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GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
CONGENITAL ABNORMALITIES
Atresia/Fistulae Diaphragmatic Hernia/ Omphalocele/Gastroschisis Meckels Diverticulum Pyloric Stenosis Hirschsprung Disease
ATRESIA / FISTULAE
Atresia is a condition in which a body orifice or passage in the body is abnormally closed or absent Fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect.
OMPHALOCELE (Exomphalos)
defect of the anterior abdominal wall at the insertion of the umbilical cord occurs in 1 in 5000 to 1 in 20,000 live births associated with chromosomal defects, (trisomies 13, 18, and 21), and with other disorders such as Beckwith-Wiedemann syndrome
OMPHALOCELE (Exomphalos)
Closure of abdominal musculature is incomplete abdominal viscera herniate into a ventral membranous sac
GASTROSCHISIS (Laparoschisis)
a small (generally < 5 cm) defect of the abdominal wall just to the right of the umbilical cord insertion, allowing evisceration of bowel loops, stomach, and sometimes the gonads Prevalence: 1 in 10,000 livebirths
GASTROSCHISIS (Laparoschisis)
MECKEL DIVERTICULUM
most common type of true diverticulum occurs in the ileum occurs as a result of failed involution of the omphalomesenteric (vitelline) duct RULE of 2s: - 2% of the popn - present within 2 feet of the ICV - approx. 2 inches long - 2x as common in males - symptomatic by age 2
MECKEL DIVERTICULUM
TRUE DIVERTICULUM: blind outpouching lined by mucosa that communicates with the lumen and includes all 3 layers of the bowel wall
MECKEL DIVERTICULUM
PYLORIC STENOSIS
due to progressive thickening of the circular muscle of the pylorus gastric outlet narrowing 3-4x more common in MALES generally presents in the 2nd or 3rd week of life new-onset regurgitation and persistent, projectile, nonbilious vomiting P.E. hyperperistalsis; ovoid abdominal mass Tx: Fredet-Ramstedt pyloromyotomy
HIRCHSPRUNG DISEASE
A.k.a. Congenital aganglionic megacolon when normal migration of neural crest cells from the cecum to rectum is arrested prematurely or when the ganglion cellsundergo premature death distal intestinal segment lacks both Meissner submucosal and the Auerbach myenteric plexus
HIRCHSPRUNG DISEASE
Clinical Features: earliest and most common presentation is delayed (> 48 hrs) passage of meconium in the newborn - Infants and older children: chronic constipation, abdominal distention and vomiting Pathologic Feature: distal narrow aperistaltic hypertonic segment (aganglionic) and a dilated proximal segment caused by obstruction
Aganglionic region may have a grossly normal or contracted appearance while the normally innervated proximal colon may undergo progressive dilation
IMPERFORATE ANUS
most common form of congenital intestinal atresia
GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
ESOPHAGUS
Esophageal Obstruction - Achalasia Esophagitis Barretts Esophagus Esophageal Varices Esophageal Tumors
DIVERTICULUM
an outpouching of the alimentary tract that contains one or more layers of the wall ZENKERS DIVERTICULUM (Cricopharyngeal / Pharyngoesophageal): located above the UES - results from increased intrapharyngeal pressure in areas of weakness along the esophageal wall
DIVERTICULUM
ZENKERS DIVERTICULUM
DIVERTICULUM
TRACTION DIVERTICULUM: located immediately above the UES - located in the lower 3rd of the esophagus and in the region of the hilum of the lung - attributed to fibrosing mediastinal processes or abnormal motility.
