Gastrointestinal Pathology Flashcards
Describe the mucosa of the gastrointestinal tract.
Oral cavity – mucosa overlying hard or soft tissues
Oesophagus, forestomaches, stomach, intestine – mucosa is part of a multi-layered wall of a tubular or saccular structure
What type of epithelium is in the upper alimentary tract?
Stratified squamous epithelium in the upper alimentary tract that may become keratinised. Beneath that there is another layer that supports that epithelium called the lamina propria, which is the supporting connective tissues that contains bloods vessels and glands.
Describe the histological layers of the oesophagus.
- Mucosa made up of the epithelium and the lamina propria
- Thin layer of muscularis mucosa and then submucosa beneath that
- Deeper to that there is 2-3 layers of muscle and the outer layer in loose connective tissue
- May/may not be covered by a mesothelial serosal surface (serosa or adevntitia if no serosal surface)
What defines the difference between an erosion and an ulcer at mucosal sites?
Erosion is going into the epithelium and not getting through the basement membrane. Ulcer can break through the basement membrane and can perforate through any number of deeper layers.
What are the main disease mechanisms affecting the alimentary tract?
- Congenital anomalies
- Hypertrophy/hyperplasia
- Neoplasia
- Inflammation
- Circulatory disturbances
- Foreign bodies, obstruction, displacement, dilation
- Functional disorders – motility, digestion, absorption, secretion
What is cheiloschisis and palatoschisis?
Orofacial clefts:
Cleft lip = harelip, cheiloschisis
Cleft palate = palatoschisis
What are the potential consequences of orofacial clefts?
- Impaired suckling due to inability to generate the negative pressure due to cleft
- Food enters nasal cavity
- Aspiration pneumonia
What is brachygnathia and proggnathia?
Anomalies in jaw growth:
Brachygnathia = short jaw
Prognathia = forward jaw
Define maxillary and mandibular jaw abnormalities.
Maxillary brachygnathism – shortness of the maxillae
Maxillary prognathism – prolongation of the maxillae
Mandibular brachygnathism – shortness of the mandibles
Mandibular prognathism – prolongation of the mandibles
What are the potential consequences of abnormalities in jaw growth?
- Malocclusion of the teeth
- Orodental trauma
- Abnormal tooth wear/overgrowth
- Difficulty feeding
What are the potential causes of upper alimentary tract inflammation?
- Infectious agents – bacteria (oral microbiota), viruses, fungi/yeasts, parasites
- Physical injury – foreign bodies, dental disorders, irritant/caustic chemicals, thermal injury
- Neoplasia, causing ulceration
- Uraemia
- Some immune-mediated diseases
- Reduced secretions
What are the general features of upper alimentary tract inflammation?
- Acute or chronic
- Redness, swelling, pain, heat
- With/without vesicles erosion or ulceration necrotic debris exudate proliferative masses
What are the 6 classifications of stomatitides?
Vesicular
Erosive/ulcerative
Granulomatous
Necrotising
Lymphoplasmacytic
Papular
Describe the lesions of vesicular stomatitides.
Vesicles/bullae are fragile and easily ruptured and rapidly progress to erosions or ulcers
What are the causes of vesicular stomatitides?
Diseases with oral vesicles caused by epitheliotropic viral infections:
- Foot and mouth disease (ruminants and pigs)
- Vesicular stomatitis (ruminants, pigs, horses)
- Swine vesicular disease
- Vesicular exanthema of swine
What are some infectious causes of erosive/ulcerative stomatitides?
- Progression from vesicular lesions in vesicular stomatitides
- Viral infections causing primary erosion or ulceration
- Feline calicivirus can cause oral vesicles
What are some non-infectious causes of erosive/ulcerative stomatitides?
Feline eosinophilic granuloma complex
Uraemia
Trauma
Ingestion of caustic substances
Some rare autoimmune skin diseases
How does uraemia cause erosive/ulcerative stomatitides?
Uraemia caused by renal failure, ulceration of tongue, often bilaterally symmetrical, foul smelling, halitosis, dribbling
Urea converted to ammonia via oral bacteria and urease and/or peripheral vasculitis and thrombosis > mucosal ulceration
Describe the lesions of granulomatous stomatitides.
