PATHOLOGY OF THE

GASTROINTESTINAL

TRACT, PART II

VI. practical training

3rd year General Medicine

Haemorrhagic infarction of the intestine

Haemorrhagic infarction of the intestine

Infarction of the intestine

Enteritis cararrhalis acuta

Enteritis cararrhalis acuta

Pseudomembranous colitis

ULCERATIVE COLITIS

Local complications

ULCERATIVE COLITIS

Systemic complications

Ulcerative colitis

Ulcerative colitis

Ulcerative colitis

1

2

3

4

4

1 Mucosa with parts of preserved epithelium

2 Inflammatory infiltrate in mucosa and

submucosal connective tissue

3 Muscularis propria

4 Ulceration in mucosa

Ulcerative colitis – crypt abscess

1

2

3

1 Crypt abscess

2 Inflammatory infiltrate in mucosa

3 Lamina muscularis mucosae

Ulcerative colitis – detail - crypt abscess

1

1 crypt abscess

Ulcerative colitis

Crohn´s disease

Crohn´s disease

Crohn´s disease

A comparison of Crohn’s disease and ulcerative

colitis

Grossly

Location

Extension

Lumen narrowing

Wall thickeness

Fistulations

Crohn’s disease

From oral cavity to anus

– right-sited colitis

– mostly small intestine

segmental

typical

typical

common

Ulcerative colitis

Large intestine

– left-sited colitis

– rektum

diffuse

not typical

not typical

absent

A comparison of Crohn’s disease and ulcerative

colitis

Microscopicaly

Transmural inflammation

Submucosal fibrosis

Fisuration

Granulomas

Crypt abscess

Crohn’s disease

typical

typical

typical

common

not typical

Ulcerative colitis

not typical

absent

sporadic

absent

typical

Enteritis regionalis (colon) – Morbus Crohn

1

2

3

4

1 Mucosa

2 Submucosa

3 Muscularis propria

4 Serosa and subserosa

5 Inflammatory infiltrate

5

Enteritis regionalis (colon)– Morbus Crohn

1 Fissure in mucosa

2 Crypts without dysplastic changes

3 Chronic inflammatory infiltrate

1

2

2

3

Morbus Crohn

Diverticular disease

Diverticulitis of the large bowel

Meckel’s diverticulum

Intestinal polyp

Intestinal polyp

Intestinal tubulo-villous adenoma

Intestinal polyps

Epithelial

Non-tumorous

Sporadic

adenomas

heredital

familiar

syndromes

Benign

hyperplastic

juvenile

inflammatory

lymphoid

tubular adenoma

villous adenoma

tubulo-villous

FAP

Gardner’s sy (+ osteomas, soft tissue tumours)

Turcot’s sy (+ malignant CNS tumours)

Peutz-Jeghers’ sy

Malignant

polypoid carcinoma

carcinoids

Intestinal polyps

Mesenchymal

Benign

lipoma

hemangioma

fibroma

leiomyoma

Malignant

sarcomas

lymphomas

Appendix-normal

copy

Ulcerophlegmonous appendicitis

copy

Ulcerophlegmonous appendicitis

1 Inflammatory exudate in lumen

2 Mucosa

3 Muscularis propria

4 Subserous connective tissue

All layers are infiltrated by phlegmonous

infiltrate

1 2 4

3

Ulcerophlegmonous appendicitis

1 Inflammatory exudate in lumen

2 Mucosa with massive inflammation

3 Muscularis propria

1

2

3

Ulcerophlegmonous appendicitis

1 Phlegmonous infiltrate in muscularis

propria

2 Phlegmonous infiltrate in subserous

connective tissue

2

1

Ulcerophlegmonous appendicitis, detail

Carcinoid of the appendix

1 2

1 Carcinoid in apendix

2 Lymphatic tissue in apendix

Carcinoid of the appendix – detail

1

1 2

1 Tumour cells

2 Stroma of tumour

Carcinoid of the appendix – detail

Chronic cholecystitis

Normal Chronic cholecystitis

1 mucosa 2 muscle layer 3 subserous tissue

1

1

1

1

2

2 2

2

3

3 3

3

Chronic cholecystitis

1 Epithelium

2 Chronic inflammatory infiltration in mucosa

3 Muscularis propria

1

1 2

2

2

3

3

Chronic cholecystitis – Aschoff-Rokitansky sinus

1 Epithelium

2 Chronic inflammatory infiltration

in mucosa

3 Muscularis propria

4 Aschoff-Rokitansky sinus

1

1

2

2

3

3 4

Absceding cholangitis

Cystic fibrosis of the pancreas

Cystic fibrosis of the pancreas

Acute haemorrhagic necrosis of pancreas

Colorectal adenocarcinoma

Colorectal adenocarcinoma

Colorectal adenocarcinoma