Normal Lab Values

Week 18: GI Pathology - Liver and Pancreas

Suggested readings from
Robbins 8th ed.
 
Inflammatory and Neoplastic GI Disease: pp. 763-832
Liver: pp. 833-890

Pancreas: pp. 891-904

Cases for Week 18

Micro Cases for Week 18

 

Review Items for Week 18: Liver

Review Items for Week 18: Pancreas

Review Items for Week 18: Gastrointestinal System

 

Pathology Case Descriptions

CASE NUMBER 240
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Clinical History: This patient was a 54-year-old male who had a long history of peptic ulcer disease. A portion of the stomach was removed. Medical management is more common today.

Image Gallery:

(Summary of Gross Findings - click here)
An endoscopic view shows that the gastric mucosa is somewhat flattened but demonstrates a focal ulcer with smooth edges.
(Summary of Microscopic Findings - click here)
Microscopic sections show a portion of antral/pyloric stomach. A large ulcer and the accompanying response have replaced all layers of the stomach mucosa and wall. Three layers may be distinguished in the bed of the ulcer. The innermost one is composed of necrotic debris and fibrino-purulent exudate in which bacteria and yeast are present. The middle layer is a zone of granulation tissue made up of small vessels and acute and chronic inflammation. The deepest portion of the ulcer is made up of fibrous scar. Some of the arteries in the scar tissue may show sclerosis. The mucosa adjacent to the ulcer shows acute and chronic gastritis.
(Review Normal Histology - click here)
Norm No. 16 Stomach, fundus
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The normal gastric mucosa of the fundus contains superficial fovea arranged in leaf like fronds and deeper gastric glands. The foveolar cells secrete mucin. The gastric glands include mucous cells, parietal cells, chief cells and enteroendocrine cells.

 

240-1. This patient’s lesion is best characterized as:

  1. Acute gastric ulcer
  2. Chronic gastric ulcer
  3. Acute gastric abscess
  4. Chronic gastric abscess

ANSWER

 

240-2. As this lesion erodes through the stomach wall, a red granular exudate forms on the serosal surface.  The exudate is:

  1. Serous
  2. Fibrinous
  3. Fibrinopurulent
  4. Purulent

ANSWER

 

240-3. Should the ulcer penetrate the anterior wall of the stomach, within an hour the patient would have:

  1. Acute peritonitis
  2. Chronic peritonitis
  3. Acute cellulitis
  4. Chronic abscess

ANSWER

 

240-4. If the ulcer penetrates the posterior wall of the stomach, within an hour the patient would have

  1. Acute peritonitis
  2. Chronic peritonitis
  3. Acute cellulitis
  4. Chronic abscess

ANSWER

 

 

 

CASE NUMBER 54
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Clinical History: An 18-year-old female had nausea, vomiting, periumbilical and lower abdominal pain, shaking chills and fever beginning two days ago. The WBC count was 21,900. Physical examination revealed local tenderness and rigidity with rebound pain in the lower abdomen. A surgical procedure was performed.

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(Summary of Gross Findings - click here)
The appendix was swollen, dark red, hemorrhagic, and covered by gray-yellow exudate. Serial cross-sections revealed a distended lumen containing hemorrhagic material and a fecalith, which apparently obstructed the lumen.
(Summary of Microscopic Findings - click here)
Portions of the mucosa are ulcerated, necrotic and heavily infiltrated with neutrophils. This acute inflammation and necrosis extends throughout the entire thickness of the wall and the serosa. In the lumen of the appendix there is pus and a fecalith.
(Review Normal Histology - click here)
Norm No. 8 Appendix
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The appendix is a tubular organ with a lumen which is lined by mucin secreting columnar epithelium. Although there are generally numerous lymph nodules in the lamina propria and submucosa under normal conditions, there is no evidence of acute inflammation.  The submucosa and muscle layers are unremarkable, and there is no inflammation of the serosa. 

 

54-1. What is the MOST LIKELY diagnosis?

