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Lecture 27

Pathology 3500 Lecture 27: Diseases of the GI Tract IIPremium

6 pages30 viewsSpring 2018

Department
Pathology
Course Code
Pathology 3500
Professor
Jessica Shepherd
Lecture
27

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PATH FEB 14
Large Bowel Anatomy
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Descending colon
Sigmoid colon
Rectum
Diverticulum
Medical term for an outpouching of a hollow (or fluid filled) structure in the body
It use implies that the structure is not normally present
Very common (about 50% of adults will have this)
Diverticulosis: presence of diverticula
Diverticulitis: inflammation of diverticula
Colonic Diverticular Disease Pathogenesis
Low fiber diet lead to low volume stools (hard)
Bowel must contract (peristalsis) more to move feces
Increase in intraluminal pressure
There are natural weak points in bowel muscle layer where blood vessels pass through
The increase pressure pushes the lining out of these weak points and thus you
develop diverticulums
Appearance
Thicken muscle of the bowel (hypertrophy) since it is working so hard
Mucosa lining is pushed into the muscle
Mostly asymptomatic on their own
However, fecal material can get stuck in the diverticulum
Areas of inflammation
Diverticulitis
Diverticular disease Complication
Abscess
Collection of pus
Stricture
Fibrosis leading to bowel obstruction
Fistular to bladder, vaginal, small bowel
Abnormal communication between 2 hollow organs
Fecal material can end up in inappropriate places
Bleeding
Rupture into the abdominal cavity
Fecal peritonitis
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Presentation
Triad of
Fever
increase lower quadrant pain
Increase leukocytes (increase WBCs count)
Treatment
Bowel rest
Antibiotics
Surgery
recurring acute attacks or complication
Remove the part of the bowel that is inflamed
For perforation and fistulas
Inflammatory Bowel Disease (IBD)
Includes 2 conditions
Ulcerative Colitis (UC)
Crohn’s DIsease (CD)
Peak onset 15-35 years (young adulthood)
Occanponal in young children, elderly
Chronic disease
Cant be cured
Just controlled
Escabration and remessions
Extraintestinal problems
Liver
Joints
Eye
Skin
Pathogenes
Abnormal immune reaction to gut flora
In genetic susceptible people
High concordance in identical twins (50%)
15% have 1st degree relative with IBD
Too much action of Tcel
Too little control by regulatory T-cells
Crohn’s DIsease
Distribution
Not resiticture to the bowel
Anywhere in the GI tract (mouth to anus)
Ulcers in the oral cavity
Fistulas in the anus
Terminal ileum and/or large bowel commonest
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