GI TRACT
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

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I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

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Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with people's health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

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More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
Inflammation
Fluids
Genes
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Autoimmunity
Other Immune
HIV infections
The Anti-Immunization Activists
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Infections
Nutrition
Environmental Lung Disease
Violence, Accidents, Poisoning
Heart
Vessels
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Eye
Ear
Autopsy
Lab Profiling
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Renal Function Tests
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Arthritis Labs
Glucose Testing
Liver Testing
Porphyria
Urinalysis
Spinal Fluid
Lab Problem
Quackery
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

We have two ends with a common link;
With one we sit, with one we think.
Success depends on which we use;
Heads we win, tails we lose!

          --Author unknown

GI
Taiwanese pathology site
Good place to go to practice

Gastrointestinal
Surgical Pathology Atlas
Nice photos, hard-core

Gastrointestinal
Brown Digital Pathology
Some nice cases

Gastrointestinal Images
University of Washington
Pictures and comments

GI Tract Pathology
Photomicrograph collection
In Portuguese

Gastrointestinal
Utah cases for path students
Juliana Szakacs MD

Gastrointestinal
Iowa Virtual Microscopy
Have fun

Pathology of GI infections
Great site
Yutaka Tsutsumi MD

Gastrolab
Endoscopy photos
Lots of great pathology

GI Tract
Photo Library of Pathology
U. of Tokushima

Gastrointestinal
Photos, explanations, and quiz
Indiana U.

KCUMB Students
"Big Robbins" -- GI Tract
Lectures follow Textbook

QUIZBANK

STUDY OBJECTIVES

Consider this mastery material.

Be sure you can use the following terms correctly, and tell how and where they apply to the gut.

Be sure you can recognize each of the kinds of lesions presented on the videodisc!

INTRODUCTION

GI Malformations
From Chile
In Spanish

For the basics of the GI viruses, click here.

Remember that blood that stays in the stomach for a while before being vomited / removed by tube will look like "coffee grounds" ("acid hematin"). Upper GI bleeding that produces diarrhea will produce melena (black tarry stools with an odor you'll come to know well), while bleeding from the hindgut will usually be bright red (hematochezia).

ESOPHAGUS

Esophageal Pathology
Sampurna Roy, MD
Lots of photos and good text

Esophagus Exhibit
Virtual Pathology Museum
University of Connecticut

Esophagus
"Pathology Outlines"
Nat Pernick MD

Normal gastro-esophageal junction

WebPath Photo


Normal gastro-esophageal junction

WebPath Photo


Throat
Ed's Histology Notes

{20073}    esophageal atresia, from behind. Lungs at the sides, stomach at the bottom

{15553}    glycogen acanthosis of esophagus, gross

{09433}    Schatzki ring
{09434}    Schatzki ring
{09435}    web


{19451}    histopathology of reflux (basal cell hyperplasia)

Barrett's esophagus

WebPath Photo


Barrett's esophagus.

WebPath Photo


Barrett's

WebPath Photo


Barrett's esophagus
Joel K. Greenson MD
U. of Michigan


Barrett's, low grade dysplasia
AFIP
Wikimedia Commons

Barrett's, low grade dysplasia
AFIP
Wikimedia Commons

Barrett's, high grade dysplasia
AFIP
Wikimedia Commons

Barrett's, high grade dysplasia
AFIP
Wikimedia Commons

Barrett's, high grade dysplasia
AFIP
Wikimedia Commons

Barrett's, low grade dysplasia
AFIP
Wikimedia Commons

Barrett's, low grade dysplasia
AFIP
Wikimedia Commons

Barrett's, no atypia
AFIP
Wikimedia Commons

{15428}    Barrett's esophagus (note tan columnar, rather than white squamous, mucosa)
{15429}    Barrett's esophagus
{15427}    acute reflux esophagitis (one heck of a case of heartburn; stomach is on the left)

