- Published on
Pathology - Colorectal Adenocarcinoma
Risk factors including adenomatous polyps, chronic ulcerative colitis, low-fiber diet, advanced age, family history of the disease, hereditary nonpolyposis colorectal cancer (HNPCC), and familial adenomatous polyposis (FAP).
Typically manifests between the ages of 60 and 80.
Pathology: Gross Appearance ranges from a polypoid mass in the proximal colon to lesions with ulcerated cores and uneven edges that encircle the bowel in the distal colon.
Micronc: Dysplastic columnar cells arranged in glands, capable of mucin production. Some cancers may exhibit anaplasia.
Clinical Symptoms
May have no symptoms; if symptoms are present, they include pallor, weight loss, intermittent diarrhea, Left Lower Quadrant pain, or blockage.
Laboratory results: Positive stool guaiac test, elevated serum CEA levels, and microcytic, hypochromic anemia indicative of iron deficiency anemia due to gastrointestinal bleeding.
Treatment: Surgical excision followed by chemotherapy with 5FU.
Colorectal cancer is the second most common cause of death from cancer in the United States. Preventive strategies involve conducting colonoscopy screenings every 10 years for all patients over the age of 50.
Risk factors including adenomatous polyps, chronic ulcerative colitis, low-fiber diet, advanced age, family history of the disease, hereditary nonpolyposis colorectal cancer (HNPCC), and familial adenomatous polyposis (FAP).
Typically manifests between the ages of 60 and 80.
Pathology: Gross Appearance ranges from a polypoid mass in the proximal colon to lesions with ulcerated cores and uneven edges that encircle the bowel in the distal colon.
Micronc: Dysplastic columnar cells arranged in glands, capable of mucin production. Some cancers may exhibit anaplasia.
Clinical Symptoms
May have no symptoms; if symptoms are present, they include pallor, weight loss, intermittent diarrhea, Left Lower Quadrant pain, or blockage.
Laboratory results: Positive stool guaiac test, elevated serum CEA levels, and microcytic, hypochromic anemia indicative of iron deficiency anemia due to gastrointestinal bleeding.
Treatment: Surgical excision followed by chemotherapy with 5FU.
Colorectal cancer is the second most common cause of death from cancer in the United States. Preventive strategies involve conducting colonoscopy screenings every 10 years for all patients over the age of 50.
- Published on
Pathology - Acute Appendicitis
Resulting from blockage of the appendix by a fecalith, irritation, foreign object, or tumor.
The highest occurrence is often observed between the ages of 10 and 30.
Study of diseases
Macroscopic observation: Inflamed appendix with fibrin deposits
Microscopic findings show a neutrophilic infiltrate spreading to the muscularis with abscess development. Ulcerations: engorged blood vessels
Initial diffuse abdominal discomfort shifting to the right lower quadrant, accompanied by fever, loss of appetite, nausea, vomiting, psoas sign, and obturator sign.
Complications may involve gangrene and perforation, which can result in peritonitis.
Laboratory results: Increased white blood cell count
Surgical procedure: Appendectomy.
Appendicitis is the most prevalent abdominal surgical emergency, impacting 10% of the population.
Resulting from blockage of the appendix by a fecalith, irritation, foreign object, or tumor.
The highest occurrence is often observed between the ages of 10 and 30.
Study of diseases
Macroscopic observation: Inflamed appendix with fibrin deposits
Microscopic findings show a neutrophilic infiltrate spreading to the muscularis with abscess development. Ulcerations: engorged blood vessels
Initial diffuse abdominal discomfort shifting to the right lower quadrant, accompanied by fever, loss of appetite, nausea, vomiting, psoas sign, and obturator sign.
Complications may involve gangrene and perforation, which can result in peritonitis.
Laboratory results: Increased white blood cell count
Surgical procedure: Appendectomy.
Appendicitis is the most prevalent abdominal surgical emergency, impacting 10% of the population.