Mucosal ulcers and wounds are vulnerable to secondary infection, including by some bacteria in the normal oral flora.
What are the causes of granulomatous stomatitides?
- Infection and inflammation may extend into deeper tissues
- Actinobacillosis (stomatitis, glossitis, lymphadenitis)
- Pyogranulomatous inflammation (Cattle, sheep, pigs)
Describe the lesions of necrotising stomatitides.
Surface exudate – fibrin, leucocytes and necrotic epithelium (diphtheritic membrane). Foul smelling
What are the causes of necrotising stomatitides?
Necrotic stomatitis, oral necrobacillosis, calf diphtheria. Cattle, sheep, pigs, oropharyngeal mucosal damage with secondary infection with fusobacterium necrophorum. Bacterial toxins cause extensive necrosis.
How can feline chronic gingivostomatitis cause lymphoplasmacytic stomatitides?
- Severe inflammation, gingiva, buccal mucosa and caudal oral mucosa
- Ulcerative or proliferative lesions at the palatoglossal folds
- Concurrent oesophagitis on esophagoscopy
- Suspected aberrant immune response to chronic antigenic stimulation
How does canine chronic ulcerative stomatitis caused lymphoplasmacytic stomatitides?
Painful, ulcerative stomatitis. Contact or kissing ulcers often occur where the mucosa lies against a tooth surface. Abnormal response to dental plaque
What causes papular stomatitides?
Parapox viruses. Sheep and goats = contagious ecthyma, cattle = bovine popular stomatitis
Describe non-neoplastic and neoplastic oral masses.
Non-neoplastic – inflammatory and reactive hyperplastic or proliferative responses
Neoplastic – benign, benign but invasive, malignant
Define epulis.
A gingival growth
Describe the lesions of gingival/fibrous hyperplasia.
- Result from chronic low-grade irritation, such as periodontal disease
- Focal, multifocal or generalised
- Pedunculated or sessile masses
- Smooth or rough
- May be ulcerated
What causes canine oral papillomatosis?
- Canine papillomavirus-1 infection
- Hyperplastic epithelial response to viral infection
- Resolve spontaneously – 4-8 weeks
What are the characteristics of peripheral odontogenic fibromas?
- Arises from the periodontal ligament
- Benign
- Fibrous (collagenous) tissue
- May contain hard tissues – bone, cementum, dentin
What are the characteristics of canine acanthomatous ameloblastomas?
- Arises from odontogenic epithelium
- Most frequently affects the rostral mandible but can occur anywhere in oral cavity
- Benign (does not metastasise)
- But often has aggressive behaviour with invasion of bone
What is the most common oral neoplasm in cats?
Squamous cell carcinoma
What are the general features of squamous cell carcinomas?
- Arises from stratified squamous mucosa lining the oral cavity, pharynx (and tonsils) and larynx
- Malignant
- Locally invasive
- Tend to metastasize late in the clinical course
What are the common sites of squamous cell carcinomas in cats?
- Ventral surface of tongue/sublingual close to frenulum
- Gingiva
- Early tumour may appear as a small, raised, fleshy mass, or as an ulcerated area
Distinguish squamous cell carcinomas in cats and dogs.
Cats - highly invasive (soft tissues, bone) and may metastasize to local lymph nodes, rarely to lung
Dogs - common sites is gingiva (tonsils). Tonsillar SCC have much higher metastatic potential – metastatic spread is common
What is the most common malignant oral neoplasm in dogs?
Malignant melanoma
What are the characteristics of malignant melanomas?
- Common sites are the gums and lips
- Can be very aggressive in infiltration
- Local invasion of bone
- Metastatic spread to local lymph nodes and often to distant sites
- Often sessile, some pedunculated. May be ulcerated. Variable degree of pigmentation
What are the common sites of fibrosarcomas?
Gingiva, palate
May invade underlying bone
What are the metastatic ability of fibrosarcomas in dogs and cats?
Dogs - may metastasise, regional lymph metastases, pulmonary metastases
Cats - low metastatic potential
How may cattle get neoplasms in the gastrointestinal or urinary tracts?
Cattle grazed on bracken fern can end up with neoplasms in the GIT or urinary tract due to the carcinogens they contain
What is the molar salivary gland?