Reflux
Eosinophils, slight atypia
KU Collection

Herpes esophagitis
Joel K. Greenson MD
U. of Michigan


CMV Esophagitis
Joel K. Greenson MD
U. of Michigan


Candida of esophagus
PAS stain
Wikimedia Commons

Herpes of the esophagus
Good herpes cells
Wikimedia Commons

Candida in the esophagus

WebPath Photo

Scleroderma
Trichrome stain
WebPath Photo


Candida of the esophagus
Urbana Atlas of Pathology

{11096}    candida esophagitis (scrapes off, unlike glycogen acanthosis)
{11099}    candida esophagitis
{49128}    candida esophagitis

Herpes esophagitis
Sharp borders
WebPath Photo


Herpes esophagitis

WebPath Photo


Herpes esophagitis

WebPath Photo


Herpes esophagitis
Nice herpes nuclei and inclusions

WebPath Photo

{19449}    herpes, histology
{25910}    herpes, pap smear

{11772}    lye burn of stomach
{15554}    lye burn of stomach

{15420}    lacerated esophagus

Esophageal varices

WebPath Photo


Esophageal varix

WebPath Photo


Esophageal varix
Inflamed after rupture
WebPath Photo


{38629}    varices, gross
{38632}    varices, gross
{15419}    esophageal varix, histology
{24406}    varices, histology
{40724}    varix with clot, histology

Esophageal Tumors
From Chile
In Spanish

Esophageal Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Esophageal cancer

WebPath Photo


Esophageal cancer
Squamous cell carcinoma
WebPath Photo


Squamous cell carcinoma

WebPath Photo


{15423}    carcinoma of the esophagus, exophytic growth
{15421}    carcinoma of the esophagus, growing as ulcer
{15422}    carcinoma of the esophagus, annular growth
{15424}    squamous carcinoma of the esophagus, histology
{15552}    carcinoma of esophagus invaded aorta
{19345}    yet another squamous cell carcinoma of the esophagus (x-ray)
{26876}    and another
{42231}    and still another

{49132}    leiomyoma, gross

STOMACH

{11889}    stomach with biscuit
{09332}    normal gastric rugae
{11740}    normal stomach fundus histology
{50459}    normal stomach fundus histology

Cool Hand Luke
"Sometimes nothing can be a pretty cool hand."

Gastric Pathology
Sampurna Roy, MD
Lots of photos and good text

Stomach Exhibit
Virtual Pathology Museum
University of Connecticut

Normal stomach

WebPath Photo


Normal gastric antrum

WebPath Photo


Normal gastric fundus mucosa

WebPath Photo


Stomach
"Pathology Outlines"
Nat Pernick MD

INTESTINAL METAPLASIA (review Gut 52: 1, 2003):

{15432}    type I intestinal metaplasia (right)
{15534}    type I intestinal metaplasia

{15607}    diaphragmatic hernia, left leaf never formed
{49138}    diaphragmatic hernia, left leaf never formed

Diaphragmatic hernia
WebPath Photo

Diaphragmatic hernia
WebPath Photo


    DILATED STOMACH

      Often impressive. Causes include beer chug-a-lugging, bowel obstruction, misplaced endotracheal tubes, gastroparesis (think of diabetic autonomic neuropathy), and (in the dead) inept CPR attempts. (Amateurs first blow air into the stomach, then rupture it by pressing in the wrong place. See Ann. Int. Med. 30: 343, 1997.)