EPIPHRENIC DIVERTICULUM: immediately above the LES - located just above the diaphragm - Cause: unclear
ESOPHAGEAL RINGS
A.k.a. Schatzkis / Lower esophageal Esophagogastric rings similar to webs but are circumferential and thicker rings include mucosa, submucosa and, in some cases, hypertrophic muscularis propria A rings: present in distal esophagus, above the GEJ B rings: located at the squamocolumnar junction of the lower esophagus
ESOPHAGEAL RINGS
ACHALASIA
A.k.a. Cardiospasm or megaesophagus failure of the cardiac mechanism to open when peristaltic waves conveying food through the esophagus reach it
nearly complete loss of myenteric ganglion cells is present in the lower 3rd of the esophagus
ACHALASIA
TRIAD:
Aperistalsis Incomplete relaxation of the LES Increased LES tone Barium swallow: dilated, aperistaltic esophagus with a beak-like tapering at distal end Progressive dysphagia starting in teens Pathogenesis: unknown
REFLUX ESOPHAGITIS
A.k.a. Gastroesophageal Reflux Disease (GERD) reflux of gastric contents into the lower esophagus (most frequent cause of esophagitis) Most common clinical symptoms: dysphagia, heartburn, regurgitation of sour-tasting gastric contents
REFLUX ESOPHAGITIS
Pathogenesis: reflux of gastric juices is central to the devt of mucosal injury
REFLUX ESOPHAGITIS
Pathogenesis:
- Conditions that decrease LES tone or increase abdominal pressure:
c) pregnancy
d) hiatal hernia e) delayed gastric emptying f) increased gastric volume
REFLUX ESOPHAGITIS
Gross: marked hyperemia with focal hemorrhage
REFLUX ESOPHAGITIS
Morphology: intraepithelial eosinophils and basal zone hyperplasia
HIATAL HERNIA
Characterized by separation of the diaphragmatic crura and protrusion of the stomach into the thorax through the resulting gap
VARICES
THREE common areas of portal/caval anastomoses
VARICES
VARICES
VARICES
FACTORS that lead to RUPTURE: - inflammatory erosion of thinned overlying mucosa - increased tension in progressively dilated veins - increased vascular hydrostatic pressure associated w/ vomiting
VARICES
VARICES
BARRETTS ESOPHAGUS
Can be defined as intestinal metaplasia of a normally SQUAMOUS esophageal mucosa.
The presence of GOBLET CELLS in the esophageal mucosa is DIAGNOSTIC. SINGLE most common RISK FACTOR for esophageal adenocarcinoma 10% of GERD patients get it Most common in white males; between 4060 years of age
BARRETTS ESOPHAGUS
GROSS: patches of red, velvety mucosa extending upward from the GEJ
BARRETTS ESOPHAGUS
INTESTINALIZED (GASTRICIZED) mucosa is AT RISK for glandular dysplasia. Searching for dysplasia when BARRETTs is present is of utmost importance MOST/ALL adenocarcinomas arising in the esophagus arise from previously existing BARRETTs
BARRETTS ESOPHAGUS
BARRETTS ESOPHAGUS
TUMORS
BENIGN MALIGNANT
Squamous cell carcinoma Adenocarcinoma
BENIGN TUMORS
LEIOMYOMAS FIBROVASCULAR POLYPS CONDYLOMAS (HPV) LIPOMAS GRANULATION TISSUE (PSEUDOTUMOR)
ADENOCARCINOMA
Arises in a background of Barrett esophagus & long-standing GERD RISK FACTORS: documented dysplasia tobacco use obesity prior radiation therapy
ADENOCARCINOMA
FACTORS that DECREASE RISK: - diet rich in fresh fruits and vegetables - H. pylori serotypes Most frequent in CAUCASIANS; M > F Usually occur in the distal 3rd of the esophagus
ADENOCARCINOMA
ADENOCARCINOMA
ADENOCARCINOMA
ADENOCARCINOMA
Adenocarcinoma
Commonest type in
US Risk factor: Barrett esophagus Distal 1/3 of esophagus Symptoms: insidious onset; late obstruction
ESOPHAGEAL CARCINOMA
FACTORS that influence survival:
1. Sex F > M 2. Stage In situ, mucosal CA, superficial CA > deeper tumors 3. LN mets 2 or more involved nodes: worse prognosis 4. Other microscopic findings: vascular/lymphatic invasion & marked tumor necrosis 5. Involvement of circumferential surgical margins high probability of recurrence 6. Overexpression of EGFR/p53 worse prognosis
GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
STOMACH
