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Diseases of GIT
 

Diseases of GIT

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    Diseases of GIT Diseases of GIT Presentation Transcript

    • Diseases of GIT
      Patho-B Lab
    • Esophagealvarices
      Chronic gastritis
      Chronic peptic ulcer
      Adenocarcinoma
      of rectum
      Adenocarcinoma of Stomach
      Hemorrhoids
      Meckel’sdiverticulum
      Acute appendicitis
      TB of intestine
      Schistosoma Appendix
      Adenocarcinoma of colon
    • EsophagealVarices
      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 ballontamponade
      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
      Intraepithelianeutrophils 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
    • LPO
      Neutophilic infiltrates within lamina propria
      Intraepithelianeutrophils and subepithelial plasma cells characteristic
    • LPO
    • LPO
      Neutrophils
    • LPO
    • HPO
      Plasma cell infiltrate
      Gastric glands
    • HPO
      Lymphocyte & Plasma cell infiltrate
    • 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 occasionalybe 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
    • LPO
      Epithelial injury
      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
      Morphology of PUD
      ** Necrotic debris
      ** Inflammation with
      predominant neutrophils
      **Granulation tissue
      **Fibrosis
    • 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 structures
      Formed from previous chronic inflammation
      LPO
    • Bulky glandular structures
      Formed 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
      Pruritisani
      Mucus discharge
      Management –
      Injection sclerotherapyor band ligation is effective in most patients
      Some patients require haemorrhoidectomy.
    • LPO
    • -
      LPO
    • LPO
    • HPO
      Demonstrative Congestion
    • HPO
      Demonstrative Congestion
    • Meckel’sDiverticulum
      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(Oxyuriasisvermicularis)
      At earliest stages only scanty of neutrophilicexudate may be found throughout the mucosa,submucosa and muscularispropria.
    • 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 infiltration
      Of neutrophils
    • LPO
      Congestion in subserosal vessel
      LPO
    • LPO
    • LPO
    • LPO
    • LPO
    • HPO
      PMNs ---- Mostly Neutrophils in
      Tunica 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
      Exudativeascites
      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,Muscleaches,abdominalpain,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
    • LPO
      Invasive Adenocarcinoma
      of colon
    • LPO
    • LPO
    • Malignant glands infilrating
      the surrounding tissue
      LPO
    • HPO
      Malignant glands infilrating
      the surrounding tissue
    • HPO
      Cytologicatypia
      Pleomorphism
    • HPO
      Cytologicatypia
      Pleomorphism
    • HPO
      Cytologicatypia
      Pleomorphism
    • HPO
    • HPO
    • Rectal Adenoma(not included in practical quiz)
    • Thanking to the entire Universe