ulcers of the intestine
TRANSCRIPT
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Ulcers of Intestine
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SLOs
• Classification
• Salient features – Pathogenesis – Gross – Histology – Complications
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Ulcer
“Ulcer is a breach in the continuity of skin,
epithelium or mucous membrane caused by
sloughing out of inflammed necrotic
tissue”
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Intestinal Ulcers
Peptic
• Duodenal
Infection
• Bacterial • Virus • Protozoa
Immune
• GVHD• Crohn• Ulcerative
Malignant
• Carcinoma
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Duodenal Peptic Ulcer
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Pathogenesis
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Gross
Necrotic slough
Rounded edge
Sharp edge
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Histopathology
Necrotic slough
Non-specific inflammtion
Granulation tissue
Fibrosis
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Complications
Bleeding Perforation
Penetration Stenosis
Malignancy
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Typhoid ulcer
Salmonella typhimurium Salmonella paratyphi
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Pathogenesis
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Gross
Peyer’s patches
Oval ulcers
Long axis
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Histopathology
Aggregates of macrophages
Typhoid nodules
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Complications
Bleeding Perforation
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Tuberculosis ulcer
Mycobacterium tuberculosis Mycobacterium bovis
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Pathogenesis
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Gross
Transverse ulcers
Short axis
Direction of lymphatics
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Histopathology
Epithelioid cell granuloma
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Complications
Bleeding Stenosis
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Amoebic ulcer
Entamoeba histolytica
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Pathogenesis
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Gross
Pin –point ulcers
Nodules
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Histopathology
Flask shaped ulcer
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Complications
Bleeding Perforation
Obstruction
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Pseudmembranous colitis
Clostridium difficile
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Pathogenesis
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Gross
Cap lesion
Pseudomembrane
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Histopathology
Mushroom / Volcanic eruption
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Complications
Malabsorption Toxic megacolon
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CMV Colitis
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Pathogenesis
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Gross
Erythematous base
Haemorrhagic
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Histopathology
Inflammation
CMV inclusion
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Complications
Malabsorption
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Ulcerative colitis
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Pathogenesis
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Gross
Continuous
Wide ulcers
Pseudopolyps
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Histopathology
Blunting and distortion of
villi
Cryptitis
Crypt abscess
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Complications
Malabsorption Toxic megacolon
Carcinoma
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Crohn’s disease
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Pathogenesis
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Gross
Skip lesions
Serpengious ulcers
Cobblestone
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Histopathology
Transmural
Fissure
Granuloma
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Complications
Malabsorption Fistula
Strictures Carcinoma
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Graft versus host disease
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Pathogenesis
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Gross
Pin point
Haemorrhagic
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Histopathology
Apoptosis
Intra-epithelial lymphocytes
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Complications
Malabsorption Haemorrhage
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Carcinoma
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Pathogenesis
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Gross
Ulceroproliferative
Rolled up indurated
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Histopathology
Irregular glands
Dysplasia
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Complications
Obstruction Metastases
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Summarise
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Questions