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Intestinal ulcers Dr. Prakash H M
Department of Pathology,
VMKV Medical College, Salem. |
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Ulcers Ulcers are defined histologically as a breach in the mucosa of the alimentary tract that extends through the muscularis mucosa into the submucosa or deeper |
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Small intestine Typhoid ulcer
Amoebic ulcer
Duodenal ulcer
Ulcerative colitis
Crohns disease
Carcinoma of intestine |
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rabiezahran@gwab.com Salmonella typhi
Small gram-negative rods (2-4 X 0.5 microns)
motile with flagella . |
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Salmonellosis. rabiezahran@gawab.com Salmonella infection in man is caused by the enteric fever group which includes :
Salmonella typhi.? Typhoid fever.
Salmonella paratyphi A. ? paratyphoid fever
Salmonella paratyphi B. ? paratyphoid fever
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Pathogenic Mechanism .Invasion, translocation, lymphoid inflammation, dissemination
Typhoid ulcers are oval and longitudinal |
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Intestinal lesions :
Ulceration of Peyer's patches
Intestinal bleeding
Ulceration 7 Dr Prakash H M |
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rabiezahran@gawab.com Lower ileum
in early typhoid
enlarged friable peyers patches Lower ileum
3rd week of typhoid
Several large paper thin areas liable to perforation . |
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Tuberculous ulcer Mostly ileum – ileo caecal junction
Transverse due to the lymphatics
Granulomas with or without necrosis, composed of epithelioid cells, langhans giant cells and lymphocytes. AFB maybe seen.
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Typical transverse ulcer |
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Multiple confluent granulomas, one of which exhibits necrosis.
There is almost no infiltration of neutrophils. |
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Amoebiasis Transmission: Fecal-oral contamination
Caecum, ascending colon, appendix, sigmoid colon |
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Flask shaped ulcers with narrow neck and broad base – 5-10% perforate – solitary abscess in liver or multiple discrete abscesses
Inflammatory infiltrate amoeba mimic macrophages, show erythrophagocytosis
PAS and iron hematoxylin positive
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Entamoeba histolytica and E. dispar 16 Dr Prakash H M |
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Amoebiasis Entamoeba histolytica 17 Dr Prakash H M |
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Amoebiasis Extension 18 Dr Prakash H M |
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Diagnosis: Examination of the stool for cysts is required for diagnosis. Colonic mucosal biopsies may reveal the organisms. Serologic titers may aid in diagnosis, particularly with disseminated infections.
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PEPTIC ULCERS chronic, most often solitary, lesions occur in any portion of the gastrointestinal tract exposed to the aggressive action of acid/peptic juices
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sites • Duodenum, first portion • Stomach, antrum • At the gastroesophageal junction, in the setting of gastroesophageal reflux or Barrett esophagus • Within the margins of a gastrojejunostomy • In the duodenum, stomach, and/or jejunum of patients with Zollinger-Ellison syndrome • Within or adjacent to an ileal Meckel diverticulum with ectopic gastric mucosa. |
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Helicobacter pylori small curved to spiral rod-shaped bacterium methylene blue stain |
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Inflammatory bowel disease (IBD) is a chronic condition resulting from inappropriate mucosal immune activation.
The two disorders that comprise IBD are Crohn disease and ulcerative colitis. |
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THE IBD COMPARISON |
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IBD COMPARISON CONTINUED |
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Adenocarcinoma of the colon is the most common malignancy of the GI tract and is a major cause of morbidity and mortality worldwide
Colorectal Adenocarcinomas Mostly Arise in Adenomatous Polyps |
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Morphologic and molecular changes in the adenoma-carcinoma sequence. It is postulated that loss of one normal copy of the tumor suppressor gene APC occurs early. Individuals may be born with one mutant allele, making them extremely prone to develop colon cancer, or inactivation of APC may occur later in life. This is the “first hit” according to Knudson's hypothesis. The loss of the intact copy of APC follows (“second hit”). Other mutations include those on KRAS, losses at 18q21 involving SMAD2 and SMAD4, and inactivation of the tumor suppressor gene p53, lead to the emergence of carcinoma, in which additional mutations occur. Although there seems to be a temporal sequence of changes, the accumulation of mutations, rather than their occurrence in a specific order, is most critical. |
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Adenocarcinoma of the colon |
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Large intestine ulcers Ulcerative colitis
Amoebic abscess
Crohn's disease
Typhoid ulcer
Colon cancer
Bacillary dysentry
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Bacillary dysentry Shigella organisms
Distal colon
Mucosa soft and friable – Persian carpet appearance – If severe, denuded mucosa over large areas.
Irregular ulcers with neutrophil and congestion |
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Other uncommon causes Infection from campylobacter jejuni, CMV, AIDS and transplant patients
Bacillary dysentry due to clostridium difficile
Behcets colitis (syndrome)
GVHD
Diverticulosis
Ischemic colitis
Intestinal worm infestation
Mesenteric artery ischemia
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