  1. Acute appendicitis
  2. Chronic appendicitis
  3. Acute cholecystitis
  4. Ectopic pregnancy with rupture

ANSWER

 

54-2. If the anatomic location of this organ were retrocecal, the expected complication would be:

  1. Retroperitoneal abscess
  2. Peritonitis
  3. Infarction
  4. Sepsis

ANSWER

 

 

 

CASE NUMBER 89
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Clinical History: This 73-year-old female presented with right upper quadrant pain and elevated WBC count. Physical exam revealed right upper quadrant tenderness. Ultrasound examination of the gallbladder revealed gallstones. A cholecystectomy was performed.

Image Gallery:

 

89-1. What is the MOST LIKELY diagnosis?

  1. Normal gallbladder
  2. Chronic cholecystitis
  3. Acute and chronic cholecystitis
  4. Adenocarcinoma of gallbladder

ANSWER

 

89-2. Gallstones predispose to:

  1. Cholangitis
  2. Carcinoma of the gallbladder
  3. Pancreatitis
  4. ALL of the above

ANSWER

 

89-3. The most common cause of extrahepatic biliary obstruction is:

  1. Carcinoma of bile duct
  2. Gallstones
  3. Carcinoma, head of pancreas
  4. Carcinoma, ampulla of Vater

ANSWER

 

 

 

CASE NUMBER 111
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Clinical History: This 51-year-old white female had bloody diarrhea which responded to immunosupressant therapy for many years. Her symptoms progressed and portion of the colon was removed.

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(Summary of Gross Findings - click here)
The mucosa showed an area of edema and hyperemia distally. This was sharply demarcated from the remainder of the colon. A superficial mucosal lesion was noted.
(Summary of Microscopic Findings - click here)
This section shows fulminant ulcerative colitis with areas of ulceration extending into the submucosa and also some areas of hemorrhage. While deep ulceration is seen, there is no fissuring necrosis, fibrous expansion of the submucosa, or transmural chronic inflammation, which differentiates this lesion from Crohn's disease. The base of the ulcerated area is covered by necrotic debris and fibrinopurulent or sanguinous exudate. Glands are distorted in shape, infiltrated by neutrophils, and lined by regenerating epithelium.
(Review Normal Histology - click here)
Norm No. 27 Colon
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The colon is lined by glandular epithelium with numerous mucin secreting goblet cells. The epithelium is infolded into straight tubular glands of uniform diameter to increase the surface area available for secretion and absorption.

 

111-1. What is the MOST LIKELY diagnosis?

  1. Pseudomembranous colitis
  2. Ulcerative colitis
  3. Crohn disease
  4. Ischemic bowel disease

ANSWER

 

111-2. Which is associated with a “Western” diet?

  1. Pseudomembranous colitis
  2. Ulcerative colitis
  3. Diverticulitis
  4. Crohn disease

ANSWER

 

111-3. Which is associated with transmural inflammation?

  1. Pseudomembranous colitis
  2. Ulcerative colitis
  3. Diverticulitis
  4. Crohn disease

ANSWER

 

111-4. Which is most likely to lead to a recto-vaginal fistula?

  1. Pseudomembranous colitis
  2. Ulcerative colitis
  3. Diverticulitis
  4. Crohn disease

ANSWER

 

111-5. Which disease is most often accompanied by sclerosing cholangitis and arthritis?

  1. Pseudomembranous colitis
  2. Ulcerative colitis
  3. Diverticulitis
  4. Crohn disease

ANSWER

 

 

 

CASE NUMBER 133
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Clinical History: This 39-year-old male had a history of non-healing rectal fistula and a long standing history of enteritis. There was bloody and mucous diarrhea. Part of the colon was resected due to bowel obstruction.

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(Summary of Gross Findings - click here)
The colon showed extensive ulcerations separated by pedunculated areas of hypertrophic mucosa. The intestinal wall was swollen and edematous. The serosa was thickened with fibrous adhesions.
(Summary of Microscopic Findings - click here)
A broad area of ulceration extends into the submucosa. The surface of the ulcer is covered by fibrinopurulent exudate overlying granulation tissue. Neutrophils infiltrate glands in the adjacent mucosa, some of which are lined by regenerating epithelium. A few crypts are distorted in shape. These features differ little from those seen in ulcerative colitis (Case No. 111). However, this section also shows transmural chronic inflammation in the form of lymphoid aggregates and granulomatous inflammation.
(Review Normal Histology - click here)
Norm No. 27 Colon
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The colon is lined by glandular epithelium with numerous mucin secreting goblet cells. The epithelium is infolded into straight tubular glands of uniform diameter to increase the surface area available for secretion and absorption.

