Gastrointestinal Tract

ACUTE APPENDICITIS
• The appendix is dilated
and its serosal surface is
reddened and covered
by a fibrinopurulent
exudate.
 Normal
Normal
Acute Appendicitis Hyperemia Acute Appendicitis Inflammation
 Acute Appendicitis
• Etiology:
– Children: Lymphoid hyperplasia following
viral infection
• In children, obstruction may be caused by a
parasitic worm (e.g. Ascaris)
– Adult: Obstruction due to fecalith
• 50% - 80% due to overt luminal obstruction
usually caused by a small stone-like mass of
stool, or fecalith;
 Acute Appendicitis
• Gross: Yellow-tan exudate, swollen, red
appendix due to hyperemia
• Micro: hyperemia in serosal layer,
neutrophilic infiltration in muscularis
externa
 Acute Appendicitis
• Clinical Correlation
– Fever-due to increase chemical mediators
(IL-1,TNF,PGE2)
– Pain- Prostaglandins(PGE2)
 Acute Appendicitis
• Signs & Symptoms
– High fever,
– Nausea and vomiting,
– Abdominal tenderness,
– Rebound tenderness at right iliac area,
McBurney’s point,
– Periumbilical pain migrating to RLQ
HEMORRHOIDS
 Hemorrhoids
• Etiology:
– Persistent elevated venous pressure
• Internal Hemorrhoids: Internal/Superior
hemorrhoidal veins
• External Hemorrhoids: External/Inferior
hemorrhoidal veins
 Hemorrhoids
Gross Features:
Shown here is the anus and
perianal region with
prominent prolapsed true
(internal) hemorrhoids,
which consist of dilated
submucosal veins
predisposed to thrombose
and rupture with hematoma
formation.
External hemorrhoids from
beyond the intersphincter groove
to produce an “acute pile” at anal
verge.
 Hemorrhoids
Microscopic Features:
• Thrombi are seen with in
the dilated veins. The
thrombus appears
laminated. The laminated
appearance is due to the
pale platelet and fibrin
deposits alternating with
darker red cell rich layers.
These laminations are
called lines of Zahn.
 Hemorrhoids
• Signs & Symptoms
Often presents with pain and rectal bleeding,
particularly bright red blood.
ADENOCARCINOMA OF THE COLON
 Adenocarcinoma of the Colon
• ORGAN
– Sigmoid Colon and Rectum
• HISTOMORPHOLOGIC DIAGNOSIS:
– LESION: Adenocarcinoma
• ETIOLOGY:
– Early mutation of adenomatous polyposis coli (APC)
gene
– DNA mismatch pair
• HALLMARK
– CELLS OF ORIGIN: Epithelial lining of glands or ducts
 Adenocarcinoma of the Colon
GROSS FEATURE:
– Protruded exophytic
mass into the lumen of
the colon; invasion of
mesenteric lymph node
Adenocarcinoma of the
cecum
• The tumor is large and its
surface is ulcerated and
bleeding. These tumors
often present in an
advanced stage, and
frequently because of
symptoms of iron
deficiency anemia
resulting from chronic
blood loss.
Adenocarcinoma of the
transverse colon
• This tumor is partly
polyploid, but it had
encircled the bowel
wall and caused
obstruction.
Adenocarcinoma of the
descending colon
• This is an infiltrating
sclerosing lesion which
has invaded the full
thickness of the bowel
wall. The central portion
of the tumor is ulcerated.
The proximal margin has
a polyploid projection
into the lumen.
 Adenocarcinoma of the Colon
MICROSCOPIC / HISTOLOGIC
FEATURE:
• Atypical glands lined by columnar
cells w/ hyperchromatic nuclei &
pleiomorphism; invasion of
muscularis layer by the glands
• Proximal colon - Polypoid,
exophytic masses that extend
along one wall of the large-caliber
cecum and ascending colon;
these tumors rarely cause
obstruction
• Distal colon tend to be annular
lesions that produce “napkin-
ring” constrictions and luminal
narrowing
 Adenocarcinoma of the Colon
• MODE OF TRANSMISSION: Autosomal
Recessive and dominant transmission
Adenocarcinoma of the Colon:
Pathogenesis
 Adenocarcinoma of the Colon
• MANAGEMENT: Surgical resection
• MANIFESTATION: Ribbon like stool and
anorexia
• LAB AND OTHER TESTS: Colonoscopy, Biopsy,
FOBT
• TUMOR MARKERS: Carcinoembryogenic
Antigen (CEA)
TUBERCULOSIS OF THE INTESTINES
 TB of the Intestines
Etiology:
– Mycobacterium bovis present in ingested
contaminated milk
– Swallowing of coughed-up material in patients
with advanced pulmonary disease (M.
tuberculosis, M. avium complex)
Gross:
• Multiple oval ulcers
running transversely
across the bowel.
 TB of the Intestines

Microscopic:
Granulomas located
in the submucosa
(white arrows)
Langhan’s giant cells
are present (black
circle)
 TB of the Intestines
Scanner view
Showing two granulomata
with the larger granuloma
having a central area of
caseation necrosis. (White
arrow)
Located within muscle
layer. Both lesions also
have giant cells located at
the periphery of each
lesion. (Black arrows)
Granuloma
Laboratory sample
slide
 TB of the Intestines
• S/Sx
– RUQ abdominal pain
– Diarrhoea
– Night sweats
– Weight loss
– Shortness of breath
– Fatigue
– The terminal ileum and cecum are most commonly
involved
– TB peritonitis can follow spread of the organism from
ruptured lymph nodes and intraabdominal organs