CHRONIC GASTRITIS PEPTIC ULCER GASTRIC POLYPS HYPERTROPHIC GASTROPATHY TUMORS
CHRONIC GASTRITIS
H. pylori gastritis: most common cause of chronic gastritis
Autoimmune gastritis: most common cause of atrophic gastritis and most common cause of chronic gastritis in patients w/o H. pylori infection
CHRONIC GASTRITIS
H. pylori gastritis:
- H. pylori: spiral shaped or curved bacilli - present in almost ALL duodenal ulcers & majority of individuals with gastric ulcers or chronic gastritis - present in 90% of individuals w/ chronic gastritis affecting the ANTRUM
CHRONIC GASTRITIS
H. pylori gastritis:
- increased acid secretion may result in PUD - H. pylori infection confers increased risk of gastric Ca - H. pylori transmission: oral-oral; fecaloral; and environmental spread
CHRONIC GASTRITIS
H. pylori gastritis:
- 4 Features linked to H. pylori virulence:
a) Flagella allow motility in viscous mucus b) Urease generates NH3 from endogenous urea & elevates local gastric pH c) Adhesins enhance bacterial adherence to surface foveolar cells d) Toxins cytotoxin-assoc gene A (cagA) involved in ulcer & cancer devt
CHRONIC GASTRITIS
Autoimmune gastritis: spares the antrum and includes hypergastrinemia - char by: a) Abs to parietal cells & IF b) Reduced serum pepsinogen I conc c) Antral endocrine cell hyperplasia d) Vit. B12 def. e) defective gastric acid secretion (achlorhydria)
CHRONIC GASTRITIS
Autoimmune gastritis: - Pathogenesis: loss of parietal cells (responsible for secretion of gastric acid and IF)
loss of gastric acid stimulates gastrin release hypergastrinemia & hyperplasia of antral gastrinproducing G cells Lack of IF disables ileal vit. B12 abs. B12 def. megaloblastic anemia
CHRONIC GASTRITIS
Autoimmune gastritis: - Morphology:
GASTRITIS
H. PYLORI-ASSOCIATED LOCATION INFLAM INFILTRATE ACID PRODUCTION GASTRIN OTHER LESIONS SEROLOGY SEQUELAE antrum PMNs, subepith plasma cells Increased to sl. decreased Normal to decreased Hyperplastic/inflam polyps Abs to H. pylori Peptic ulcer, adenoCA AUTOIMMUNE body Lymphocytes, macrophages Decreased Increased Neuroendocrine hyperplasia Abs to parietal cells Atrophy, PA, AdenoCA, carcinoid tumor
ASSOCIATIONS
DYSPLASIA
Chronic gastritis exposes epith to inflam-related free radical damage & proliferative stimuli genetic alterations Morphologic HALLMARKS:
a) Variations in epithelial size, shape and orientation b) coarse chromatin texture c) hyperchromasia and nuclear enlargement
HYPERTROPHIC GASTROPATHY
Rugal prominence (cerebriform) No inflammation Hyperplasia of mucosa
HYPERTROPHIC GASTROPATHY
Mntrier disease: resulting from profound hyperplasia of the surface mucous cells with accompanying glandular atrophy, ass. w/ CMV, H. Pylori, TGF- Hypertrophic-hypersecretory gastropathy: associated with hyperplasia of the parietal and chief cells within gastric glands
(normal gastrin)
MENETRIER DISEASE
HYPERTROPHIC GASTROPATHY
Gastric gland hyperplasia secondary to
ZOLLINGER-ELLISON SYNDROME
GASTRIC POLYPS
Polyps: nodules or masses that project above the level of the surrounding mucosa Inflammatory and Hyperplastic Polyps:
approx. 75% of all gastric polyps usually develop in assoc with chronic gastritis Gross: majority are smaller than 1 cm. & frequently multiple; ovoid w/ smooth surface
HYPERPLASTIC POLYP
GASTRIC POLYPS
Fundic Gland Polyps:
occur sporadically and in individuals w/ familial adenomatous polyposis 5x more common in females (ave. 50 y/o) occur in the gastric fundus Gross: well-circumscribed & smooth Micro: cystically dilated, irregular glands lined by flattened parietal or chief cells
GASTRIC POLYPS
Gastric adenoma:
almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia 3x more common in males (50-60 y/o) increased incidense in pts w/ FAP Risk of adenoCA is related to the size of the lesion (> 2 cm.) CA may be present in up to 30% of gastric adenomas
GASTRIC POLYPS
Gastric adenoma:
