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Lecture 27
Pathology 3500 Lecture 27: Diseases of the GI Tract IIPremium
6 pages46 viewsSpring 2018
School
Western UniversityDepartment
PathologyCourse Code
Pathology 3500Professor
Jessica ShepherdLecture
27This preview shows pages 1-2. to view the full 6 pages of the document.
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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