Podcast
Questions and Answers
What is one of the least likely complications of acute appendicitis?
What is one of the least likely complications of acute appendicitis?
Which of the following is true regarding Meckel’s diverticulum?
Which of the following is true regarding Meckel’s diverticulum?
Which of the following describes colonic diverticula?
Which of the following describes colonic diverticula?
What is a significant clinical feature of Hirschsprung disease?
What is a significant clinical feature of Hirschsprung disease?
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What is the primary defect in Hirschsprung disease?
What is the primary defect in Hirschsprung disease?
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Which of the following is NOT a listed complication of acute appendicitis?
Which of the following is NOT a listed complication of acute appendicitis?
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Which factor is associated with the acquired form of diverticular disease?
Which factor is associated with the acquired form of diverticular disease?
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What condition might result from ectopic gastric mucosa in the context of diverticular disease?
What condition might result from ectopic gastric mucosa in the context of diverticular disease?
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What is a characteristic microscopic feature seen during the acute phase of ulcerative colitis?
What is a characteristic microscopic feature seen during the acute phase of ulcerative colitis?
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Which of the following complications is associated with ulcerative colitis after 10 years of pancolitis?
Which of the following complications is associated with ulcerative colitis after 10 years of pancolitis?
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In acute appendicitis, which statement describes the gross appearance of the affected appendix?
In acute appendicitis, which statement describes the gross appearance of the affected appendix?
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What symptom commonly precedes the pain associated with acute appendicitis?
What symptom commonly precedes the pain associated with acute appendicitis?
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What type of cell predominates in the chronic inflammatory infiltration seen in ulcerative colitis?
What type of cell predominates in the chronic inflammatory infiltration seen in ulcerative colitis?
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Which of the following features differentiates ulcerative colitis from Crohn’s disease?
Which of the following features differentiates ulcerative colitis from Crohn’s disease?
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Which of these is NOT a cause of obstruction leading to acute appendicitis?
Which of these is NOT a cause of obstruction leading to acute appendicitis?
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What occurs in the chronic phase of ulcerative colitis regarding epithelial structure?
What occurs in the chronic phase of ulcerative colitis regarding epithelial structure?
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What is the underlying immunologic process in celiac disease?
What is the underlying immunologic process in celiac disease?
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Which clinical manifestation is common across malabsorption syndromes?
Which clinical manifestation is common across malabsorption syndromes?
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What is a characteristic feature of Whipple's disease?
What is a characteristic feature of Whipple's disease?
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What is a key difference between celiac disease and tropical sprue?
What is a key difference between celiac disease and tropical sprue?
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What condition is characterized by a deficiency of the lactase enzyme?
What condition is characterized by a deficiency of the lactase enzyme?
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Which microscopic feature is indicative of celiac disease?
Which microscopic feature is indicative of celiac disease?
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Which symptom is specifically associated with lactose intolerance?
Which symptom is specifically associated with lactose intolerance?
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What is the primary cause of diarrhea in patients with malabsorption syndromes?
What is the primary cause of diarrhea in patients with malabsorption syndromes?
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What is a distinct characteristic of Crohn's disease as observed in imaging studies?
What is a distinct characteristic of Crohn's disease as observed in imaging studies?
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Which of the following clinical features is NOT commonly associated with Crohn's disease?
Which of the following clinical features is NOT commonly associated with Crohn's disease?
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Which of the following is a characteristic lesion found microscopically in Crohn's disease?
Which of the following is a characteristic lesion found microscopically in Crohn's disease?
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What is a potential complication of Crohn's disease due to narrowing of the intestine?
What is a potential complication of Crohn's disease due to narrowing of the intestine?
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Which age groups are the primary peaks for the occurrence of Crohn's disease?
Which age groups are the primary peaks for the occurrence of Crohn's disease?
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What type of ulceration is commonly seen in Crohn's disease?
What type of ulceration is commonly seen in Crohn's disease?
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What is the nature of ulcerative colitis compared to Crohn's disease?
What is the nature of ulcerative colitis compared to Crohn's disease?
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Which feature is commonly documented in the gross appearance of ulcerative colitis?
Which feature is commonly documented in the gross appearance of ulcerative colitis?
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Study Notes
Pathology of Intestines
- This presentation covers various pathologies of the intestines, including diverticula, congenital megacolon (Hirschsprung's disease), malabsorption syndromes, inflammatory bowel diseases (IBDs), acute appendicitis, and diverticular disease.
Topics to be Covered
- Diverticula of the intestine
- Congenital megacolon (Hirschsprung's disease)
- Malabsorption syndromes (Celiac disease, Tropical sprue, Lactose intolerance, Whipple's disease)
- Inflammatory bowel diseases (IBD): Crohn's disease, Ulcerative colitis
- Acute appendicitis
- Diverticular disease (Meckel's diverticulum, Colonic diverticula)
Inflammatory Bowel Diseases (IBD)
- Also known as idiopathic intestinal inflammations.
- Crohn's disease (CD): Chronic non-specific granulomatous disease
- Cause: Unknown
- Sites: Typically the terminal ileum, but can affect any part of the colon or intestines.
- Gross appearance: Segmental (skip) lesions, cobblestone mucosa with deep linear or fissure ulcers along the bowel axis. Thickened intestinal wall, narrow lumen (string sign in x-ray), and serosal extension of mesenteric fat.
- Microscopic: Diffuse infiltration of all intestinal wall layers by mononuclear cells; hyperemia and edema. Submucosal tubercles formed of epithelioid and giant cells without caseation necrosis. Fibrosis in late stages.
- Clinical features: Recurrent diarrhea, abdominal cramps, fever (lasting days to weeks); two peaks in age: 10-30, 50-70.