- Published on
Pharmacology - Hirschsprung Disease
Caused during embrogenesis by a lack of neural crest cell migration
Is linked to Down syndrome; affects boys more than girls; occurs in 1 in 3000 births.
Gross: Colon dilatation near the aganglionic segment (megacolon): the rectum is involved.
Macroscomic: Meissner and Auerbach plexus ganglion cels absent
Clinical Signs and Symptoms
occurs early in childhood and manifests as a colon perforation or persistent constipation with bloating in the abdomen; it can also manifest as acute enterocolitis with watery, foul-smelling stools.
Management
Surgery and Anastomosis
The term "Ogilvie syndrome," also known as "acute colonic pseudo-obstruction," describes the radiological and clinical manifestation of colonic obstruction when there isn't a real obstruction. Older patients with a history of trauma, infection, or specific prescription use (such as opioids or anticholinergics) are more likely to experience it. Significant colonic dilatation with low air-fluid levels is seen on the abdominal x-ray. The course of treatment involves the installation of a nasogastric tube, maintaining NPO state, stopping any problematic medications, and, if necessary, colonoscopic decompression. If left untreated, this illness may develop into a colonic perforation.
Caused during embrogenesis by a lack of neural crest cell migration
Is linked to Down syndrome; affects boys more than girls; occurs in 1 in 3000 births.
Gross: Colon dilatation near the aganglionic segment (megacolon): the rectum is involved.
Macroscomic: Meissner and Auerbach plexus ganglion cels absent
Clinical Signs and Symptoms
occurs early in childhood and manifests as a colon perforation or persistent constipation with bloating in the abdomen; it can also manifest as acute enterocolitis with watery, foul-smelling stools.
Management
Surgery and Anastomosis
The term "Ogilvie syndrome," also known as "acute colonic pseudo-obstruction," describes the radiological and clinical manifestation of colonic obstruction when there isn't a real obstruction. Older patients with a history of trauma, infection, or specific prescription use (such as opioids or anticholinergics) are more likely to experience it. Significant colonic dilatation with low air-fluid levels is seen on the abdominal x-ray. The course of treatment involves the installation of a nasogastric tube, maintaining NPO state, stopping any problematic medications, and, if necessary, colonoscopic decompression. If left untreated, this illness may develop into a colonic perforation.
- Published on
Pathology - Carcinoid Syndrome
Resulting from the release of serotonin by specific carcinoid tumors
Affects 1% of individuals with carcinoid tumors
Pathology
Carcinoid tumor A yellowish-tan mass is commonly found in the appendix but can also be present in various organs such as the gastrointestinal tract, pancreas, respiratory tract, gallbladder, thymus, and reproductive organs.
The tumor cells originate from neuroendocrine cells in the gastrointestinal system and feature pink granular cytoplasm with stippled nuclei when viewed under a microscope.
Pathophysiology: Carcinoid syndrome is a result of carcinoid tumor metastases in the liver. Carcinoid tumors in the colon secrete serotonin into the portal circulation, where it is processed and eliminated. Hepatic metastases emit serotonin into the hepatic portal vein, which enters the systemic circulation, causing carcinoid syndrome.
Clinical Symptoms
Recurring watery diarrhea, face flushing, asthma with bronchospasm, and right-sided valvular disease affecting the pulmonic and tricuspid valves, which increases the patient's risk of endocarditis and right-sided heart failure.
Laboratory results: Elevated amounts of 5-HIAA in the urine.
Cyproheptadine is used to treat diarrhea by blocking histamine receptors; octreotide acetate decreases urinary 5-HIAA levels; surgery is performed for localized carcinoid tumors.
The 5-year survival rate for carcinoid tumors is 90%.
The most prevalent tumor found in the appendix is the carcinoid tumor.
Individuals who have used fen-phen diet pills may develop left-sided cardiac disease in carcinoid syndrome.
Resulting from the release of serotonin by specific carcinoid tumors
Affects 1% of individuals with carcinoid tumors
Pathology
Carcinoid tumor A yellowish-tan mass is commonly found in the appendix but can also be present in various organs such as the gastrointestinal tract, pancreas, respiratory tract, gallbladder, thymus, and reproductive organs.