{49141}    gastric dilatation

Cool Hand Luke

{49150}    bezoar
{10160}    trichobezoar

Pernicious anemia
Immunoglobulin on parietal cells
WebPath Photo


{15426}    "atrophic gastritis", gross
{15434}    "atrophic gastritis"
{15561}    early atrophic gastritis, starting on surface

Helicobacter

KU Collection

Helicobacter

KU Collection

Acute gastritis
Me after beer, pizza, and aspirin
WebPath Photo


Nasogastric tube erosions

WebPath Photo


Acute gastritis

WebPath Photo


Helicobacter

WebPath Photo


Helicobacter
H&E
Wikimedia Commons

Helicobacter pylori
Stained black
New England Journal of Medicine

Helicobacter gastritis (Warthin-Starry stain)
Dr. Tsutsumi
Wikimedia Commons

Helicobacter
Antibody stain
Wikimedia Commons

{11728}    Helicobacter in gastritis (look close)
{15440}    Helicobacter
{19492}    type B, antrum
{19491}    type B, antrum
{26903}    type A
{26906}    type A
{26909}    type A, some atypia

Gastritis I
From Chile
In Spanish

Gastritis II
From Chile
In Spanish

{19486}    Menetrier's, gross
{19487}    Menetrier's, histology

Menetrier's disease
Pittsburgh Pathology Cases

Watermelon Stomach
Joel K. Greenson MD
U. of Michigan


{15425}    "stress ulcer", gross
{18711}    "stress ulcers", gross
{19350}    "gastric erosion", histology
{39426}    hemorrhagic gastritis, nasogastric tube erosions
{07184}    hemorrhagic gastritis, nasty case

Curling ulcers

KU Collection

Stomach ulcer
Bleeder
WebPath Photo


Chronic gastric ulcer
Great labels
Romanian Pathology Atlas

Peptic Ulcer
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Benign gastric ulcer
Ed Uthman MD
Wikimedia Commons

Peptic Ulcer I
From Chile
In Spanish

Peptic Ulcer II
From Chile
In Spanish

Stomach ulcer

WebPath Photo


Stomach ulcer

WebPath Photo


Stomach ulcer

WebPath Photo


Stomach ulcer

WebPath Photo


{10471}    benign stomach peptic ulcer
{15438}    benign stomach peptic ulcer
{15439}    benign stomach ulcer, with clot
{15560}    histology of ulcer, arrow marks bleeding point
{19372}    peptic ulcer
{26888}    peptic ulcer, stomach

BENIGN TUMORS

{09292}    hyperplastic polyps of stomach
{38656}    hyperplastic polyps of stomach

Gastric hyperplastic polyp

Wikimedia Commons

{09333}    adenomatous polyp
{09312}    adenomatous polyp
{09331}    adenomatous polyp

Adenomatous colon polyp
WebPath Photo


Adenomatous polyp
Ed Uthman MD
Wikimedia Commons

Leiomyoblastoma
Bryan Lee

Leiomyosarcoma

WebPath Photo


{09299}    leiomyoblastoma

Stomach Tumors I
From Chile
In Spanish

Stomach Tumors II
From Chile
In Spanish

Stomach cancer
Pittsburgh Pathology Cases

Gastric carcinoma, intestinal type
Great labels
Romanian Pathology Atlas

Stomach cancers
Adenocarcinomas
Wikimedia Commons

Gastric carcinoma, diffuse mucinous type
Great labels
Romanian Pathology Atlas

Gastric Adenocarcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Gastric Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Stomach cancer

WebPath Photo


Stomach cancer

WebPath Photo


Stomach cancer
Linitis plastica
WebPath Photo


Stomach cancer at autopsy

WebPath Photo


Stomach cancer
Adenocarcinoma
WebPath Photo


Stomach cancer
Adenocarcinoma
WebPath Photo


Stomach cancer
Anaplastic adenocarcinoma
WebPath Photo


Stomach cancer
Signet ring adenocarcinoma
WebPath Photo


Stomach carcinoma
Positive cytokeratin stain
WebPath Photo


Huge Stomach Cancer
CDC
Wikimedia Commons

{17511}    Stomach cancer, exophytic
{10472}    Stomach cancer, ulcerated
{15509}    Stomach cancer, linitis plastica, gross
{15562}    Stomach cancer, linitis plastica, histology
{08818}    Stomach adenocarcinoma, intestinal type
{17517}    Stomach adenocarcinoma, intestinal type
{10473}    Stomach adenocarcinoma, diffuse type
{39380}    Stomach adenocarcinoma, diffuse type
{39392}    Stomach adenocarcinoma, diffuse type
{15510}    Signet ring stomach cancer
{19346}    Stomach cancer, superficial

{15443}    early stomach cancer

{15441}    non-metaplastic dysplasia
{15444}    non-metaplastic dysplasia

Helicobacter lymphoma
Joel K. Greenson MD
U. of Michigan


Lymphocytic gastroenteritis
Joel K. Greenson MD
U. of Michigan


The one really common problem you will see in the DUODENUM is peptic ulcer, already discussed above.

