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Lecture 27

Pathology 3500 Lecture 27: Diseases of the GI Tract IIPremium

by OneClass839189

6 pages30 viewsSpring 2018

School

Western University

Department

Pathology

Course Code

Pathology 3500

Professor

Jessica Shepherd

Lecture

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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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