 

133-1. What is the BEST diagnosis for this case?

  1. Chronic ulcerative colitis
  2. Peudomembranous colitis
  3. Crohn's disease
  4. Tuberculosis

ANSWER

 

133-2. In the average person with this disease, the frequency of involvement is GREATEST in:

  1. Small bowel alone
  2. Colon alone
  3. Stomach
  4. Both small bowel and colon

ANSWER

 

 

 

CASE NUMBER 81
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Clinical History: This 62-year-old white male had a history of alcoholism.

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(Summary of Gross Findings - click here)
The liver weighed 1800 grams. The entire organ was uniformly composed of nodules about 0.5 cm in diameter, each surrounded by fibrous tissue. The organ was jaundiced and firm.
(Summary of Microscopic Findings - click here)
The usual architecture present in the liver has been completely disrupted by the bands of connective tissue. In these bands one sees chronic inflammatory cells, mainly lymphocytes and other mononuclear cells. There is some proliferation of the bile ductules.
(Review Normal Histology - click here)
Norm No. 3 Liver
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The liver is the organ that metabolizes nutrients received from the digestive tract. These nutrients and processed by tissue hepatocytes which are large polygonal cells. The hepatocyes are separated by portal triads. The triads consist of an artery, a vein and a bile duct. The bile duct is lined by cuboidal epithelium. The artery has a muscular wall and a flat endothelial lining. The sinuses are well defined and contain a small amount of blood.

 

What is the MOST LIKELY diagnosis?

ANSWER

 

81-1. What feature of this disease is NOT seen on microscopic exam in this patient?

  1. Regenerative nodules
  2. Fibrosis
  3. Bile duct proliferation
  4. Fatty change

ANSWER

 

81-2. What is a catastophic cause of death often associated with this disease?

  1. Hepatic failure
  2. Ruptured hemorrhoids
  3. Ruptured spleen
  4. Ruptured esophageal varices

ANSWER

 

81-3. Acetaminophen overdose can lead to:

  1. Micronodular cirrhosis
  2. Macronodular cirrhosis
  3. Centrilobular necrosis
  4. Fatty liver

ANSWER

 

81-4. The lesion LEAST likely to be seen in alcoholic hepatitis

  1. Mallory bodies
  2. Neutrophilic reaction
  3. Fibrosis
  4. Councilman bodies

ANSWER

 

81-5. Mallory bodies are intracytoplasmic accumulations of which kind of intermediate filament?

  1. Keratin
  2. Neurofilament
  3. GFAP
  4. Desmin

ANSWER

 

 

 

CASE NUMBER 229
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Clinical History: This 6-month-old female experienced increased jaundice over a one month period. She died with pneumonia and liver failure.

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(Summary of Gross Findings - click here)
The liver was deep yellow and green after formalin fixation. The surface was nodular, and cut surfaces were firm.
(Summary of Microscopic Findings - click here)
The liver architecture is completely replaced by fibrosis and regenerative nodule formation. In the broad fibrous bands separating regenerative nodules, there is abundant proliferation of bile ductules. The most striking feature of this liver is the severe cholestasis. Bile is seen in ducts, ductules and dilated cannuliculi. In scattered foci, it breaks into the liver parenchyma forming "bile lakes".
(Review Normal Histology - click here)
Norm No. 3 Liver
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The liver is the organ that metabolizes nutrients received from the digestive tract. These nutrients and processed by tissue hepatocytes which are large polygonal cells. The hepatocyes are separated by portal triads. The triads consist of an artery, a vein and a bile duct. The bile duct is lined by cuboidal epithelium. The artery has a muscular wall and a flat endothelial lining. The sinuses are well defined and contain a small amount of blood.

 

What is the MOST LIKELY diagnosis?