Ampullary carcinoma
Joel K. Greenson MD
U. of Michigan


Ampulla
"Pathology Outlines"
Nat Pernick MD

SMALL INTESTINE

Small Intestine Exhibit
Virtual Pathology Museum
University of Connecticut

Small Bowel Transplant Pictures
Great site
Transplant Pathology Internet Services

Small intestine
Good vascular arcade
WebPath Photo


Small intestine, opened

WebPath Photo


Small Intestine Pathology
Sampurna Roy, MD
Lots of photos and good text

Small intestine

WebPath Photo


{53768}    duodenal atresia

Intestinal Obstruction
From Chile
In Spanish

Bowel obstruction -- Autopsy
Source unknown
Not for young or sensitive visitors.

{18709}    diverticulosis, duodenum
{11111}    diverticulum, duodenum

Meckel's

WebPath Photo


Carcinoid
Pittsburgh Pathology Cases

Carcinoid of Meckel's
Pittsburgh Pathology Cases

{10157}    Meckel's
{10459}    Meckel's
{15563}    Meckel's
{38674}    Meckel's

Red infarct of the colon
Neglected peritonitis with
vascular compromise

Ischemic Bowel
From Chile
In Spanish

Bowel infarct
Urbana Atlas of Pathology

Ischemic bowel

WebPath Photo


Ischemic bowel

WebPath Photo


Ischemic bowel

WebPath Photo


Bowel infarct
Urbana Atlas of Pathology

{15515}    ischemic enteritis, gross
{15538}    ischemic enteritis, histology
{19519}    ischemic colitis, gross
{49211}    ischemic colitis, gross

{09826}    acid-fast stain, atypical mycobacteria

    CROHN'S DISEASE ("regional enteritis", "terminal ileitis"): Review of the new stuff on etiology Lancet 359: 62, 2002; NEJM 346: 614, 2002; Lancet 369: 1641, 2007.

      A systemic disease where ulcers and fibrosis, often with granulomas, affect portions of the alimentary canal. Maybe one person in 1000 is affected; the onset is typically in the teens or in later middle age (two peaks).

Eisenhower
Dwight Eisenhower

{09825}    Crohn's disease, gross
{18707}    Crohn's disease, gross
{19509}    Crohn's disease, gross
{10190}    Crohn's disease, histology
{10193}    Crohn's disease, histology, with a granuloma
{20251}    Crohn's disease, string sign
{20286}    Crohn's disease, histology
{25464}    Crohn's disease, histology
{26804}    Crohn's disease, colon

giardia

Giardiasis
Joel K. Greenson MD
U. of Michigan


The "index patient" in Jerome Groopman's admittedly anecdote-based but disturbing 2007 best-seller was a woman with postprandial nausea and vomiting leading to anemia, emaciation, and osteomalacia. Groopman reports she was assumed to have self-induced vomiting, and visited around 30 physicians over around 15 years before a gastroenterologist drew blood and endoscoped her and made the easy diagnosis of celiac sprue.

"A physician is only as a good as his/her index of suspicion."

"Uncommon presentations of common diseases are more common than common manifestations of uncommon diseases."