The tumor cells originate from neuroendocrine cells in the gastrointestinal system and feature pink granular cytoplasm with stippled nuclei when viewed under a microscope.
Pathophysiology: Carcinoid syndrome is a result of carcinoid tumor metastases in the liver. Carcinoid tumors in the colon secrete serotonin into the portal circulation, where it is processed and eliminated. Hepatic metastases emit serotonin into the hepatic portal vein, which enters the systemic circulation, causing carcinoid syndrome.
Clinical Symptoms
Recurring watery diarrhea, face flushing, asthma with bronchospasm, and right-sided valvular disease affecting the pulmonic and tricuspid valves, which increases the patient's risk of endocarditis and right-sided heart failure.
Laboratory results: Elevated amounts of 5-HIAA in the urine.
Cyproheptadine is used to treat diarrhea by blocking histamine receptors; octreotide acetate decreases urinary 5-HIAA levels; surgery is performed for localized carcinoid tumors.
The 5-year survival rate for carcinoid tumors is 90%.
The most prevalent tumor found in the appendix is the carcinoid tumor.
Individuals who have used fen-phen diet pills may develop left-sided cardiac disease in carcinoid syndrome.
- Published on
Pathology-Crohn's disease
idiopathic, despite the possibility of infectious origins
most common in women between the ages of 15 and 30.
Gross Pathology: Changes to the colon, small intestine, and terminal ileum; absent from the rectum: creeping fat across the surface of the gut. Cobblestone mucosa submucosal edema with elevation of surviving mucosa; thickened bowel wall resulting in a constricted lumen and linear ulceration of the mucosa).
Microscopic Pathology : Skip lesions, or sections of healthy bowel mixed with diseased bowel, are indicative of transmural inflammation. fissures: noncaseating granulomas: crvpt atronhv: metaplasia of the mucosa
sporadic episodes of low-grade fever diarrhea, frequently accompanied by blood and pain in the right lower quadrant: physical examination may reveal a mass in this area.
Extraintestinal manitestations: Oral apthous ulcer,migrant polyarthritis; uveitis: ankylosing spondylitis; sacroilitis: ankylosing spondylitis
Complications include perianal fistulas and abscesses, malabsorption syndrome, and fibrous strictures that result in intestinal blockage or perforation.
Imaging: Evidence of ulceration, stricturing, or fistulas of the small intestine or colon on endoscopy; string sign on x-ray following barium swallow (represents constricted gut lumen).
Immunomodulators, glucocorticoids, sulfasalazine, antidiarrheals, and surgery as necessary to repair fistulas or obstructons
Crohn's disease and ulcerative colitis are classified as inflammatory bowel diseases.
idiopathic, despite the possibility of infectious origins
most common in women between the ages of 15 and 30.
Gross Pathology: Changes to the colon, small intestine, and terminal ileum; absent from the rectum: creeping fat across the surface of the gut. Cobblestone mucosa submucosal edema with elevation of surviving mucosa; thickened bowel wall resulting in a constricted lumen and linear ulceration of the mucosa).
Microscopic Pathology : Skip lesions, or sections of healthy bowel mixed with diseased bowel, are indicative of transmural inflammation. fissures: noncaseating granulomas: crvpt atronhv: metaplasia of the mucosa
sporadic episodes of low-grade fever diarrhea, frequently accompanied by blood and pain in the right lower quadrant: physical examination may reveal a mass in this area.
Extraintestinal manitestations: Oral apthous ulcer,migrant polyarthritis; uveitis: ankylosing spondylitis; sacroilitis: ankylosing spondylitis
Complications include perianal fistulas and abscesses, malabsorption syndrome, and fibrous strictures that result in intestinal blockage or perforation.
Imaging: Evidence of ulceration, stricturing, or fistulas of the small intestine or colon on endoscopy; string sign on x-ray following barium swallow (represents constricted gut lumen).