ANSWER

 

229-1. Which of the following has markedly increased incidence in females:

  1. Primary sclerosing cholangitis
  2. Primary biliary cirrhosis
  3. Secondary biliary cirrhosis
  4. Alcoholic cirrhosis

ANSWER

 

229-2. Which of the following is associated with gallstones:

  1. Primary sclerosing cholangitis
  2. Primary biliary cirrhosis
  3. Secondary biliary cirrhosis
  4. Alcoholic cirrhosis

ANSWER

 

229-3. Which of the following is associated with inflammatory bowel disease?

  1. Primary sclerosing cholangitis
  2. Primary biliary cirrhosis
  3. Secondary biliary cirrhosis
  4. Alcoholic cirrhosis

ANSWER

 

 

 

CASE NUMBER 155
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Clinical History: A 72-year-old male with dementia died of bronchopneumonia. This was an incidental finding at autopsy.

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(Summary of Gross Findings - click here)
In the right lobe of the liver there was a circumscribed, dark red, spongy mass 4 cm in size. In the center of the mass there was a gray, firm, fibrous core.
(Summary of Microscopic Findings - click here)
Inspection reveals a mass with many blood filled spaces. These are formed by anastomosing strands of connective tissue, partially hyalinized, lined by endothelial cells. Notice the subcapsular location of the tumor and its relationship to the liver parenchyma.
(Review Normal Histology - click here)
Norm No. 3 Liver
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The liver is the organ that metabolizes nutrients received from the digestive tract. These nutrients and processed by tissue hepatocytes which are large polygonal cells. The hepatocyes are separated by portal triads. The triads consist of an artery, a vein and a bile duct. The bile duct is lined by cuboidal epithelium. The artery has a muscular wall and a flat endothelial lining. The sinuses are well defined and contain a small amount of blood.

 

What is the MOST LIKELY diagnosis?

ANSWER

 

155-1. Which feature in a tumor suggests that it is likely to be a benign neoplasm?

  1. Circumscription
  2. Lack of nuclear pleomorphism
  3. Very few mitotic figures
  4. ALL of the above
  5. NONE of the above

ANSWER

 

 

Microbiology Case Descriptions

 

Micro Case 12 (UMich Slide 017)
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Clinical history: A 45-year-old woman is being treated in the hospital for pneumonia complicated by septicemia. She has required multiple antibiotics and was intubated and mechanically ventilated earlier in the course. On day 20 of hospitalization, she has abdominal distention. Bowel sounds are absent, and abdominal radiograph shows dilated loops of small bowel suggestive of ileus. She has a low volume of bloody stool.

Image Gallery

(Summary of Gross and Lab Findings - click here)
A pseudomembrane composed of an adherent layer of inflammatory cells and debris covers the injured bowel mucosa.
(Summary of Microscopic Findings - click here)
Damaged crypts are distended by a mucopurulent exudate.

 

m12-1. Based on these clinical findings, what is the likely causative agent?

ANSWER

 

m12-2. Which of the following are appropriate specimen samples for anaerobe culturing:

  1. blood, spinal fluid, abscess aspirate
  2. deep tissue biopsy, sputum, blood
  3. cerebrospinal fluid, tissue and debridement from decubitus ulcer, bile
  4. tissue swabs, blood, urine

    ANSWER

 

LIVER and BILIARY TRACT Review Items

Key Vocabulary Terms (click here to search any additional terms on Stedman's Online Medical Dictionary)

acidophil body Councilman body liver function test
alcoholic hepatitis Crigler-Najjar disease macronodular cirrhosis
alcoholic liver disease delta hepatitis Mallory body (hyaline)
α-1-antitrypsin deficiency direct vs. indirect bilirubin massive necrosis
ascites Dubin-Johnson syndrome micronodular cirrhosis
bile fatty liver nutmeg liver
bile duct hamartoma focal nodular hyperplasia porcelain gallbladder
bile lake galactosemia portal hypertension
bile stones gallstone ileus primary biliary cirrhosis
biliary atresia Gilbert syndrome primary sclerosing cholangitis
bilirubin hemochromatosis Reye syndrome
bridging fibrosis hemosiderosis  Rokitansky-Aschoff sinus
Budd-Chiari syndrome hepatic coma schistosomiasis
cardiac sclerosis hepatic encephalopathy secondary biliary cirrhosis
centrilobular necrosis hepatitis  splenomegaly
cholangitis hepatorenal syndrome steatohepatitis
cholecystitis hyperbilirubinemia steatosis
choledocholithiasis hypoalbuminemia strawberry gallbladder
cholelithiasis icterus submassive necrosis
cholestasis interface hepatitis von Meyenburg complex
cholesterolosis jaundice Wilson disease
cirrhosis kernicterus