{15513}    celiac sprue, small bowel; no villi
{19500}    celiac sprue, small bowel; no villi
{19501}    celiac sprue, small bowel; no villi

{06100}    Whipple's disease
{06103}    Whipple's disease, PAS

Whipple's
PAS Stain
Wikimedia Commons

{24557}    incisional hernia

Mesh
Twenty-Four Hours Post-Op
Poem by Ed

Adhesion

WebPath Photo


Infarct from adhesions

WebPath Photo


{40680}    adhesions
{40681}    adhesions

{09832}    intussusception
{38677}    intussusception, colonic, with gangrene
{39391}    intussusception

Intussusception
Great photos
Pittsburgh Pathology Cases

{07210}    volvulus

Cecal volvulus

WebPath Photo


{24441}    meconium ileus and volvulus (cystic fibrosis)
{46271}    volvulus, sigmoid colon ("chronic")

Lymphoma of small intestine

WebPath Photo


Lymphoma of small intestine

WebPath Photo


Microvillous inclusion disease
Pittsburgh Pathology Cases

Carcinoid
Nice argentaffin stain
Pittsburgh Pathology Cases

Carcinoid

WebPath Photo


Carcinoid

WebPath Photo


Carcinoid

WebPath Photo


Carcinoid
Tom Demark's Site

{19521}    carcinoid, appendix, gross
{19522}    carcinoid, appendix, gross
{19508}    carcinoid, small bowel, histology
{49187}    carcinoids, small bowel, gross
{24678}    carcinoid, small intestine
{26348}    carcinoid, ileum
{09175}    carcinoid, electron micrograph
{09176}    carcinoid, electron micrograph

APPENDIX

Appendix Exhibit
Virtual Pathology Museum
University of Connecticut

Worm in appendix
Or perhaps a Meckel's?
KU Collection

{20088}    appendicitis with fecalith

Appendix pinworms

Wikimedia Commons

{13283}    acute appendicitis, gross
{10196}    acute appendicitis, gross
{11445}    acute appendicitis, gross
{19526}    acute appendicitis, histology
{17558}    acute appendicitis, histology
{17562}    acute appendicitis, polys
Acute Appendicitis
Australian Pathology Museum
High-tech gross photos

Acute Suppurative Appendicitis
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Acute appendicitis
Urbana Atlas of Pathology

COLON AND RECTUM

Colon Exhibit
Virtual Pathology Museum
University of Connecticut

Colorectal Images
University of Washington
Pictures and comments

{49202}    melanosis coli from cascara laxatives, the terminal ileum is normal color

Lymphocytic colitis
Joel K. Greenson MD
U. of Michigan


{49199}    imperforate anus ("atresia of the anus")

{20090}    aganglionic megacolon

Hirschsprung's
WebPath Photo


{49197}    acquired megacolon

{42227}    colonic diverticulosis, gross (inflated specimen)
{08086}    colonic diverticulum, histology (this is all mucosa, protruding out into adventitia)
{10514}    colonic diverticulum with bleeding point
{19702}    diverticulosis coli, x-ray
{24425}    diverticulosis coli, x-ray
{39995}    diverticulosis; barium fills the "ticks"

Hemorrhoids
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Angiodysplasia
Endoscopic photos.

{08088}    angiodysplasia of cecum; the glands are normal

Ulcerative Colitis
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Ulcerative Colitis
Gross and Microscopic
Wikimedia Commons

Inflammatory Bowel I
From Chile
In Spanish

Inflammatory Bowel II
From Chile
In Spanish

Inflammatory Bowel III
From Chile
In Spanish

Inflammatory Bowel IV
From Chile
In Spanish


{26822}    ulcerative colitis, gross
{08113}    ulcerative colitis
{08809}    ulcerative colitis with atypia (worse on the bottom)
{26825}    ulcerative colitis, good pseudopolyps
{10172}    ulcerative colitis, histology
{10175}    ulcerative colitis, crypt abscess
{10178}    ulcerative colitis
{11554}    ulcerative colitis, crypt abscess
{49203}    ulcerative colitis
{24809}    ulcerative colitis, pseudopolyps, gross
{24422}    pseudopolyp, histology; there has been substantial healing of the mucosa between the pseudopolyps, which in a better case would be ulcerated

Ulcerative colitis, acute lesions
Classic drawing
Adami & McCrae, 1914

Pseudopolyp and ulcer
Tom Demark's Site

Crypt abscess
Tom Demark's Site


{08105}    amebic colitis

Amebic dysentery
H&E
Wikimedia Commons

Amebiasis of the colon
Classic drawing
Adami & McCrae, 1914

Here is the inevitable chart comparing "Crohn's" and "Ulcerative Colitis"...

