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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.
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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.
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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.
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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.
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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
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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
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Symptoms and Signs – Differential Diagnosis of Elevated Hemidiaphragm
• Aortic aneurysm
• Atelectasis
• Eventration
• Idiopathic
• Infectious process (pneumonia, empyema, TB, subphrenic abscess, hepatic abscess)
• Intra-abdominal mass
• Neoplasm (bronchogenic carcinoma, mediastinal neoplasm, intrahepatic lesion)
• Phrenic nerve dysfunction (myelitis, myotonia, herpes zoster)
• Pleurisy
• Pulmonary infarction
• Radiation therapy
• Rib fracture
• Substernal thyroid
• Trauma to phrenic nerve or diaphragm (e.g., surgery)
• Aortic aneurysm
• Atelectasis
• Eventration
• Idiopathic
• Infectious process (pneumonia, empyema, TB, subphrenic abscess, hepatic abscess)
• Intra-abdominal mass
• Neoplasm (bronchogenic carcinoma, mediastinal neoplasm, intrahepatic lesion)
• Phrenic nerve dysfunction (myelitis, myotonia, herpes zoster)
• Pleurisy
• Pulmonary infarction
• Radiation therapy
• Rib fracture
• Substernal thyroid
• Trauma to phrenic nerve or diaphragm (e.g., surgery)
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Symptoms and Signs – Differential Diagnosis of Arterial Emboli
• Sick sinus syndrome
• Prosthetic heart valve
• Paradoxical embolus from venous thrombosis
• Myocardial infarction (MI) with mural thrombi
• Left ventricular (LV) aneurysm
• Left atrial myxoma
• Endocarditis
• Congestive heart failure (CHF)
• Cardiomyopathy
• Atrial fibrillation
• Atheromatous ulcers of large blood vessels
• Aneurysms of large blood vessels
• Sick sinus syndrome
• Prosthetic heart valve
• Paradoxical embolus from venous thrombosis
• Myocardial infarction (MI) with mural thrombi
• Left ventricular (LV) aneurysm
• Left atrial myxoma
• Endocarditis
• Congestive heart failure (CHF)
• Cardiomyopathy
• Atrial fibrillation
• Atheromatous ulcers of large blood vessels
• Aneurysms of large blood vessels
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Symptoms and Signs - Differential Diagnosis of Emesis at Pediatric Age
INFANCY
Gastrointestinal Tract
• Congenital
• Regurgitation: chalasia, gastroesophageal reflux
• Atresia: stenosis (tracheoesophageal fistula, prepyloric diaphragm, intestinal atresia)
• Duplication
• Volvulus (errors in rotation and fixation, Meckel’s
diverticulum)
• Congenital bands
• Hirschsprung’s disease
• Meconium ileus (cystic fibrosis [CF]), meconium plug
• Acquired
• Acute infectious gastroenteritis, food poisoning
(staphylococcal, clostridial)
• Pyloric stenosis
• Gastritis, duodenitis
• Intussusception
• Incarcerated hernia: inguinal, internal secondary to old adhesions
• Cow’s milk protein intolerance, food allergy, eosinophilic gastroenteritis
• Disaccharidase deficiency
• Celiac disease: presents after introduction of gluten in diet; inherited risk
• Adynamic ileus: the mediator for many nongastrointestinal causes
• Neonatal necrotizing enterocolitis
• Chronic granulomatous disease with gastric outlet obstruction Non–Gastrointestinal Tract
• Infectious: otitis, urinary tract infection (UTI), pneumonia, upper respiratory tract infection, sepsis, meningitis
• Metabolic: aminoaciduria and organic aciduria, galactosemia, fructosemia, adrenogenital syndrome, renal tubular acidosis, diabetic ketoacidosis, Reye’s syndrome
• CNS: trauma, tumor, infection, diencephalic syndrome, rumination, autonomic responses (pain, shock)
• Medications: anticholinergics, aspirin, alcohol, idiosyncratic reaction (e.g., codeine)
CHILDHOOD
Gastrointestinal Tract
• Peptic ulcer: vomiting is a common presentation in children younger than 6 years.
• Trauma: duodenal hematoma, traumatic pancreatitis, perforated bowel
• Pancreatitis: mumps, trauma, CF, hyperparathyroidism, hyperlipidemia, organic acidemias
• Crohn’s disease
• Idiopathic intestinal pseudo-obstruction
• Superior mesenteric artery syndrome
Non–Gastrointestinal Tract
• CNS: cyclic vomiting, migraine, anorexia nervosa, bulimia
INFANCY
Gastrointestinal Tract
• Congenital
• Regurgitation: chalasia, gastroesophageal reflux
• Atresia: stenosis (tracheoesophageal fistula, prepyloric diaphragm, intestinal atresia)
• Duplication
• Volvulus (errors in rotation and fixation, Meckel’s
diverticulum)
• Congenital bands
• Hirschsprung’s disease
• Meconium ileus (cystic fibrosis [CF]), meconium plug
• Acquired
• Acute infectious gastroenteritis, food poisoning
(staphylococcal, clostridial)
• Pyloric stenosis
• Gastritis, duodenitis
• Intussusception
• Incarcerated hernia: inguinal, internal secondary to old adhesions
• Cow’s milk protein intolerance, food allergy, eosinophilic gastroenteritis
• Disaccharidase deficiency
• Celiac disease: presents after introduction of gluten in diet; inherited risk
• Adynamic ileus: the mediator for many nongastrointestinal causes
• Neonatal necrotizing enterocolitis
• Chronic granulomatous disease with gastric outlet obstruction Non–Gastrointestinal Tract
• Infectious: otitis, urinary tract infection (UTI), pneumonia, upper respiratory tract infection, sepsis, meningitis
• Metabolic: aminoaciduria and organic aciduria, galactosemia, fructosemia, adrenogenital syndrome, renal tubular acidosis, diabetic ketoacidosis, Reye’s syndrome
• CNS: trauma, tumor, infection, diencephalic syndrome, rumination, autonomic responses (pain, shock)
• Medications: anticholinergics, aspirin, alcohol, idiosyncratic reaction (e.g., codeine)
CHILDHOOD
Gastrointestinal Tract
• Peptic ulcer: vomiting is a common presentation in children younger than 6 years.
• Trauma: duodenal hematoma, traumatic pancreatitis, perforated bowel
• Pancreatitis: mumps, trauma, CF, hyperparathyroidism, hyperlipidemia, organic acidemias
• Crohn’s disease
• Idiopathic intestinal pseudo-obstruction
• Superior mesenteric artery syndrome
Non–Gastrointestinal Tract
• CNS: cyclic vomiting, migraine, anorexia nervosa, bulimia
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Symptoms and Signs – Differential Diagnosis of Empyema
• Collagen-vascular disease (particularly rheumatoid lung and systemic lupus erythematosus [SLE])
• Congestive heart failure (CHF)
• Malignant neoplasm involving the pleura
• Tuberculous pleurisy
• Uninfected parapneumonic effusion
• Collagen-vascular disease (particularly rheumatoid lung and systemic lupus erythematosus [SLE])
• Congestive heart failure (CHF)
• Malignant neoplasm involving the pleura
• Tuberculous pleurisy
• Uninfected parapneumonic effusion