 

LEARNING OBJECTIVES

Absolutely critical information you must know to practice medicine is in bold font.
Important information that will be needed for routine patient care is in regular font.
Information about less common diseases that you may encounter in clinical practice and that will probably appear on examinations is in italics

  1. Describe the formation of bile and explain abnormalities that could cause jaundice.

  2. Discuss the clinical indications for the following laboratory tests:
  3. Compare and contrast the clinical and pathologic features of
  4. Compare and contrast biliary atresia and neonatal hepatitis, in terms of:
    • etiology and pathogenesis
    • morphology
    • laboratory findings
    • clinical features and course
    • complications

  5. Describe the principal clinical and morphologic findings in chronic liver disease.

  6. Compare and contrast the clinical and pathologic features of viral hepatitis
  7. Compare and contrast the clinical and pathologic features of:
  8. Discuss pathogenesis, morphology, clinical course of alcohol-induced liver diseases:
  9. Classify types of cirrhosis, in terms of:
    • etiology
    • pathogenesis
    • morphologic pattern (gross and microscopic)
    • relationship to neoplasia

  10. Compare and contrast the clinical and pathologic features of
  11. Discuss portal hypertension in terms of:
    • etiologic factors
    • pathogenesis
    • clinical features and course

  12. Compare predictable and unpredictable drug induced liver disease.

  13. Describe the pathophysiologic mechanism whereby the following hepatotoxic drugs/chemicals cause liver injury:
  14. Compare and contrast the clinical and pathologic features of:
  15. Describe typical infectious liver diseases caused by bacteria, protozoa and helminths; in terms of clinical and morphologic findings.

  16. List causes of fatty change (steatosis) of the liver, in terms of:
    • size of fat vacoules
    • zonal distribution of fat

  17. Describe the etiopathogenesis and consequences of:
  18. Compare and contrast the clinical and pathological features of the following tumors:
  19. Describe cholelithiasis in terms of
    • risk factors
    • mechanisms of stone formation
    • composition of stones
    • morphology of stones and gallbladder
    • clinical features
    • complications, including those of therapy

  20. Compare and contrast acute and chronic cholecystitis, in terms of:
    • epidemiology and associated diseases
    • morphology
    • clinical findings
    • complications, including complications of therapy

  21. Compare and contrast empyema and hydrops of the gallbladder, in terms of:
    • etiology
    • pathogenesis
    • morphology
    • clinical findings

  22. Discuss carcinoma of the gallbladder and extrahepatic bile ducts, in terms of:
    • epidemiology
    • relationship to cholelithiasis
    • morphology
    • clinical findings and course

  23. Describe the indications, benefits, and hazards of liver transplantation.

  24. Describe the morphology of liver transplant rejection.

 

PANCREAS Review Items

Key Vocabulary Terms (click here to search any additional terms on Stedman's Online Medical Dictionary)

amylase pancreatitis
cystic fibrosis (CF) pseudocyst
gastrinoma somatostatinoma
glucagonoma sweat chloride test
insulinoma VIPoma
lipase Whipple triad
mucoviscidosis Zollinger-Ellison syndrome

LEARNING OBJECTIVES

Absolutely critical information you must know to practice medicine is in bold font.
Important information that will be needed for routine patient care is in regular font.
Information about less common diseases that you may encounter in clinical practice and that will probably appear on examinations is in italics

  1. Compare and contrast the clinical and pathologic features of:
    • exocrine pancreatic insufficiency
    • endocrine pancreatic insufficiency