CROHN'S DISEASE ULCERATIVE COLITIS
Etiology? Unknown / immune? Unknown / immune?
Sex? equal slightly more among females;
Ethnic group? more among Jewish more among Jewish
Hereditary? Contributes Contributes
Exacerbate/remit? Yes Yes
Stress exacerbates? Maybe Maybe
Smoking? Makes worse, try to quit Quitting may exacerbate
Location? Variable Rectum and upwards
Bowel? Small more than Large Large only
Terminal ileum? Favorite site "Backwash"
Colon? Right more than left, if any Left more than right
Bile ducts? May be damaged (Crohn's itself) May be damaged (sclerosing cholangitis)
Anal troubles? Common No
Oral lesions? Maybe No
Skip lesions? Yes No; continuous
Layers? All three Mucosa only
Ulcers? Linear fissures Broad / irregular
Pseudopolyps? May be some Usually, may be spectacular
Fibrosis? Severe No
Fistulas? Yes No
Creeping fat? Yes No
Granulomas? Often No
Bleeding? Subtle Heavy-duty
Pain? Wretched Not so much
Malabsorption? Maybe No
Bowel obstruction? Maybe No
B-12 deficiency? Maybe No
Lymphs/plasma cells? Yes Yes
Arthritis, uveitis? Yes Yes
Ankylosing spondylitis? if (+) for HLA-B27 if (+) for HLA-B27
Diagnosis? Tough Easy
Surgery? Avoid Cures
Carcinoma risk? Fairly low High in the long run

Neonatal Necrotizing Enterocolitis
CDC
Wikimedia Commons

Neonatal Necrotizing Enterocolitis
CDC
Wikimedia Commons

Neonatal necrotizing enterocolitis
CDC
Wikimedia Commons

Necrotizing enterocolitis
WebPath Photo


Pseudomembranous colitis
Tom Demark's Site

{08103}    collagenous colitis (thin band under the surface mucosa; the normal colonic glands are cut at an angle)
{08104}    collagenous colitis

Collagenous colitis
Joel K. Greenson MD
U. of Michigan


{15516}    hyperplastic colon polyp, histology
{15517}    hyperplastic colon polyp, histology

{15540}    juvenile polyp protruding through anus
{15541}    juvenile polyp, histology

{09342}    Peutz-Jeghers polyp

{15519}    normal colon vs. dysplasia in an adenoma

{15547}    colon polyp (a villous adenoma)
{46461}    pedunculated tubular adenoma
{15499}    pedunculated tubular adenoma
{09284}    sessile villous adenoma (on the right)
{50560}    sessile colon polyp
{15500}    sessile colon polyp
{15503}    tubulovillous adenoma

Pedunculated tubular adenoma
Great labels
Romanian Pathology Atlas

Sessile villous adenoma
Great labels
Romanian Pathology Atlas

Sigmoid villous adenoma
CDC
Wikimedia Commons

Colon, villous adenoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Tubulovillous colon polyp
Ed Uthman MD
Wikimedia Commons

Familial colonic polyposis
WebPath Photo


Intestinal Tumors I
From Chile
In Spanish

Intestinal Tumors II
From Chile
In Spanish

Intestinal Tumors III
From Chile
In Spanish

Perforated colon cancer
Autopsy
Ed Lulo's Pathology Gallery

Perforated colon cancer
Ed Lulo's Pathology Gallery

Rectal adenocarcinoma
Easy-to-see gland formation
Wikimedia Commons

Colon adenocarcinoma
Invading glands
WebPath Photo


Colon Adenocarcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Colon Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Napkin Ring Colon Cancer
CDC
Wikimedia Commons