Immunomodulators, glucocorticoids, sulfasalazine, antidiarrheals, and surgery as necessary to repair fistulas or obstructons
Crohn's disease and ulcerative colitis are classified as inflammatory bowel diseases.
- Published on
Pathology - Meckel Diverticulum
Originating from the remaining portion of the vitelline duct (yolk stalk).
Affects 2% of the population.
Pathology
Gross: A blind pouch located on the antimesenteric boundary of the ileum within 2 feet of the ileocecal valve, leading to a tubular outpouching of the small intestine.
Microscopic: A genuine diverticulum consisting of all three layers of the intestine wall (mucosa, submucosa, muscularis propria); may include acid-secreting gastric mucosa and/or pancreatic tissue.
Occurring within the initial two years of life. Typically without symptoms, but can result in peptic ulcerations causing gastrointestinal bleeding or intussusception or volvulus.
Management
Surgery to remove tissue
Meckel diverticulum is the most prevalent congenital anomaly in the gastrointestinal tract.
Intussusception is the process of a section of the colon folding into a lower section of the gut. It typically manifests in children under the age of 2 with sporadic abdominal pain and feces like currant jelly. Treatment involves either an air-barium enema or surgical decompression, if necessary.
Volvulus is the rotation of a section of the colon around its mesentery, causing intestinal blockage and reduced blood supply (ischemia). It can manifest in several parts of the gastrointestinal tract such as the stomach, small intestine, and colon, typically causing sudden abdominal pain, constipation, gas, and distention of the sigmoid colon. Treatment involves decompression of the stomach via a nasogastric tube or surgery.
Originating from the remaining portion of the vitelline duct (yolk stalk).
Affects 2% of the population.
Pathology
Gross: A blind pouch located on the antimesenteric boundary of the ileum within 2 feet of the ileocecal valve, leading to a tubular outpouching of the small intestine.
Microscopic: A genuine diverticulum consisting of all three layers of the intestine wall (mucosa, submucosa, muscularis propria); may include acid-secreting gastric mucosa and/or pancreatic tissue.
Occurring within the initial two years of life. Typically without symptoms, but can result in peptic ulcerations causing gastrointestinal bleeding or intussusception or volvulus.
Management
Surgery to remove tissue
Meckel diverticulum is the most prevalent congenital anomaly in the gastrointestinal tract.
Intussusception is the process of a section of the colon folding into a lower section of the gut. It typically manifests in children under the age of 2 with sporadic abdominal pain and feces like currant jelly. Treatment involves either an air-barium enema or surgical decompression, if necessary.
Volvulus is the rotation of a section of the colon around its mesentery, causing intestinal blockage and reduced blood supply (ischemia). It can manifest in several parts of the gastrointestinal tract such as the stomach, small intestine, and colon, typically causing sudden abdominal pain, constipation, gas, and distention of the sigmoid colon. Treatment involves decompression of the stomach via a nasogastric tube or surgery.
- Published on
Pathology - Celiac Sprue
Autoimmune reaction to gluten found in wheat, oat, rye, and barley.
More prevalent in individuals of northern European ancestry and linked to HLA-DR3 and HLA-DQw2.
Pathology
Gross: Diminishing and wasting away of tiny intestinal mucosal villi
Microscopic findings include elevated levels of lymphocytes and plasma cells in the lamina propria, as well as absence of the brush boundary.
Clinical Manifestations
Symptoms may appear in infancy as growth retardation and failure to thrive, or in young adulthood as malabsorption symptoms. May exhibit steatorrhea characterized by pale, bulky, and frothy stools. malodorous feces. Abdominal bloating. Weight reduction. Dermatitis herpetiformis is a condition characterized by symmetric, recurrent, itchy, subepidermal blisters that typically appear on the extensor surfaces of the limbs, trunk, scalp, and neck. 10% to 15% of patients will develop enteropathy-type T-cell lymphoma.
