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Gastrointestinal II, Case 3

Gastrointestinal II, Case 3. 19-year-old woman with non-bloody diarrhea and crampy abdominal pain. Identify the organ and structures Describe the gross findings Diagnosis?. A Colon B Terminal Ileum. Crohn Disease The surgical specimen of the terminal ileum and proximal colon reveals

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Gastrointestinal II, Case 3

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  1. Gastrointestinal II, Case 3 • 19-year-old woman with non-bloody diarrhea and crampy abdominal pain.

  2. Identify the organ and structures Describe the gross findings Diagnosis?

  3. A Colon B Terminal Ileum Crohn Disease The surgical specimen of the terminal ileum and proximal colon reveals severe inflammation. The ileum is swollen, distorted, and bent on itself. The serosa is hyperemic and covered by a fibrinous exudate. Note the surgical margin (*). The serosa is smooth, glistening, and transparent. The diameter of the ileum here is normal.

  4. Identify the organ (s) Describe the gross findings Diagnosis?

  5. Crohn Disease The surgical specimen of the terminal ileum and proximal colon is opened. The wall of the ileum is markedly thickened; the mucosa is ulcerated and hyperemic. The lumen of the ileum is narrow (held open by paperclips).

  6. Identify the organ (s) Describe the gross findings Diagnosis?

  7. Crohn Disease A loop of small intestine is revealing hyperemic mucosa with ulceration. The wall of the intestine is thick because of transmural inflammation. The mesenteric fat is inflamed.

  8. Describe the gross findings. Diagnosis?

  9. B A Crohn Disease A section of small intestine reveals an area of inflammation (A) that includes mucosal ulceration and transmural thickening. Note the adjacent segment of normal intestine (B) that represents a "skip lesion." The transverse mucosal folds are normal. Compare the thickness of the normal and abnormal segments.

  10. Identify the organs. Describe the gross findings. Diagnosis?

  11. Identify the organs. Describe the gross findings. Diagnosis?

  12. The serosa and mesenteric fat are inflamed. Crohn Disease The surgical specimen reveals loops of small intestine adherent to one another.

  13. Identify the organ Describe the gross findings Diagnosis?

  14. A B Crohn Disease A section of opened small intestine reveals chronic inflammation and fibrosis of the wall. The lumen is narrowed (A). The proximal segment (B) is dilated.

  15. Chronic inflammation of all layers from mucosa to serosa Noncaseating granulomas

  16. lymphocytes histiocytes Multicucleated giant cell Noncaseating granuloma

  17. This is an intravenous pyelogram (IVP) - contrast material is injected into a vein in the patient's arm, it travels through the blood stream and collects in the kidneys and urinary tract, turning these areas bright white. Identify the structures.

  18. A Urinary bladder B Intestinal Tract C Ureter How did the contrast material enter the intestinal tract?

  19. A Urinary bladder B Intestinal Tract C Ureter How did the contrast material enter the intestinal tract? A fistula between the bladder and intestine in this case of Crohn Disease allows contrast material to enter the intestinal tract.

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