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GIT 3
Dr. Basu MD
Topic
Ischemic bowel disease
Hirschsprung disease (congenital mega colon)
Meckel diverticulum
Diverticular Disease
Intestinal obstructions
Volvulous, hernia
Intussuseption
Angiodysplasia.
Ischemic bowel disease
Etiology
Cause by sudden (acute) complete
obstruction of the ‘blood flow’.
Transmural
infarction
All layers are involved, gangrene.
Clinical: mimic perforation.
Etiology
• Mesenteric Arterial
thrombosis: sources=
MI, IE, paradoxical
embolism.
• Venous thrombosis=
hypercoagulable
states.
Morphology
Common in Splenic flexure
Severe, acute abdominal
pain and tenderness.
Peristaltic sounds diminish
or disappear, and
Spasm creates board-like
rigidity of the abdominal
wall.
No free air in abdomen ( a
feature of perforation)
Hirschsprung disease
• About 50% of familial cases are a
consequence of mutations in the RET gene.
• Incidence: 1: 5000/8000 live birth
• Area of constriction : is the aganglionic
segment.
• Proximal portion to that area: undergoes
progressive dilation and hypertrophy
Aganglionic segment
Diverticula
True diverticula
False diverticula
Diverticulum
Meckel diverticulum Rule of 2 ( 2%, 2 inch, 2 ft
away from ilioceacal jn.),
produce peptic ulcer disease.
Diverticular Disease Blind pouch leading off the
alimentary tract.
Produce
diverticulitis,diarrhea.
Meckel diverticulum:
Vitelline duct produces this.
Study other similar picture
Present in anti
mesenteric border.
Mucosa contain gastric
parietal cells.
Diverticular Disease
Study other similar picture
Site: Most common site is the left side of
the colon, with the majority in the sigmoid
colon.
Age : adult
Diverticular Disease
• Out pouching of the colon mucosa
• If Infection present = call it diverticulitis (
acute pain in left lower abdomen with
leukocytosis).
• Discomfort, constipation, distention.
• Rectal (lower GI) bleeding.
Intestinal obstruction
Causes:
Intussusception,
Herniation (umbilical or inguinal),
Adhesion between loops of
intestine- from peritonitis.
Volvulus formation.
Hernia
• Def: The protrusion of an
organ or structure into
surrounding tissues.
Inguinal hernia: bulges in the groin area become more
prominent when coughing, straining, or standing up.
They are often painful, and the bulge commonly
disappears on lying down.
Can cause intestinal obstruction!
Volvulus
• Def: is a loop of the bowel whose nose has
twisted on itself .
• Etiology : may be spontaneous
• C/F: sudden abdominal pain, distension, and
absolute constipation. Cannot introduce
scope after certain distance per rectum.
• Complications:
– Ischemia, gangrene
INTUSSUSCEPTION
INTUSSUSCEPTION Proximal segment Invaginate
(telescoped) into the
immediately distal segment of
bowel.
Cause: without any reason or
rotavirus infection (child).
Intra luminal mass ( adult).
Telescoped intestine
Intra luminal mass
- arrow.
Clinical : Sudden pain abdomen
Current jelly stool. Sausage shaped mass in
abdomen.
Clinical of obstruction
Clinical of obstruction
• A high obstruction = severe vomiting, no passage of
stool, Distension, ? a mass palpable.
• Low obstruction= Distension, ? Mass palpable, no
passage of stool/ flatus (absolute constipation).
• Acute obstruction= colicky pain (increased
peristalsis).
• Gradual obstruction= tumor= insidious, over some
weeks. Symptoms may gradually worsen. Diameter
of stool will gradually decrease.
Note pad
Miscellaneous
Angiodysplasia
Osler-weberrendu
Arteriovenous malformation.
Cecum and rt. Colon.
C/F: episodes of rectal bleeding.
Associated with Osler-weberrendu and CREST syndrome
Heredetary telangectesis ( lips,
tongue, finger),
Autosomal dominant.
Next topic
• Acute appendicitis
• HEMORRHOIDS
• Peritonitis
Acute appendicitis*******
Cause→
Obstruction ( by fecalith, a gallstone,
tumor, or ball of worms (oxyuriasis
vermicularis).
Clinical feature
Pain localizing to the right
→
lower quadrant.
Morphology →
Gross and micro: Exudate and
trans mural acute inflammation.
Lab →
Leukocytosis ( due to reactive
myeloid hyperplasia)
Tumor of →
Carcinoids and Mucinous
appendix
tumors.
Leukemoid reaction
• = reactive myeloid hyperplasia
• = accelerated release of myeloid cells from
the BM (reserve pool).
Exudates on serosa with
congested blood vessels
Trans mural
acute inflammation
HEMORRHOIDS
• Hemorrhoids are variceal dilations
of the anal and perianal venous
plexuses.
• Cause: Constipation ( by cocaine),
strain on stool, and pregnancy,
after child birth.
• Clinical : fresh blood during
defecation (pain in external type).
Peritonitis
• Cause: appendicitis, ruptured peptic ulcer,
pancreatitis, bile, acute salpingitis [PID], dialysis.
• c/f: acute abdominal pain and gurding, which
are exacerbated by moving the peritoneum,
Rebound tenderness .
Thank you

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