GIT 3

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GIT 3

• Dr. Basu MD

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Topic

• Ischemic bowel disease
• Hirschsprung disease (congenital mega colon)
• Meckel diverticulum
• Diverticular Disease
• Intestinal obstructions
• Volvulous, hernia
• Intussuseption
• Angiodysplasia.

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Ischemic bowel disease
Etiology Cause by sudden (acute) complete obstruction of the blood flow.
Transmural infarction All layers are involved, gangrene. Clinical mimic perforation.
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Etiology

• Mesenteric Arterial thrombosis sources MI, IE,
  paradoxical embolism.
• Venous thrombosis hypercoagulable states.

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Morphology
Common in Splenic flexure
Severe, acute abdominal pain and tenderness.
Peristaltic sounds diminish or disappear, and
Spasm creates board-like rigidity of the
abdominal wall. No free air in abdomen ( a
feature of perforation)
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Hirschsprung disease

• About 50 of familial cases are a consequence of
  mutations in the RET gene.
• Incidence 1 5000/8000 live birth
• Area of constriction is the aganglionic
  segment.
• Proximal portion to that area undergoes
  progressive dilation and hypertrophy

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Aganglionic segment
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Diverticula
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True diverticula
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False diverticula
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Diverticulum
Meckel diverticulum Rule of 2 ( 2, 2 inch, 2 ft away from ilioceacal jn.), produce peptic ulcer disease.
Diverticular Disease Blind pouch leading off the alimentary tract. Produce diverticulitis,diarrhea.
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Meckel diverticulum Vitelline duct produces
this.
Study other similar picture
Present in anti mesenteric border. Mucosa
contain gastric parietal cells.
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Diverticular Disease
Study other similar picture
Site Most common site is the left side of the
colon, with the majority in the sigmoid
colon. Age adult
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Diverticular Disease

• Out pouching of the colon mucosa
• If Infection present call it diverticulitis (
  acute pain in left lower abdomen with
  leukocytosis).
• Discomfort, constipation, distention.
• Rectal (lower GI) bleeding.

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Intestinal obstruction
Causes Intussusception, Herniation (umbilical or inguinal), Adhesion between loops of intestine- from peritonitis. Volvulus formation.
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Hernia

• Def The protrusion of an organ or structure into
  surrounding tissues.

Inguinal hernia bulges in the groin area become
more prominent when coughing, straining, or
standing up. They are often painful, and the
bulge commonly disappears on lying down. Can
cause intestinal obstruction!
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Volvulus

• Def is a loop of the bowel whose nose has
  twisted on itself .
• Etiology may be spontaneous
• C/F sudden abdominal pain, distension, and
  absolute constipation. Cannot introduce scope
  after certain distance per rectum.
• Complications
• Ischemia, gangrene

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INTUSSUSCEPTION
INTUSSUSCEPTION Proximal segment Invaginate (telescoped) into the immediately distal segment of bowel.
INTUSSUSCEPTION Cause without any reason or rotavirus infection (child). Intra luminal mass ( adult).
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Telescoped intestine
Intra luminal mass - arrow.
Clinical Sudden pain abdomen Current jelly
stool. Sausage shaped mass in abdomen.
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Clinical of obstruction
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Clinical of obstruction

• A high obstruction severe vomiting, no passage
  of stool, Distension, ? a mass palpable.
• Low obstruction Distension, ? Mass palpable, no
  passage of stool/ flatus (absolute constipation).
• Acute obstruction colicky pain (increased
  peristalsis).
• Gradual obstruction tumor insidious, over some
  weeks. Symptoms may gradually worsen. Diameter of
  stool will gradually decrease.

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Note pad
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Miscellaneous
Angiodysplasia Arteriovenous malformation. Cecum and rt. Colon. C/F episodes of rectal bleeding. Associated with Osler-weber-rendu and CREST syndrome
Osler-weber-rendu Heredetary telangectesis ( lips, tongue, finger), Autosomal dominant.
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Next topic

• Acute appendicitis
• HEMORRHOIDS
• Peritonitis

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Acute appendicitis
Cause? Obstruction ( by fecalith, a gallstone, tumor, or ball of worms (oxyuriasis vermicularis). Obstruction ( by fecalith, a gallstone, tumor, or ball of worms (oxyuriasis vermicularis).
Clinical feature ? Clinical feature ? Pain localizing to the right lower quadrant.
Morphology ? Morphology ? Gross and micro Exudate and trans mural acute inflammation.
Lab ? Lab ? Leukocytosis ( due to reactive myeloid hyperplasia)
Tumor of ? appendix Tumor of ? appendix Carcinoids and Mucinous tumors.
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Leukemoid reaction

• reactive myeloid hyperplasia
• accelerated release of myeloid cells from the
  BM (reserve pool).

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Trans mural acute inflammation
Exudates on serosa with congested blood vessels
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HEMORRHOIDS

• Hemorrhoids are variceal dilations of the anal
  and perianal venous plexuses.
• Cause Constipation ( by cocaine), strain on
  stool, and pregnancy, after child birth.
• Clinical fresh blood during defecation (pain in
  external type).

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Peritonitis

• Cause appendicitis, ruptured peptic ulcer,
  pancreatitis, bile, acute salpingitis PID,
  dialysis.
• c/f acute abdominal pain and gurding, which are
  exacerbated by moving the peritoneum, Rebound
  tenderness .

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Thank you