  2. Discuss the clinical and pathologic features of cystic fibrosis.

  3. Compare and contrast acute and chronic pancreatitis, in terms of:
    • etiologic/predisposing factors
    • pathogenesis
    • morphologic features
    • laboratory manifestations
    • clinical findings and course
    • complications

  4. Compare and contrast the clinical and pathologic features of adenocarcinoma of the:
    • pancreatic head
    • pancreatic body/tail
    • ampulla of Vater

  5. 5. Discuss islet cell tumors of the pancreas, in terms of:
    • incidence
    • morphology
    • benignity vs. malignancy
    • immunohistochemical characteristics
    • endocrine function
    • clinical features and course

  6. Discuss indications and complications of pancreatic islet cell transplantion.

 

GI SYSTEM Review Items

Key Vocabulary Terms (click here to search any additional terms on Stedman's Online Medical Dictionary)

achalasia gastritis, chronic idiopathic necrotizing enterocolitis (NEC)
acute gastritis gastroesophageal reflux disease (GERD) odynophagia
adhesion Helicobacter pylori peptic ulcer
angiodysplasia hematemesis pernicious anemia
appendicitis, acute hematochezia Peutz-Jegher syndrome
atresia hemorrhoids Plummer-Vinson syndrome
Barrett esophagus hernia pseudomembranous colitis
carcinoid syndrome Hirschsprung disease pseudomyxoma peritonei
carcinoid tumor hypergastrinemia pyloric stenosis
chronic gastritis hyperplastic polyp reflux esophagitis
chronic inflammatory bowel disease inflammatory polyp Schatzki ring
Crohn disease intestinal metaplasia signet ring cell
Cushing ulcer intrinsic factor sprue (celiac, tropical, nontropical)
d-xylose absorption test intussusception steatorrhea
diarrhea ischemic enteritis or colitis stress ulcer
diverticulum juvenile polyp  superficial gastritis
dysentery Krukenberg tumor transmural inflammation
dysphagia linitis plastica tubular adenoma
dysplasia malabsorption ulcer
enterocolitis Mallory-Weiss syndrome ulcerative colitis
enterotoxin Meckel diverticulum villous adenoma
erosion Mediterranean lymphoma Virchow node
esophageal varices megacolon volvulus
esophagitis melena Whipple disease
gastritis, atrophic mucocele Zenker diverticulum
gastritis, autoimmune napkin ring lesion

LEARNING OBJECTIVES

Absolutely critical information you must know to practice medicine is in bold font.
Important information that will be needed for routine patient care is in regular font.
Information about less common diseases that you may encounter in clinical practice and that will probably appear on examinations is in italics

  1. Describe the clinical and pathologic features of disorders of the esophagus:
  2. Describe the clinical presentation and morphology of the following esophageal lesions:
    • congenital stenosis/atresia and associated tracheal lesions
    • mucosal webs
    • diverticula

  3. Discuss the etiology, pathogenesis, gross appearance, histopathology, clinical course, and the route of metastasis of esophageal carcinoma.

  4. Describe esophageal varices, their pathogenesis and typical complications.

  5. Discuss the clinical and pathologic features of the following congenital gastric anomalies:
  6. Compare and contrast acute (erosive), autoimmune, atrophic, and chronic gastritis.
    • etiology
    • pathogenesis
    • morphology
    • clinical presentation and course

  7. Discuss the pathogenesis and the morphology of stress ulcers.

  8. Contrast and compare duodenal and gastric peptic ulcers, and their typical complications.

  9. Compare and contrast clinical and pathologic features of the following types of gastric polyp:
  10. Describe typical gross and histologic features of gastric adenocarcinoma.

  11. Discuss the epidemiology and risk factors of gastric adenocarcinoma.

  12. Correlate the pathologic findings and clinical symptoms of gastric adenocarcinoma.

  13. Discuss gastrointestinal stromal tumors (GIST), in terms of:
    • histogenesis
    • morphology
    • prognosis and treatment

  14. Discuss gastrointestinal lymphoma, in terms of:
    • epidemiology
    • etiology and pathogenesis
    • level of the alimentary tract most frequently affected
    • morphologic features
    • clinical features and course

  15. Compare and contrast the clinical and pathologic features of the following diseases:
  16. Compare and contrast ulcerative colitis and Crohn disease, in terms of:
    • epidemiology
    • pathogenesis
    • morphology
    • clinical features and course
    • compications
    • malignant potential

  17. List the important viral, bacterial and parasitic pathogens causing enterocolitis.

  18. Contrast and compare diarrheal disease caused by enterotoxin-producing bacteria and diarrhea due to enteroinvasive microbes.