Exophytic Colon Cancer
CDC
Wikimedia Commons

{39680}    adenocarcinoma of the colon ("napkin ring")
{09839}    adenocarcinoma of the colon
{10540}    adenocarcinoma of the colon, cross-section; note metastases in the lymph nodes
{15456}    adenocarcinoma of the colon
{19565}    adenocarcinoma of the colon ("napkin ring")
{19567}    adenocarcinoma of the colon, histology; note cribriform "swiss cheese" pattern
{49225}    adenocarcinoma of the transverse colon; anus is at bottom
{20231}    adenocarcinoma of the colon, histology
{23887}    adenocarcinoma of the colon, stained for CEA
{39598}    adenocarcinoma of the colon, perineural invasion

Adenocarcinoma, colon
Great labels
Romanian Pathology Atlas

Mucin-lakes colon adenocarcinoma
Great labels
Romanian Pathology Atlas



SECONDARY TUMORS OF THE GI TRACT

AT THE END

{40364}    anal condylomas

Anal condyloma

Wikimedia Commons



Cloacogenic carcinoma
Pittsburgh Pathology Cases

PERITONEUM: Worth knowing

Neglected peritonitis with
neutrophils and necrosis
One of my autopsies

Suppurative peritonitis

WebPath Photo


{39721}    peritonitis, acute
{42229}    peritonitis, with lots of fibrin & pus
{49191}    peritonitis, after appendicitis

Prothecal peritonitis
Pittsburgh Pathology Cases

Compassion, love for our brothers, for those who love us, and for those who hate us, love for our enemies -- yes, that is the love which God preached on earth, and which Princess Marya tried to teach me and I did not understand; that is what made me loath to relinquish my life; that is what remained for me had I lived. But now it is too late. I know it!
        -- Prince Andrei, peritonitis victim, in Tolstoy's "War and Peace"

POST-SCRIPT

* THE COW'S MILK FLAP

* Serious evidence for the effectiveness of acupuncture in GI disease is conspicuous by its absence. Even the Chinese now admit that it's best reserved for patients that you can't help by any established method (Gut 51: 617, 2002).

PETA's merchandising campaign "Got pus? Milk does" reflects the fact that dairy cattle may have bacterial infections of the udders, just as a nursing mother may. Of course, milk is one of the most regulated products, and must be pasteurized. It is ironic that the scientifically-illiterate targets of this campaign are the same people who are targeted by anti-pasteurization disinformation.

In 2008, the World Health Organization published Safer Water, Better Health. It is a good read, and is intended to persuade those in power to make the drinking water supply safe in the poor nations. This time, the WHO wisely appealed to the greed of the governments and entrepreneurs of the poor nations, calculating a payback of $84 billion in better employee performance etc. for the $11 billion annual investment for water treatment. See Lancet 371: 2145, 2008.

