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​Pathology - Biliary Cirrhosis 
Primary biliary cirrhosis (PBC) is an autoimmune illness that typically affects women between the ages of 40 and 60. It can coexist with other autoimmune disorders such as Sjogren syndrome, thyroiditis, and rheumatoid arthritis.
SBC, or secondary biliary cirrhosis: caused by biliary blockage outside of the liver

Pathology 
PBC: Gross: liver begins to turn green gradually. Microscopic factors include lymphocyte infiltration in the portal system, periportal granuloma development that destroys bile ducts, and the final destruction of hepatic parenchyma that results in hepatic cirrhosis.
SBC: Vellow-green liver, disgusting. Microscopic features include bile stasis, bile lakes (an buildup of bile in the hepatic parenchyma), fibrous septa, and variations in bile duct size. 
Pathophysiology: a bacterial infection of the intrahepatic ducts known as ascending cholangitis can exacerbate extrahepatic biliary blockage by raising intrahepatic duct pressure, which in turn causes ductal damage and ultimately fibrosis.

Clinical Signs and Symptoms 
severe obstructive jaundice, xanthomas, pruritus, weariness, hepatosplenomegaly, and ultimately portal hypertension-associated liver failure.
Results from the lab: elevated bilirubin levels, elevated ALP, hypercholesterolemia, and antimitochondrial antibodies (PBC).

Treatment
Vitamin supplements, cholestyramine for itching, ursodeoxycholic acid, and live transplants in cases of severe illness.
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​Pathology - Diverticular Disease (Diverticulosis and Diverticulitis)
Diverticulosis is the formation of diverticula due to elevated pressure in the intestine and weakened intestinal wall, typically found in those over 60 years old and linked to a low-fiber diet.
Diverticulitis is inflammation of diverticula, typically caused by impacted fecal debris, and it affects 10%-25% of individuals with diverticula.

Study of diseases
Diverticula are blind pouches that branch off from the alimentary tract and connect with the gut lumen. They are typically false diverticula, caused by the herniation of mucosa through weak spots in the muscle layer, but can also be true diverticula, made up of mucosa, muscularis, and serosa. Microscopic findings show mucosa that is atrophic with a thin muscularis propria.
Diverticulosis is the condition of having several diverticula, typically found in the sigmoid colon.
Diverticulitis: Diverticulitis with inflammatory infiltration and edema

Clinical Symptoms 
Diverticulosis typically has no symptoms but may cause mild stomach pain and visible blood in the stool without white blood cells or cells from the intestinal lining.
Diverticulitis is characterized by symptoms such as fever, persistent cramp-like pain in the lower left part of the abdomen, and potentially the presence of bright red blood in the stool. Complications may involve perforation, abscess development, and obstruction. peritonitis and fistula formation


Treatment for diverticulosis includes a high-fiber diet and psyllium fiber laxatives.
Treatment for diverticulitis includes antibiotics, a high-fiber diet, and colonic resection may be necessary for recurrent occurrences.
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​Pathology - Ulcerative Colitis
Possibly linked to immune system malfunction
Primarily seen in women between the ages of 20 and 25, but can impact individuals of all age groups.

Pathology - Gross• Persistent colon lesions with rectal involvement, fragile mucosal lining, pseudopolyps (residual mucosal tissue from past ulcers) with freely hanging mesentery.
Minuscule. Mononuclear inflammatory cells have infiltrated the lamina propria, leading to crypt abscesses and ulcers with a neutrophilic infiltrate in the crypt lumen. Dysplastic alterations are present in the epithelial cells. Fibrosis in the submucosa and glandular atrophy are consequences of the healed disease.

May manifest as tenesmus (the feeling of needing to pass stools with unsuccessful straining). Persistent diarrhea accompanied by blood and mucous. and experiencing lower abdomen ache with cramps
Extraintestinal signs include pyoderma gangrenosum, which are severe ulcerating boils, and primary sclerosing cholangitis.
 
Possible complications are severe narrowing of the colon, toxic megacolon (inflammation of nerve networks in the intestinal wall leading to tissue death), and higher chances of developing colorectal cancer.
Imaging: Loss of haustrations results in a lead-pipe look.
Antidiarrheals, sulfasalazine, glucocorticoids, immunomodulators, and proctocolectomy with ileostomy installation are curative treatments.
Ulcerative colitis is classified as an inflammatory bowel disease, similar to Crohn's disease.
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​Pathology - Mesenteric ischemia
Can result from arterial or venous thrombosis due to hypercoagulable states or atherosclerosis. Arterial embolism can occur from atrial fibrillation, endocarditis, or poor perfusion conditions such as shock.
Mesenteric ischemia can manifest as either acute or chronic and may affect the superior mesenteric artery, inferior mesenteric artery, or celiac artery.