  19. Compare and contrast the clinical and pathologic features of:
  20. Discuss the clinical and pathologic features of the following intestinal processes:
  21. Compare and contrast the clinical and pathologic features of small intestina neoplasms:
  22. Discuss the clinical and pathologic features of the following types of colonic polyps:
  23. Compare and contrast the clinical and pathologic features of the following syndromes:
  24. Describe colorectal carcinoma, in terms of:
    • etiology
    • pathogenesis, including genetic and molecular factors
    • morphology, including grading and staging criteria
    • clinical features and course

  25. Contrast and compare clinical and pathologic features of carcinoma of right and left colon.

  26. Discuss carcinoid tumors of the colon, rectum, and appendix, in terms of:
    • pathogenesis
    • morphology
    • clinical features (including extra-colonic manifestations)
    • course and prognosis

  27. Describe the etiology, pathogenesis, and morphology of appendicitis

    actinomycotic appendicitis. chronic suppurative appendicitis resulting from infection by Actinomyces israelii.
    acute appendicitis. acute inflammation of the appendix, usually resulting from bacterial infection, which may be precipitated by obstruction of the lumen by a fecalith; variable symptoms often consisting of periumbilical, colicky pain and vomiting may be followed by fever, leukocytosis, persistent pain, and signs of peritoneal inflammation in the right lower quadrant of the abdomen; perforation or abscess formation is a frequent complication of delayed surgical intervention.
    bilharzial appendicitis. appendicitis caused by deposition of the eggs of the blood fluke Schistosoma mansoni in the vermiform appendix.
    chronic appendicitis. fibrous adhesions, scarring, or deformity of the appendix following subsidence of acute appendicitis; fibrous obliteration of the distal lumen is not abnormal in older persons; term frequently used to refer to repeated mild attacks of acute appendicitis.
    focal appendicitis. acute appendicitis involving only part of the appendix, sometimes at the site of, or distal to, an obstruction of the lumen.
    foreign-body appendicitis. appendicitis caused by obstruction of the lumen of the appendix by a foreign substance, such as a particulate foreign body.
    gangrenous appendicitis. acute appendicitis with necrosis of the wall of the appendix, most commonly developing in obstructive appendicitis and frequently causing perforation and acute peritonitis.
    left-sided appendicitis. appendicitis occurring on the left side of the abdomen, usually the left lower quadrant, due to abnormal rotation of the gut (e.g., situs inversus).
    lumbar appendicitis. acute appendicitis in a retrodisplaced appendix in the lumbar region.
    obstructive appendicitis. acute appendicitis due to infection of retained secretion behind an obstruction of the lumen by a fecalith or some other cause, including carcinoma of the cecum.
    perforating appendicitis. inflammation of the appendix leading to perforation of the wall of the appendix into the peritoneal cavity, resulting in peritonitis.
    recurrent appendicitis. repeated episodes of right lower quadrant abdominal pain attributed to recurrence of inflammation of the appendix in a person who did not have an appendectomy for prior episodes. SYN: relapsing appendicitis.
    relapsing appendicitis. SYN: recurrent appendicitis.
    stercoral appendicitis. appendicitis following a lodgment of fecal material in the appendix.
    subperitoneal appendicitis. appendicitis of a subperitoneally displaced appendix.
    suppurative appendicitis. acute appendicitis with purulent exudate in the lumen and wall of the appendix.
    verminous appendicitis. appendicitis caused by obstruction or in response to the presence of parasitic worms such as Ascaris lumbricoides, Strongyloides stercoralis, or the pinworm Enterobius vermicularis.

  28. and list the most common complications.
  29. Compare and contrast the clinical and pathologic features of
  30. List the clinical situations in which stool examination may be helpful in the diagnosis of alimentary diseases.

 

 

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