa<br />
  50. 50.
  51. 51.
  52. 52.
  53. 53.
  54. 54. Acute Appendicitis<br />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(Oxyuriasisvermicularis)<br />At earliest stages only scanty of neutrophilicexudate may be found throughout the mucosa,submucosa and muscularispropria.<br />
  55. 55. Diagnosis<br />Until the localization of pain occurs diagnosis is not made.<br />CBC counts are taken if pain is manifested in RLQ, to confirm inflammation in appendix.<br />Clinical manifestation <br />Epigastric pain is the initial symptom<br />Later classically nausea,vomiting then pain becomes generalized which finally shifts to Right lower Quadrant.<br />Management<br />Non surgical treatment can be approached but there are chances of recurrence and perforation.<br />Conventional Appendectomy is performed in most cases.<br />
  56. 56. LPO<br />Tunica<br />muscularis<br />Wtih infiltration<br />Of neutrophils<br />
  57. 57. LPO<br />Congestion in subserosal vessel<br />LPO<br />
  58. 58. LPO<br />
  59. 59. LPO<br />
  60. 60. LPO<br />
  61. 61. LPO<br />
  62. 62. HPO<br />PMNs ---- Mostly Neutrophils in<br />Tunica muscularis layer<br />
  63. 63. TB of intestines<br />Extrapulmonary TB <br />Upper GI involvement is rare and is usually an unexpected findings in endoscopy or laparotomy specimen<br />Ileocecal disease accounts for approximately half of the abdominal TB cases.<br />Commonly found in immunocompromised patients(HIV patients)<br />
  64. 64. Diagnosis<br />Diagnosis rest on obtaining histology by either colonoscopy or minilaparotomy.<br />Cultures from obtained specimens<br />Ultrasound/Ct may reveal thickened bowel wall,mesenteric thickening or ascites.<br />Clinical manifestation <br />Exudativeascites<br />Intestinal obstruction<br />Fever<br />Night sweats<br />Anorexia <br />Weight loss<br />Management<br />Classical 4 drug therapy for TB<br />
  65. 65. LPO<br />
  66. 66. HPO<br />
  67. 67. LPO<br />
  68. 68. HPO<br />
  69. 69. Schistosoma Appendix<br />As the worm produces more eggs the lesion tends to be more extensive and widespread.<br />Clinical feature resemble those of severe infection.<br />Small as well as large bowel can be affected.<br />
  70. 70. Diagnosis<br />Diagnosis depends on demonstrating eggs or serological evidence of infection.<br />Stool examination<br />Eosinophilia<br />Clinical manifestation <br />Initially itching at the site of penetration<br />Later 5-6 weeks Acute schistosomiasis(Katayama syndrome) may develop with allergic presentation such as urticaria,fever,Muscleaches,abdominalpain,cough,sweating.<br />Management<br />Objective is to kill the adult schistosome so that it stop producing eggs. (Praziquantel is the drug of choice)<br />Surgery may be required <br />
  71. 71. LPO<br />
  72. 72. LPO<br />
  73. 73. HPO<br />
  74. 74. HPO<br />
  75. 75. HPO<br />
  76. 76. LPO<br />
  77. 77. Adenocarcinoma of colon<br />98% of cancers in large intestine are adenocarcinomas.<br />Tumors in the proximal colon tend to grow as polyp.Obstruction is uncommon<br />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.<br />Almost all cancers of colon are adenocarcinomas which range from well differentiated to Undifferentiated, frankly anaplastic masses.<br />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.<br />
  78. 78. Diagnosis<br />Barium enema<br />Colonoscopy<br />Confirmatory biopsy<br />Digital rectal examination and fecal testing for occult blood loss<br />Clinical manifestation <br />Fatigue<br />Weakmess<br />Weight loss<br />Changes in bowel habits<br />Left lower quadrant discomfort<br />Management<br />Chemotherapy determined on the basic of the cancer classification.<br />Prognosis for T1 stage in 97% of patients is 5 year survival rate<br />Palliative surgical segmental resection<br />
  79. 79. LPO<br />Invasive Adenocarcinoma<br />of colon<br />
  80. 80. LPO<br />
  81. 81. LPO<br />
  82. 82. Malignant glands infilrating<br /> the surrounding tissue<br />LPO<br />
  83. 83. HPO<br />Malignant glands infilrating<br /> the surrounding tissue<br />
  84. 84. HPO<br />Cytologicatypia<br />Pleomorphism<br />
  85. 85. HPO<br />Cytologicatypia<br />Pleomorphism<br />
  86. 86. HPO<br />Cytologicatypia<br />Pleomorphism<br />
  87. 87. HPO<br />
  88. 88. HPO<br />
  89. 89. Rectal Adenoma(not included in practical quiz)<br />
  90. 90.
  91. 91.
  92. 92.
  93. 93.
  94. 94.
  95. 95.
  96. 96.
  97. 97.
  98. 98.
  99. 99.
  100. 100.
  101. 101.
  102. 102.
  103. 103.
  104. 104.
  105. 105. Thanking to the entire Universe<br />
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