13. INTESTINAL TUBERCULOSIS
Causative agent- Mycobacterium tuberculosis
Mostly affects the ileum or ileocaecal junction
Intestinal tuberculosis contracted by the drinking of
unpasteurised milk.
In countries where milk is pasteurized, intestinal TB is caused
by the swallowing of coughed-up infective material in patients
with advanced pulmonary disease
24. CROHN’S DISEASE
General considerations
Chronic inflammatory condition of unknown etiology
Can affect any part of the GIT
Most commonly involves terminal ileum, ileocaecal valve
and caecum.
Younger individuals.
24
25. CROHN’S DISEASE
Gross
Earliest lesion, aphthous ulcer coalesce to form multiple, elongated,
serpentine ulcers along the axis of the bowel.
Skip lesions
Cobblestone appearance
Fissures
Fistula
Creeping fat
25
26. LOSS OF NORMAL MUCOSAL FOLDS ( LINEAR MUCOSA )
( COBBLESTONE –SHAPED MUCOSA )
26
The characteristic of crohn's disease
32. Gross
Mucosal inflammation and ulceration always
involves rectum and extends proximally in a
continuous fashion to involve colon
Red or granular appearance of mucosa
Extensive broad based ulcers
Pseudopolyps
Mural thickening is not present
Serosa is normal
No strictures
Toxic megacolon – medical emergency 32
36. FEATURES THAT DIFFER BETWEEN CROHN
DISEASE AND ULCERATIVE COLITIS
Feature Crohn Disease Ulcerative Colitis
MACROSCOPIC
Bowel region Ileum ± colon Colon only
Distribution Skip lesions Diffuse
Stricture Yes Rare
Wall appearance Thick Thin
MICROSCOPIC
Inflammation Transmural Limited to mucosa
Pseudopolyps Moderate Marked
Ulcers Deep, knife-like Superficial, broad-based
Lymphoid reaction Marked Moderate 36
37. FEATURES THAT DIFFER BETWEEN
CROHN DISEASE AND ULCERATIVE
COLITIS
Feature Crohn Disease Ulcerative Colitis
Fibrosis Marked Mild to none
Serositis Marked Mild to none
Granulomas Yes ( 50%)∼ No
Fistulae/sinuses Yes No
CLINICAL
Perianal fistula Yes (in colonic disease) No
Fat/vitamin
malabsorption
Yes No
Malignant potential With colonic involvement Yes
Recurrence after surgery Common No
Toxic megacolon No Yes
37
38. ADENOCARCINOMA OF THE COLON AND
RECTUM
Most common malignancy of the GIT
The peak age incidence is in the sixth to seventh decades.
38
39. TWO GENETIC PATHWAYS ARE
INVOLVED
APC/ β – CATENIN PATHWAY
MICROSATELLITE INSTABILITY
PATHWAY
39
41. Predisposing factors
1. Adenomatous polyps
2. Familial adenomatous polyposis
3. Hereditary non polyposis colonic cancer
4. Long-standing ulcerative colitis
5. Genetic factors; up to a four-fold increase in incidence is
noted among relatives of patients with colon cancer.
6. A low-fiber diet that is high in animal fat; the disease is
less common in much of the Third World, where populations
consume a high-fiber diet that is low in animal fat.
41
45. COLORECTAL ADENOCARCINOMA -
CHARACTERISTICS
Right Sided growth
Fungating, large
cauliflower-like, soft and
friable mass projecting
into the lumen
Left Sided growth
Napkin-ring
configuration, encircling
the bowel wall
circumferentially with
increased fibrous tissue
forming annular ring with
central mucosal
ulceration
45
46. Right sided growth - Adenocarcinoma of caecum demonstrates an
exophytic growth pattern.
49. CLINICAL FEATURES
Right Sided growth
Iron deficiency anaemia
Fatigue and weakness
Left Sided growth
Obstruction
Occult bleeding
Changes in bowel habits
Cramping
Left lower quadrant pain
49
50. The barium enema - the classic "apple core” lesion is present, representing an
encircling adenocarcinoma that constricts the lumen.