Study of diseases 
Acute cases can vary from minor damage involving only the mucosa (swollen, bleeding thickening of the mucosa with shedding of the outer layer) to total damage across the entire bowel wall (areas of bleeding, swelling, and tissue death with signs of gangrene caused by intestinal bacteria within 1-4 days).
Chronic inflammation underneath the mucosa with fibrosis present in a patchy distribution, potentially leading to the formation of strictures. Intestinal villi atrophy

Clinical Symptoms
Acute: Abrupt start of widespread, continuous abdominal discomfort that is disproportionate to examination findings; accompanied by nausea and vomiting
Symptoms of chronic abdominal pain after eating and weight loss may indicate involvement of the inferior mesenteric artery, leading to conditions such ischemic colitis which can cause bloody diarrhea.
Complications of acute mesenteric ischemia may involve widespread intestinal necrosis, shock, and even death.

Therapy 
Manage risk factors such as lipid control and smoking cessation. Consider antibiotics, anticoagulation for embolic causes, surgical excision of necrotic bowel, and revascularization of blocked blood vessels as necessary.
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​Pathology - Adenomatous Polyps of the Colon 
Linked to a hereditary tendency (perhaps related to a mutation of a tumor suppressor gene on chromosome 5).
Found in 35% of persons over 50 years old.
Tubular adenomas account for 75% of cases. Typically located in the colon; tiny and pedunculated with a stalk. Dysplastic epithelium exhibiting hyperchromatic nuclei and disorientation of cells.
Tubulovillous adenomas make for 15% of cases. Similar to tubular adenomas, however the surface is lined with fingerlike villi. resembling villous adenomas
Villous adenomas (10%): Typically located in the rectum or sigmoid colon, these polyps are broad-based (sessile) and contain many fingerlike villi with dysplastic columnar epithelium.

Clinical Symptoms 
Typically without symptoms but can lead to rectal bleeding, perhaps resulting in iron deficiency anemia. 
Linked to a higher likelihood of developing colorectal adenocarcinoma, particularly in cases including villous adenomas.

Therapy 
Colonoscopy to remove adenomatous polyps, surgery to remove big sessile lesions, and follow-up colonoscopy every 3-5 years.
Aspirin and NSAIDs are employed to reduce the occurrence of adenomas and colorectal cancer.
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Pathology - ​Multiple Polyposis Syndromes
Familial Adenomatous Polyps 
Etiology: Autosomal dominant disorder resulting from a mutation in the APC gene located on chromosome 5.
Clinical presentation: 500-2500 colonic adenomas are observed at puberty.
Treatment: Prophylactic colectomy (necessary to prevent 100% of cases from developing into colon cancer if not removed)

Hereditary nonpolyposis Colorectal Cancer 
Cause: An autosomal dominant disease is the result of a failure in DNA mismatch repair genes located on chromosome 2, 3, or 7.
Clinical symptoms: Early development of colonic adenomas in young adulthood raises the likelihood of developing colorectal cancer and other cancers, particularly endometrial cancer.
Treatment: Surgery

Peutz-Jeghers syndrome 
Etiology. Autosomal dominant genetic disorder.
Clinical features include palpable hamartomatous polyps in the colon and small intestine, as well as melanotic macules in the mouth, lips, hands, and genitalia. While there is no heightened risk of colorectal cancer, there is an increased susceptibility to stomach, breast, ovarian, pancreatic, uterine, or lung cancer.
Treatment: Regular monitoring for cancer.

Gardner Syndrome and Turcot Syndrome 
Cause: Autosomal dominant disorders linked to abnormalities in the APC gene on a certain chromosome.
Clinical symptoms: Gardner Syndrome is characterized by the presence of adenomatous polyps, osteomas, and soft-tissue tumors. Turcot Syndrome is characterized by the presence of adenomatous polyps with carcinoma in situ tumors. Both disorders have a higher risk of developing colorectal cancer. Treatment: Surgical removal
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​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.
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​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.
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​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 
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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. 
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​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.
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