*  SLICE OF LIFE REVIEW Cool Hand Luke

{08789}    small bowel, normal
{08790}    small intestine normal
{10163}    duodenum, normal
{10502}    colon, normal mucosa
{11740}    stomach, normal
{11741}    colon, normal
{11742}    colon, normal
{11744}    appendix, normal
{11745}    appendix, normal
{11804}    bowel, normal
{11808}    bowel, normal
{11810}    ileocecal valve and bowel, normal
{14829}    esophagus (esophageal gland), normal
{14830}    esophagus (esophageal gland), normal
{14831}    esophagus (esophageal gland), normal
{14832}    esophagus (esophageal gland), normal
{14833}    stomach body, normal
{14834}    stomach body, normal
{14836}    stomach body (gastric glands), normal
{14837}    stomach body (pits & glands), normal
{14838}    stomach body (pits & glands), normal
{14839}    stomach body (glands), normal
{14840}    stomach body (glands), normal
{14841}    stomach pylorus (pits & glands), normal
{14842}    stomach pylorus (pits & glands), normal
{14843}    duodenum (brunner's glands), normal
{14845}    duodenum (brunner's glands), normal
{14847}    brush border, intestine
{14848}    brush border, intestine
{14849}    villus, normal intestine
{14850}    villus, normal intestine
{14851}    crypt of Lieberkuhn, normal
{14852}    crypt of Leiberkuhn, normal
{14854}    enterochromaffin cells, normal
{14855}    villi, jejunum
{14857}    Auerbach's plexus
{14859}    Meissner's plexus
{14862}    Peyer's patches ileum
{14863}    appendix, normal
{14865}    colon, normal
{14868}    colon (crypt), normal
{14869}    colon (crypt), normal
{14870}    anal rectal junction, normal
{14871}    pectinate line, anorectral junction
{15090}    ileum, Peyer's patches
{15094}    ileum, Peyer's patches
{15095}    ileum
{15096}    rectum
{15097}    rectum
{15100}    jejunum, normal
{15101}    jejunum, normal
{15102}    rectum
{15103}    rectum
{15175}    esophagus
{15176}    esophagus
{15177}    esophagus
{15178}    esophagus
{15179}    esophagus
{15182}    stomach, body
{15183}    stomach, body and pylorus
{15184}    stomach, body and pylorus
{15185}    stomach, body and pylorus
{15186}    stomach, body and pylorus
{15204}    duodenum
{15206}    duodenum
{15207}    duodenum
{15208}    duodenum
{15236}    appendix
{15238}    esophagus, gland
{15239}    esophagus, duct and gland
{15242}    esophagus, lymphocyte aggregate
{15243}    stomach, cardia
{15244}    stomach, cardia
{15245}    stomach, cardia
{15246}    stomach, body
{15247}    stomach, body
{15248}    muscularis mucosa, stomach
{15249}    auerbach's plexus, stomach
{15250}    meissner's plexus, stomach
{15251}    lamina propria, stomach
{15253}    surface mucus cells, stomach
{15254}    stomach, venule
{15255}    stomach, pyloric/body junction
{15256}    stomach, pyloric/body junction
{15257}    jejunum, normal
{15258}    jejunum, crypts
{15259}    jejunum, terminal bars (tb)
{15260}    paneth cell, jejunum
{15261}    brunner's gland, duodenum
{15262}    brunner's gland, duodenum
{15264}    auerbach's plexus, duodenum
{15266}    appendix, lymphocyte aggregate
{15267}    peyer's patch, ileum
{15268}    peyer's patch, ileum
{15269}    lamina propria, ileum
{15270}    colon, normal
{15271}    colon, normal
{15272}    colon, lymphocytes
{15273}    colon, taenia coli
{15329}    ileum, Peyer's patches
{15581}    stomach, normal unfixed
{15582}    stomach, rugae unfixed
{15584}    stomach, normal unfixed
{15586}    stomach, normal
{15595}    small bowel unfixed, normal
{15596}    small bowel unfixed, normal
{15597}    small bowel unfixed, normal
{15598}    small bowel unfixed, normal
{14835}    stomach cardia, normal
{16505}    tonsil, normal
{17557}    appendix, normal
{19365}    jejunum, normal
{19366}    jejunum, normal
{19368}    jejunum, normal scanning EM
{19450}    esophageal gastric junction, normal
{19494}    jejunum, normal
{20842}    stomach, cardia
{20868}    valve of kerckring, duodenum
{20878}    taenia coli, colon
{24412}    duodenum, normal
{24413}    small intestine, normal
{24423}    appendix, normal
{24424}    appendicitis and normal appendix
{24432}    polyp, adenomatous and normal colon
{24810}    appendix, normal
{24811}    appendix, normal
{25463}    esophagus, normal
{49192}    appendix, normal

BIBLIOGRAPHY / FURTHER READING

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