Subject: Patho Lab Topic: GIT Lecturer: Dr. Bautista Date of Lecture: Nov.

10, 2011 Transcriptionist: Pinkyred Pages: 7

GIT Prelab 36 y/o female, recurrent epigastric pain with massive hematemesis submucosa, and even muscularis area is exposed, meaning this is in fact an ulcer

Hematemesis vomiting of blood blood is typically brownish and frothy Hemoptysis comes from the lungs blood is bright red (due to it being fresh) Ulcer

the lesion in the photo complete loss of epithelium submucosa is exposed if due to Peptic Ulcer Disease (PUD), borders are regular and the base is smooth if due to malignancy, or if having malignant potential, borders are heaped up (meaning there is an elevation in the border)

a. Necrotic debris b. Acute inflammation inflammatory cell infiltrates may be found cells may be acute or chronic, depending on the activity of the ulcer c. Granulation tissue normal process/response of the body to repair injury (in this case[ulcer], there is vascularization and fibrosis) differerent from granuloma: ream of lymphocytes, activated macrophages (epitheloid cells), multinucleated giant cells d. Fibrosis Complications: perforation obstruction o edema o fibrosis o depends on ulcer location if ulcer is located near an opening (e.g. pyloric opening, ulcer in the antral area), if the ulcer forms an elevated lesion, it may cause obstruction sepsis o if perforated, it could cause peritonitis, causing sepsis rupture hemorrhage o due to exposure of the blood vessels anemia o due to chronic bleeding 45 y/o, male

Erosion loss of epithelium is superficial submucosa still hidden Peptic Ulcer

Peptic Ulcer Disease (PUD) borders are regular base is smooth

SY 2011-2012

Benign lesion well demarcated borders no area of necrosis punctate areas of hemorrhages are possible even in benign lesions Gastrointestinal Stromal Tumor (GIST) mucosa may be normal or ulcerated (there is a visible bulge [elevated area], but the mucosa is still normal) neoplasm in the stroma pushes the mucosa upward or outward, but mucosal lining is normal

Melena black tarry stool Based on the history, lesion is in the pyloric area of the stomach lesions in the pyloric area are likely to cause obstructions because the opening is small, and there is a muscular sphincter Malignant lesion necrosis bleeding irregular border Adenocarcinoma, pyloric area

histologically uniform population of spindle cells very few pleomorphisms cells look alike cytoplasms may be delineated 75 y/o male, epigastric fullness, weight loss, black tarry stool

Adenocarcinoma most common GIT tumor more common in the colon Well-differentiated carcinoma glands and granular formation are seen glands are compact, forming cribriform patterns, sieve-like (there are holes all over)

22 y/o male, severe abdominal pain

Meckels diverticulum shown in the photo congenital pathogenesis: failure of vitelline duct to involute a true diverticulum involves all layers lined by gastric mucosa, sometimes with non-malignant pancreatic tissue usually located at the antimesenteric side (opposite side of where the mesentery is) Colonic diverticulum pathogenesis: invagination of the wall, usually in the colon (due to it having 2 layers: inner circular, outer longitudinal) not a true diverticulum does not involve all layers 68 y/o male, severe abdominal pain, vomiting and diarrhea

gangrenous could be an infarction caused by o hypoxic injury mechanical obstruction intussusception volvulus adhesion hernia would not cause infarction immediately would incarcerate first, then strangulate o reperfusion injury

histologically infarction/gangrene mucosa is already necrotic and deluded(being detached from the lining) there are thrombosed veins in submucosa inflammation extends to serosa (inflammatory cells: acute or chronic depends on the onset of injury) congestion/hemorrhages mucosa is normal affects only the submucosa

33 y/o male, abdominal enlargement

patient also manifested with chronic cough (>2 weeks) and hemoptysis diagnosis: ileocecal tuberculosis

Mixed hemorrhoids -possible liver failure -portal hypertension, backflow of blood at tributaries, @ egd-possible esophageal varices

On closer view, granuloma and giant cells may be seen chronic granulomatous formation 64 y/o, abdominal enlargement, small scanty hard stool

Infectiouscausative agent: Entamoeba histolytica Amebic colitis- flask shape ulcer, @ base- cyst and trophozoite

Multiple cervical lymphadenopathyNon Hodgkins lymphoma @ scanning view- take note of diffuse proliferation of malignant cell, no demarcation @ hpo- uniform population of malignant cell, presence of prominent nucleoli, pleomorphism

Juvenile Polyp @ microscope-cystic dilation of glands No malignant potential *NHL

Floating cells- malignant cells floating in lakes /pools of mucin Invades the submucosa, full thickness of colonic wall or sometimes extending to colonic fat

Villus- fingerlike projection @ submucosa invading-high malignant potential

Pigmented: melanoma- can be at back, perineal area, scalp

Clusters of malignant cells with pigment

Right sided malignancy- Carcinoma ( epithelial origin) @ Ileocecal junction MUCINOUS ADENOCARCINOMA *L sided vs R sided malignancy- napkin ring Right sided- fungating, capacious at cecum, with space, with enlargement but no obstruction, it outgrows the blood supply causing necrotic site area, which is site for bleeding Manifestation- anemia due to bleeding Left sided- napkin ring lesion, narrowing of lumen, presentation-obstruction, goat stool like stool

Malignant version of gist Gist- leiomyoma+ spindle cells Grossly with hemorrhages

Pinkish/purplish-mucin

Diagnosis: Appendicitis RUQ pain : differentials Female: ectopic pregnancy, salphingitis Male: meckels diverticulum ( 2ft from ileocecal area)- may rupture and inflamed and may present as RUQ pain

Section taken from the appendix Malignant-glandular Adenocarcinoma of the Appendix More common tumor/ malignancy of the appendix: carcinoid, usually found at the tip of the appendix

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