most commonly located in antrum Gross: solitary, < 2 cm. Micro: ALL GI adenomas have epithelial dysplasia
GASTRIC ADENOMA
CARCINOMA
Pathogenesis: closely related to environmental factors Arise from the generative or basal cells of the foveolae, on a background of chronic atrophic gastritis w/ intestinal metaplasia and preceded by various stages of dysplasia, CIS, and superficial CA Accompanied by hypochlorhydria in 8590% of cases
CARCINOMA
(2) Major categories of gastric adenocarcinoma: a. INTESTINAL-TYPE - arise from metaplastic epithelium B. DIFFUSE-TYPE - best represented by linnitis plastica or signet ring (adeno)carcinoma
LINITIS PLASTICA
LINITIS PLASTICA
ADENOCARCINOMA
Depth of invasion & extent of nodal and distant metastasis at time of diagnosis: MOST powerful prognostic indicators for gastric cancers Advanced CA: first detected as mets to the supraclavicular sentinel LN (Virchows node) Sister Mary Joseph nodule: marker of metastatic CA - subcutaneous nodule in periumbilical region
GASTRIC CARCINOMA
FACTORS related to prognosis:
1. Patients age CA in the young: worse 2. Tumor stage the deeper the penetration, the greater the chance of mets; polypoid, large intraluminal tumors have lower mets < tumors growing within the wall 3. Location within the stomach: 80% of 5-yr survivors, the lesion is in the distal half of the stomach 4. Tumor margins: pushing/expanding border vs. Diffuse infiltration
GASTRIC CARCINOMA
FACTORS related to prognosis:
5. Microscopic type and grading intestinal type > diffuse type 6. Inflammatory reaction: cellular infiltrate at the interface bet tumor & normal tissue: GOOD px sign 7. Perineural invasion: poor px 8. Regional LN involvement: if NEG, >50% may survive for 5 years
GASTRIC CARCINOMA
FACTORS related to prognosis: 9. Type of surgery radical subtotal
gastrectomy: best survival 10. Overexpression of c-erbB2 protein, p53 poor prognosis 11. Detection of cathepsins and cyclindependent kinase inhibitor (p27Kip1) expression by IHC: reduced survival
LYMPHOMA
5% of gastric malignancies Most common are extra-nodal marginal zone B-cell lymphomas (lymphoma of mucosaassociated lymphoid tissue or MALToma) Pathogenesis: Usually arise at sites of chronic inflammation - pro-lymphomatous inflam: H. Pylori infection - translocations: t(11;18)(q21;q21) most common activation of NF-kB, a transcription factor that promotes B cell growth & survival
LYMPHOMA
Micro: dense lymphocytic infiltrate in the lamina propria lymphoepithelial lesions - express B cell markers CD19 and CD20 Clinical Features: most common presenting symptoms dyspepsia & epigastric pain
CARCINOID TUMOR
Arise from the diffuse components of the endocrine system Gross: intramural or submucosal masses that create small polypoid lesions
CARCINOID TUMOR
Micro: islands, trabeculae, strands, glands, or sheets of uniform cells with scant, pink granular cytoplasm and a round to oval, stipples nucleus
CARCINOID TUMOR
Immuno: (+) for endocrine granule markers (synaptophysin and chromogranin A) The MOST important prognostic factor for GI carcinoid tumors is LOCATION Foregut carcinoid tumors RARELY METASTASIZE
G.I.S.T.
Can behave and/or look benign or malignant Usually look like smooth muscle, i.e., stroma, spindly tumor cells are derived from the interstitial cells of Cajal, a neural type of cell, similar to the neural plexi found in the intestines (pacemaker cells for gut peristalsis)
G.I.S.T.
Pathogenesis: 75-80% of all GISTS have oncogenic, gain-of-function mutations of the gene encoding the tyrosine kinase c-KIT (receptor for stem cell factor) Gross: solitary, well-circumscribed, fleshy mass
G.I.S.T.
G.I.S.T.
G.I.S.T.
CD 117
G.I.S.T.
Can behave and/or look benign or malignant Usually look like smooth muscle, i.e., stroma, spindly Are usually POSITIVE for c-KIT (CD117) tumor cells are derived from the interstitial cells of Cajal, a neural type of cell, similar to the neural plexi found in the intestines.
G.I.S.T.
G.I.S.T.
G.I.S.T.
