GI Path

  1. What is this? Why is the extensive blood flow and venous drainage important?

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    Seen here is a loop of bowel attached viathe mesentery. An extensive vascularnetwork is present to the supplyadequate blood flow to the bowel.making it more difficult to infarct. Theextensive venous drainage of the bowelleads into the portal venous systemsupplying the liver.
  2. What area are we in? To what do the arrows point?

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    • Small intestine
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  3. Where are we? What are 1, 2, 3, and 4?
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  4. Where are we? What are 1, 2, 3, and 4?

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  5. Where are we? What do the arrows point to?

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  6. Where are we? What are the labels?
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  7. Where are we? What are the numbers?

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  8. Where are we? What are the labels? What is significant about number one?Image Upload 14
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  9. Where are we? What do the arrows point to?
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  10. What is this and why is it important?
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    • Bowel Ischemia and Infarction of the small intestine
    • The infarction is the dark red portion as compared to the light pink, healthy bowel
    • The forcepts extend through an internal hernia in which a loop of bowel and mesentery has been caught (what caused the trapped bowel to lose its blood supply). In this case, this is a complication of adhesions from a previous surgery.
  11. What is this (normal is on left, path is on right)?

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    • Left: Normal small intestinal mucosa
    • Right: Celiac disease, in which the mucosa has a blunting and flattening of villi (caused by the disease)
    • Celiac disease is diagnosed in about 1 in 3000 persons in the U.S. It is more common inCaucasians and uncommon in African‐Americans and Asians. About 95% of patientshave the HLA‐DQ2 allele, which suggests a genetic basis for developing celiac disease. Ingestion of certain grains (wheat, rye, barley) that contain gluten (the gliaden protein)will cause celiac sprue. The enzyme tissue transglutamidase breaks down gliaden intopeptides that, when displayed to antigen presenting cells, activate CD4 lymphocytes to generate mucosal inflammation.
  12. Where is this? What is unusual here? What are numbers 1, 2, 3, and 4?

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    • The intestine, showing chronic inflammation
    • 1: Lymph nodules
    • 2: Mucosa
    • 3: Submucosa
    • 4: Muscularis externa
    • Except in the appendix and in Peyer's patches of the ileum, the presence of lymphoidtissue is normally infrequent in the intestine. However, chronic inflammation, as occursin inflammatory bowel disease, can lead to heavy lymphocyte infiltration and formationof lymph nodules throughout the mucosa.
  13. What disease is associated with this? What is a each arrow?
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    • Crohn's disease: Although any portion of the gastrointestinaltract may be involved in Crohn's disease,the small intestine and terminal ileum inparticular, are most likely to be involved.Areas of inflammation tend to bediscontinuous throughout the bowel andserosal inflammation often leads to adhesions.
    • Arrows 1 and 2 relate to the middle portion of the bowel, specifically
    • 1: Shows where the mucosa has lost its normal folds
    • 2: Shows the thickened wall of the bowel
    • Arrows 3 and 4 relate to the fact that Crohn's is a transmural disease, specifically
    • 3: In this section, inflammatory cells (bluestainedinfiltrates) extend from mucosathrough submucosa and muscularis.
    • 4: Inflammatory cells form nodular patcheson the serosal surface with palegranulomatous centers.
  14. What disease is this? What do the arrows indicate?
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    • This is Crohn's disease
    • Arrows 1-3 represent the granulomatous nature of Crohn's, specifically
    • 1: giant cells
    • 2: epitheloid cells
    • 3: neutrophils
    • 4: A fissure extending through the mucosa into the submucosa toward the muscular wall (will eventually form a fistula); one of the many complications of Crohn's disease. Fistulae can form between loops of bowel, bladder and skin. With colonic involvement, peri‐rectal fistulae often occur
  15. What organ is this and what function does it serve?
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    • Appendix, normal
    • Although the function of the appendix isunknown, one theory is that the appendix actsas a reservoir for normal colonic bacteria and“reboots” the digestive system after diarrhealepisodes. Others believe the appendix is just auseless remnant from our evolutionary past.Surgical removal of the appendix causes noobservable health problems.
    • 1: submucosa
    • 2: lymph nodules
    • 3: crypts
    • 4: lumen
    • 5: submucosa
    • 6: crypts
    • 7: mucosa
    • 8: submucosa
    • 9: lymph nodule
  16. What disease is this? What do the arrows represent?
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    • Acute Appendicitis
    • Serosal surface of gross image at the left shows a tan yellow exudate
    • 1: yellowish‐tan mucosal exudation
    • 2: hyperemic border
    • 3 and 4 relate to inflammation
    • 3: mucosal layer and extending into the
    • 4: sub‐mucosa
  17. What disease is this? What do the arrows indicate?
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    • Acute Appendicitis
    • 1: Medium magnification of a section showingextensive inflammation throughout mucosallayer. Some evidence of hemorrhage is seenat the top of this section.
    • 2: High magnification of a section showingextensive neutrophil infiltration.
  18. What regions of the colon are these?
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    • 1: Rectum
    • 2: Sigmoid colon
    • 3: Splenic flexure
    • 4: Ascending colon
    • 5: Cecum
    • 6: Cecum and appendiceal orifice
    • 7: transverse colon
  19. Where is this? What do the arrows indicate? What is special about 10?
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    • Large intestine: Mucosal layer
    • 1: submucosa
    • 2,9: muscularis mucosa
    • 3,4,5: crypts
    • 6,8: lamina propria
    • 7: crypt lumen
    • 10: High magnification of a section showingextensive neutrophil infiltration.
  20. Where are we? What is this specialized stain called and how does it work? What do the arrows represent?
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    • Large Intestine: PAS stain for mucous
    • PAS stain: Periodic acid-Shiff (PAS) is a staining methodused to detect polysaccharides like glyogen and neutrol mucosubstances like glycoproteins/glycolipids and neutral mucins in tissues. The reaction of PAS modifies aldehyde groups on carbs to give a purple-magenta color
    • 1: lamina propria
    • 2: goblet cells
    • 3: lumen of colon
    • 4: crypt lumen
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Card Set
GI Path
path for exam 2