- Complications: Intestinal obstruction, perforation of fissuring ulcers (leading to peritonitis or fistula formation), malabsorption syndrome, bleeding, and anemia; increased risk of malignancy (five-fold to six-fold).
- Ulcerative colitis (UC): Inflammatory condition of the colon and rectum; initially acute, then chronic with periods of remission.
- Cause: Unknown
- Inflammation is limited to the mucosa and submucosa, except in severe cases.
- Gross appearance: Continuous lesions throughout the colon; congested velvety mucosa; shallow ulcers; pseudopolyps (intact mucosa).
- Microscopic: Acute phase: severe mucosa congestion and crypt abscess formation; chronic phase: destruction of glandular epithelium, infiltration by chronic inflammatory cells (mainly plasma cells); epithelial hyperplasia, potentially dysplasia.
- Clinical features: Diarrhea with mucus and blood in stool; may persist for days to weeks or months, and subside to recur; peaks in age 20-30.
- Complications: Rectal hemorrhage, diarrhea and weight loss, perforation, malignant change (after 10 years of pancolitis), secondary amyloidosis, toxic megacolon.
Acute Appendicitis
- The most common cause of acute abdomen in children and young adults.
- Cause: Obstruction of the lumen (e.g., fecoliths, hyperplastic lymphoid tissue, worms, or tumors) leading to ischemia of the wall and secondary bacterial infection (e.g., E. coli).
- Gross appearance: Swollen, congested appendix; fibrin on the serosal surface.
- Microscopic: Inflammatory exudate in the lumen; infiltration of the intestinal wall by acute inflammatory cells (primarily neutrophils), especially the muscular layer; ulceration and necrosis of the mucosa; congestion of blood vessels and edema of the wall; gangrenous necrosis (severe cases).
- Clinical features: Peri-umbilical pain migrating to the right lower quadrant, anorexia, vomiting, mild fever, leucocytosis (>15000/cmm).
- Complications: Perforation, peritonitis (with possible toxemia and death), portal pyemia, chronic appendicitis.
Diverticular Disease
- Diverticula: Outpouchings of the intestinal wall.
- Types:
- Meckel's diverticulum: Congenital; remnant of the vitelline duct; typically found 2 feet (60cm) from the ileocecal valve; 2cm in length; 2% risk of carcinoid tumor. Rule of 2's: occurs in 2% of population, usually diagnosed at 2 years of age.
- Colonic diverticulosis: Acquired; multiple outpouchings in the sigmoid colon, mucosa and submucosa protruding through weak points in muscularis; due to chronic constipation.
- Complication: Inflammation (diverticulitis), peptic ulcer (if ectopic gastric mucosa present), carcinoid tumor, intestinal obstruction.
Hirschsprung's Disease
- Genetic disorder causing lack of ganglion cells in a segment of the colon.
- Results in dilatation of the colon above the affected segment and constriction of the affected colonic segment.
- Microscopic: Absence of ganglion cells in Auerbach's and Meissner's plexuses in the submucosa.
- Clinical features: Occurs in infancy, somewhat more frequent in females (4:1); constipation, abdominal distension, vomiting.
- Complications: Enterocolitis (life-threatening), perforation.
Malabsorption Syndromes
- Maldigestion: Issues with digesting food due to pancreatic, biliary, or intestinal diseases, or overgrowth of bacteria.
- Reduced absorptive capacity: Diseases like celiac disease, Crohn's disease, and surgical resection reduce the intestines' ability to absorb nutrients.
- Transport abnormalities: Lymphoma, tuberculosis also can disrupt normal transportation of nutrients.
- Clinical manifestations: Diarrhea, bulky stools, weight loss, evidence of vitamin deficiencies, fatigue.
Celiac Disease
- Gluten-sensitive enteropathy (non-tropical sprue)
- Characterized by: Flat small bowel mucosa, prompt clinical improvement after withdrawal of gluten-containing foods.
- Pathogenesis: Immunologic disorder; reactivity to gliadin (a gluten protein) damages epithelial cells lining the villi. Antibodies (anti-gliadin, anti-reticulin, and anti-endomysial) present in serum.
- Gross appearance: Atrophic changes most severe in proximal small bowel.
- Microscopic: Loss of villi; increased intra-epithelial lymphocytes; increased plasma cells in lamina propria.
- Clinical manifestations: Presents in childhood, abdominal distention, flatulence, diarrhea, steatorrhea, weight loss. Treatment: Dietary gluten restriction.
Tropical Sprue
- Found in tropical climates; malabsorption, likely secondary to bacterial infection (E. coli).
- Microscopic: Variable degrees of villous atrophy.
- Patients respond well to broad-spectrum antibiotics.
Lactose Intolerance
- Lactase enzyme deficiency; the enzyme is located in the small intestinal brush border and digests lactose.
- Absence of the enzyme results in sugar fermentation in the lumen.
- Clinical manifestations: Abdominal cramps, diarrhea, flatulence, weight loss.
Whipple's Disease
- Rare infectious disease involving multiple organs (small intestine, joints, lungs, heart, liver, spleen, and CNS).
- Occurs primarily in adult males (30-50 years).
- Pathogenesis: Caused by the bacterium Tropheryma whipplei.
- Microscopic: Macrophages in the lamina propria of the small intestine are filled with PAS-positive rod-shaped bacilli .
- Treatment: Antibiotics.
- Clinical manifestations: Malabsorption, weight loss, diarrhea.
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Description
This quiz covers key pathologies associated with the intestines, including diverticula, congenital megacolon, and various inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. It also explores conditions like malabsorption syndromes and acute appendicitis. Test your understanding of these significant digestive health issues.
