P year‎ > ‎Surgery‎ > ‎

13.01.17 Pathology teaching

Granuloma
  • Aggregate of ACTIVATED (epithelioid) macrophages
  • Causes:
    • TB
    • Sarcoid
    • Crohn's

Crohn's
  • Ileocecal area
  • Rectal sparing
  • Patchy distribution
  • Aphthous ulcers
  • Transmural inflammation
    • Adhesions
    • Fistulas
    • Strictures
  • GRANULOMAS
  • Fissuring ulcers
    • => Cobblestoning (areas of surviving mucosa between fissures)
  • Dysplasia is less common

UC
  • Affects mucosa only
  • Crypt abscesses
    • In mucosa
    • Full of neutrophils
  • Extensive, diffuse inflammation
  • Dysplasia is common
    • Because it affects the mucosa

Bowel obstruction
  • Features
    • Absolute constipation
      • Faeces
      • Flatus
    • Colicky pain
    • Vomiting
    • Abdominal distension
  • Small bowel
    • Adhesions (=> kinking)
    • Crohn's
    • Volvulus
    • Hernia
    • Intususception
  • Large bowel
    • CRC
      • 25% present with obstruction
    • Diverticular strictures
    • Sigmoid volvulus

Ileus
  • Clinical features
    • Mimics obstruction
      • Distension
      • Vomiting
    • BUT pain is from the underlying disorder, not from the bowel
      • Bowel is paralysed => No colicky pain
  • Causes
    • Post-op
    • Any cause of peritonitis
    • Opioids
    • Electrolyte imbalance

Notes

  • 4 signs of acute inflammation, plus LOF
  • Neutrophils climb along fibrin scaffold
  • IL-6 stimulated mediators
    • CRP
      • Opsonin
      • Complement activation
    • Fibrinogen
    • Mannose binding lectin
  • Granulation tissue is PINK
    • Huge proliferation of capillaries
  • Pseudomonas => Green tinge
  • Old patient with rectal bleeding
    • Angiodysplasia
    • Ischaemic bowel disease
    • Ca
  • Anterior resection = Removal of all or part of the rectum, with primary anastamosis
    • cf APR
  • Obstruction: Pain progresses from colicky to peritonitic as bowel is paralysed and dies

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