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Lower GIT

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Lower GIT

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Lower GIT

  1. 1. LOWER GASTROINTESTINAL TRACT Dr. Shameera Begum
  2. 2. DIFFERENCE BETWEEN SMALL INTESTINE AND LARGE INTESTINE
  3. 3. LARGE INTESTINE 3
  4. 4. LARGE INTESTINE 4
  5. 5. SMALL INTESTINE 5
  6. 6. 6
  7. 7. DUODENUM 7
  8. 8. 8
  9. 9. ILEUM 9
  10. 10. 10
  11. 11. COLON 11
  12. 12.  TB intestine  Wet gangrene of intestine  Inflammatory bowel disease  Crohn disease  Ulcerative colitis  Colorectal adenocarcinoma OVERVIEWOVERVIEW
  13. 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
  14. 14. MORPHOLOGY OF TUBERCULAR ULCER GROSS -Transverse ulcer in the direction of lymphatics -multiple and circumferential - Ulcer leads to fibrosis which cause stenosis and obstruction
  15. 15. TRANSVERSE ULCERS IN TB
  16. 16. TB OF COLON
  17. 17. 17
  18. 18. MICROSCOPY  CASEATING GRANULOMA - Shows central caseous necrosis surrounded by granuloma - Granuloma composed of epitheloid cells, langhans giant cells and lymphocytes. - AFB/ ZN Stain positivity.
  19. 19. TB- MICROSCOPY
  20. 20. WET GANGRENE OF INTESTINE 20
  21. 21. 21
  22. 22. 22
  23. 23. INFLAMMATORY BOWEL DISEASE
  24. 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. 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. 26. LOSS OF NORMAL MUCOSAL FOLDS ( LINEAR MUCOSA ) ( COBBLESTONE –SHAPED MUCOSA ) 26 The characteristic of crohn's disease
  27. 27. 27
  28. 28. THE CHARACTERISTIC OF CROHN'S DISEASE  Strictures (stenosis ) 28
  29. 29.  Creeping fat 29 The characteristic of crohn's disease
  30. 30. CROHN’S DISEASE 30
  31. 31. ULCERATIVE COLITIS  Limited to colon and rectum 31
  32. 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
  33. 33. 33 ULCERATIVE COLITIS
  34. 34. HEALTHY MUCOSA VS ULCERATIVE COLITIS 34
  35. 35. ULCERATIVE COLITIS -CRYPT ABSCESS 35
  36. 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. 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. 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. 39. TWO GENETIC PATHWAYS ARE INVOLVED APC/ β – CATENIN PATHWAY MICROSATELLITE INSTABILITY PATHWAY 39
  40. 40. 40
  41. 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
  42. 42. 42
  43. 43. MULTIPLE POLYPOSIS. THE POLYPS ARE BENIGN, BUT EACH OF THE INNUMERABLE POLYPS HAS ABOUT A 1% POTENTIAL FOR MALIGNANT CHANGE. 43
  44. 44. TYPICAL SITES OF INCIDENCE AND SYMPOMS OF COLON CANCER
  45. 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. 46. Right sided growth - Adenocarcinoma of caecum demonstrates an exophytic growth pattern.
  47. 47. Adenocarcinoma of the rectosigmoid region
  48. 48. 48 Right Sided growth Left Sided growth
  49. 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. 50. The barium enema - the classic "apple core” lesion is present, representing an encircling adenocarcinoma that constricts the lumen.
  51. 51. INVASIVE ADENOCARCINOMA OF COLON SHOWING MALIGNANT GLANDS INFILTRATING THE MUSCLE WALL. 51

Editor's Notes

  • plicae semilunaris – volvulae conniventes in x ray
  • oval ulcers along the axis of lumen
  • inflammation limited to mucosa and submucosa
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