CD 117
GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
SMALL/LARGE INTESTINE
INFLAMMATORY BOWEL DISEASE Crohns Disease Ulcerative Colitis OBSTRUCTION TUMORS
IBD
CROHNS DISEASE (granulomatous
colitis)
ULCERATIVE COLITIS
IBD DIFFERENCES
Crohns disease
Ulcerative colitis
CHROHNS DISEASE
CHROHNS DISEASE
CHROHNS DISEASE
ULCERATIVE COLITIS
ULCERATIVE COLITIS
ULCERATIVE COLITIS
OBSTRUCTION
Small Intestine most often involved Clinical manifestations: - abdominal pain & distention, vomiting and constipation
OBSTRUCTION
ANATOMY
ADHESIONS (post-surgical) IMPACTION HERNIAS VOLVULUS INTUSSUSCEPTION TUMORS INFLAMMATION, such as IBD (Crohn) or diverticulitis STRICTURES/ATRESIAS STONES, FECALITHS, FOREIGN BODIES CONGENITAL BANDS, MECOMIUM, INPERF. ANUS
OBSTRUCTION
HERNIAS
Any weakness in the wall of the peritoneal cavity that permits protrusion of a serosa-lined pouch of peritoneum (hernial sac) Acquired hernias: most commonly occur anteriorly via the femoral and inguinal canal or umbilicus or sites of surgical scars visceral protrusion (external herniation)
HERNIAS
ADHESIONS
Surgical procedures, infection or other causes of peritoneal inflam (eg. Endometriosis) adhesions between bowel segments, abdominal wall & operative sites fibrous bridges create closed loops internal herniation
INTUSSUSCEPTION
A length of intestine (intussuscipiens) literally swallows part of the bowel just proximal to it (intussusceptum) most cases are seen during the first 5 yrs of life Infants & children: rotavirus infection Older children and adults: intraluminal mass or tumor serves as point of traction
OBSTRUCTION
PHYSIOLOGY
ILEUS, esp. postsurgical INFARCTION MOTILITY DISEASES, esp., HIRSCHSPRUNG DISEASE
TUMORS
NON-NEOPLASTIC (POLYPS) BENIGN MALIGNANT
POLYPS
Inflammatory Polyps - forms as a result of chronic cycles of injury and healing
POLYPS
Hamartomatous Polyps - occur sporadically - hamartoma: tumor-like growths of mature tissues that are normally present at the site in which they develop - assoc w/ genetically determined or acquired syndromes
POLYPS
Hamartomatous Polyps
POLYPS
Juvenile Polyp - focal malformations of the mucosal epith & lamina propria - majority occur in children <5 y/o - majority are located in rectum rectal bleeding
POLYPS
Hyperplastic Polyp - epithelial proliferations discovered in the 6th and 7th decades of life - Pathogenesis: decreased epith turnover & delayed shedding of surface epith cells piling up of goblet & absorptive cells - NO malignant potential
Gross appearance of multiple hyperplastic polyps. The lesions are characteristically small, sessile, and pale.
Microscopic appearance of hyperplastic polyp. The individual glands show a typical serration of their mid portion.
POLYPS
Neoplastic Polyp (Adenomas) - precursors to the majority of colorectal adenocarcinomas - char by the presence of epithelial dysplasias
POLYPS
Sessile polyp
Pedunculated polyp
POLYPS
Neoplastic Polyp (Adenomas) - Micro: HALLMARK of epithelial dysplasia nuclear hyperchromasia, elongation and stratification - classified as TUBULAR, TUBULOVILLOUS OR VILLOUS
Adenomatous polyp showing marked contrast between the dysplastic glands of the polyp and adjacent normal glands.
Microscopic appearance of villoglandular polyp. There is an admixture of villous and glandular structures.
ADENOCARCINOMA
Most common malignancy of the GIT Dietary factors assoc w/ increased risk: low intake of unabsorbable vegetable fiber & high intake of refined CHOs & fat Pathogenesis: APC/Beta-catenin pathway and microsatellite instability pathway
GROWTH PATTERNS
POLYPOID: proximal colon ANNULAR, CONSTRICTING: distal colon DIFFUSE
Gross appearance of signet ring carcinoma. This tumor type is highly malignant, narrows the lumen, and has a pebbly mucosal surface and thickened muscular wall.