Laboratory results show abnormal D-xylose test, presence of antigliadin, antiendomysial, and anti-TTG antibodies.
Therapy
Following a gluten-free diet, using dapsone for dermatitis herpetiformis, and taking vitamin B2 and calcium supplements.
Tropical sprue is a malabsorption syndrome induced by the proliferation of enterotoxigenic organisms in tropical regions and is treated with broad-spectrum antibiotics.
Whipple illness is a rare multisystemic infection caused by a PAS-positive actinomycete. Tropheryma whippelii.
It manifests as malabsorption syndrome and arthralgias.
Involvement of the central nervous system, heart, and eyes.
Autoimmune reaction to gluten found in wheat, oat, rye, and barley.
More prevalent in individuals of northern European ancestry and linked to HLA-DR3 and HLA-DQw2.
Pathology
Gross: Diminishing and wasting away of tiny intestinal mucosal villi
Microscopic findings include elevated levels of lymphocytes and plasma cells in the lamina propria, as well as absence of the brush boundary.
Clinical Manifestations
Symptoms may appear in infancy as growth retardation and failure to thrive, or in young adulthood as malabsorption symptoms. May exhibit steatorrhea characterized by pale, bulky, and frothy stools. malodorous feces. Abdominal bloating. Weight reduction. Dermatitis herpetiformis is a condition characterized by symmetric, recurrent, itchy, subepidermal blisters that typically appear on the extensor surfaces of the limbs, trunk, scalp, and neck. 10% to 15% of patients will develop enteropathy-type T-cell lymphoma.
Laboratory results show abnormal D-xylose test, presence of antigliadin, antiendomysial, and anti-TTG antibodies.
Therapy
Following a gluten-free diet, using dapsone for dermatitis herpetiformis, and taking vitamin B2 and calcium supplements.
Tropical sprue is a malabsorption syndrome induced by the proliferation of enterotoxigenic organisms in tropical regions and is treated with broad-spectrum antibiotics.
Whipple illness is a rare multisystemic infection caused by a PAS-positive actinomycete. Tropheryma whippelii.
It manifests as malabsorption syndrome and arthralgias.
Involvement of the central nervous system, heart, and eyes.
- Published on
Symptoms and Signs – Differential Diagnosis of Ejaculation, Premature
• Anxiety disorder
• In as many as 25% of men with complaints of premature ejaculation, partner is anorgasmic.
• In young adolescents, premature ejaculation may be normally experienced as a consequence of heightened excitation.
• Anxiety disorder
• In as many as 25% of men with complaints of premature ejaculation, partner is anorgasmic.
• In young adolescents, premature ejaculation may be normally experienced as a consequence of heightened excitation.
- Published on
Symptoms and Signs – Differential Diagnosis of Ejection Sound or Click
• Aortic aneurysm
• Aortic regurgitation
• Aortic root dilatation
• Atrial septal defect
• Chronic pulmonary hypertension
• Pulmonary valve stenosis
• Systemic hypertension
• Tetralogy of Fallot
• Aortic aneurysm
• Aortic regurgitation
• Aortic root dilatation
• Atrial septal defect
• Chronic pulmonary hypertension
• Pulmonary valve stenosis
• Systemic hypertension
• Tetralogy of Fallot
- Published on
Symptoms and Signs – Differential Diagnosis of Elbow Pain
• Cervical disease (referred pain)
• Entrapment neuropathy
• Gout
• Infection
• Inflammatory arthritis
• Lateral or medial epicondylitis
• Loose body
• Olecranon bursitis
• Osteoarthritis
• Partial subluxation
• Shoulder disease (referred pain)
• Synovial osteochondromatosis
• Trauma
• Cervical disease (referred pain)
• Entrapment neuropathy
• Gout
• Infection
• Inflammatory arthritis
• Lateral or medial epicondylitis
• Loose body
• Olecranon bursitis
• Osteoarthritis
• Partial subluxation
• Shoulder disease (referred pain)
• Synovial osteochondromatosis
• Trauma