Stage B2
Stage C
Stage C1
Stage C2
Stage D
Carcinoma in situ
TNM Staging
Tumor Stage Tis T1 T2 Histologic Features of the Neoplasm Carcinoma in situ (high-grade dysplasia) or intramucosal carcinoma (lamina propria invasion) Tumor breaches the musc. Muc. invades into submucosa Extending into the muscularis propria but not penetrating through it
T3
T4
Nx
N0 N1 N2 Mx M0 M1
COLORECTAL CARCINOMA
Clinical: - Right-sided: fatigue & weakness due to IDA - Left-sided: occult bleeding, changes in bowel habits or cramping LLQ discomfort - Most important prognostic factors: depth of invasion & +/- LN mets
COLORECTAL CARCINOMA
FACTORS related to prognosis:
1. Patients age very young and very old: poor px 2. Sex better px: F > M 3. CEA serum levels > 5.0 ng/ml 4. Tumor location: favorable px - lesions located in the left colon > lesions in sigmoid colon and rectum 5. Local extent focal microscopic CA in a polyp/tumor restricted to mucosa & submucosa: good px
COLORECTAL CARCINOMA
FACTORS related to prognosis:
6. Obstruction poor px 7. Perforation poor px 8. Tumor margins & inflammatory reaction better px 9. Vascular/perineural invasion: poor px 10. Microscopic tumor type Mucinous CA, signet ring CA and anaplastic CA: worse px 11. LN involvement - > 6 LNs: <10% survive >5 yrs.
HEMORRHOIDS
Develop secondary to persistently elevated venous pressure w/in the hemorrhoidal plexus Most common predisposing influences: straining at stool fr constipation & venous stasis of pregnancy Pathogenesis: variceal dilatations of anal & perianal venous plexus that forms collaterals that connect portal & caval venous systems to relieve venous HPN
HEMORRHOIDS
External hemorrhoids: collateral vessels w/in the inferior hemorrhoidal plexus located below the anorectal line Internal hemorrhoids: dilatation of the superior hemorrhoidal plexus within the distal rectum
HEMORRHOIDS
Micro: thin-walled, dilated, submucosal vessels that protrude beneath the anal or rectal mucosa
HEMORRHOIDS
ANAL CARCINOMAS
MORE LIKELY TO BE SQUAMOUS, or basaloid F > M (3:1) Worse in prognosis HPV related (HPV16)
ANAL CARCINOMAS
NORMAL
ANAL CARCINOMA
FACTORS related to prognosis:
1. Tumor stage depth of invasion & regional LN involvement; inguinal LN involvement (grave px sign) 2. Tumor size inversely related to px 3. Tumor recurrence - tumor recurrence in the pelvic or perineal regions following APR: ominous px
GIT Pathology
CONGENITAL ABNORMALITIES ESOPHAGUS STOMACH SMALL/LARGE BOWEL APPENDIX
ACUTE APPENDICITIS
A normal TRUE DIVERTICULUM of the cecum GENERALLY, a disease of YOUNGER people Pathogenesis: OBSTRUCTION by FECALITH the classic cause but fecaliths present only about half the time - Other causes: gallstones, tumor, mass of worms eg. O. vermicularis - Ischemic injury & stasis of luminal contents bacterial proliferation trigger inflam response eg. tissue edema, PMN infiltration
ACUTE APPENDICITIS
DDx: - mesenteric lymphadenitis (sec. to unrecognized Yersinia infection or viral enterocolitis) - acute salpingitis - ectopic pregnancy - mittelschmerz (pain fr minor pelvic bleeding during ovulation) - Meckel diverticulitis
ACUTE APPENDICITIS
ACUTE APPENDICITIS
EARLY APPENDICITIS: NEUTROPHILSMucosa, submucosa NEED NEUTROPHILS in the MUSCULARIS to confirm the DIAGNOSIS Classic clinical finding: MCBURNEYS SIGN Perforationperitonitis the rule, if no surgery Perforationperitonitis the rule, if no surgery Complications: perforation, pyelophlebitis, portal venous thrombosis, liver abscess and bacteremia
ACUTE APPENDICITIS
TUMOR
Carcinoid: most common - incidental finding - most frequent location: DISTAL TIP - distant spread: rare Mucocele (common): obstructed appendix w/ inspissated mucin Mucinous Cystadenoma (rather rare) Mucinous Cystadenocarcinoma (rare) - invasion of wall peritoneal implants
MUCOCELE
COMMON CYST on APPENDIX filled with MUCIN Can RUPTURE to become:
PSEUDOMYXOMA PERITONEI
(mucinous ascites and mucinous tumor disseminated on peritoneal surfaces)
MUCOCELE
MUCOCELE
MUCINOUS CYSTADENO(CARCINO)MA
MUCINOUS CYSTADENO(CARCINO)MA