In cats only – this is not a tumour
How do true salivary cysts form?
- Salivary gland duct blockage – congenital atresia, foreign body, salivary calculi, inflammation, strictures
- Duct remains intact
- Cystic dilation of the salivary gland or ducts
How do pseudocysts/sailoceles form?
- Salivary gland duct rupture – often small intraglandular duct
- Saliva pooling in soft tissues stimulate encapsulation and mild inflammation
- Fluid filled cavity in soft tissues of the mouth or neck
What are mucoceles and seroceles?
Mucocele – mucus content
Serocele – serous content
What are ranula?
A smooth, rounded, fluctuant, cystic swelling on the floor of the mouth. May be a pseudocyst or true salivary cyst
What is sialoadenitis?
Salivary gland inflammation, may cause duct obstruction
What causes sialoadenitis?
Infection via duct or haematogenous spread, or trauma
What may glandular atrophy be a result of?
From partial or complete duct obstruction or chronic inflammation
What is necrotising sialometaplasia?
Salivary gland infarction
Areas of salivary gland infarction with coagulative necrosis, inflammation and swelling – variable degrees of pain
What is persistent aortic arch and the consequence of this?
When it forms on the right side instead of the left.
Entrapment and constriction of the oesophagus between the ligamentum arteriosum and the trachea at the level of the heart base = oesophageal obstruction
What are the predisposed sites for obstruction to occur?
Larynx
Thoracic inlet
Heart base
Diaphragmatic hiatus
What are the potential consequences of choke?
Scarring
Stricture
Perforation leading to periesophageal cellulitis
What are the causes of oesophagitis?
- Traumatic injury or obstruction – foreign bodies, choke
- Some viral diseases – mucosal disease/BVDV
- Reflux of gastric acid (reflux oesophagitis) – chronic gastric regurgitation or vomiting
- Ingestion of caustic/irritant chemicals, plants or drugs – doxycycline in cats if not flushed down the oesophagus and is left there
What are 2 oesophageal neoplasms?
Squamous cell carcinoma – cattle from bracken fern, may infiltrate local tissues, may metastasise to regional lymph nodes
Papillomas (viral) – cattle
What is megaoesophagus?
Dilated hypomotile oesophagus, unable to effectively transport food from the pharynx to stomach
How does megaoesophagus develop?
- Muscular dysfunction
- Failure of peristalsis
- Accumulation of ingesta in the oesophagus
- Oesophageal dilation, regurgitation, may have secondary oesophagitis, ulceration
Which species can congenital megaoesophagus occur in?
Dogs, cats, horses and cattle
What are some conditions that cause acquired megaoesophagus?
- Idiopathic
- Neurological diseases – such as, peripheral neuropathies, dysautonomia, toxins (lead poisoning), trauma (vagal nerve injury)
- Neuromuscular diseases - myasthenia gravis, polymyositis
- Hypoadrenocorticism
- Prolonged oesophageal obstruction
Which part of the stomach is prone to ulceration?
Glandular region
What are the primary causes of stomach dilation in horses?
Overconsumption of fermentable feeds, expansile or indigestible foods – changes osmolarity and draws in a lot of water
Ingestion of large quantities of water
What are the secondary causes of stomach dilation in horses?
- Gastrointestinal obstruction
- Ileus (gastrointestinal hypomotility)
- Dysautonomia/grass sickness
What can be a consequence of stomach dilation in horses?
Can lead to bloat and then gastric rupture
Can happen ante or post mortem – differentiate by haemorrhage, inflammation, fibrin?
What are the primary causes of stomach dilation in dogs?
- Overeating in young puppies
- Component of gastric dilation and volvulus
What are the secondary causes of stomach dilation in dogs?
- Obstruction
- Gastric ulceration
- Gastric lymphomas
- Uraemia (renal failure)
What factors may be included gastric dilation?
Gastric distension by gas, fluid or feed
Gas source - aerophagia, bacteria?
Outline the pathogenesis of gastric dilation and volvulus.
- Normally positioned stomach
- As the stomach distends and rotates, the oesophagus twists and the pylorus begins to point upwards.
- The stomach twists and the pylorus moves to the opposite side. Air is trapped in the stomach and the stomach continues to dilate.
- In a nearly upside down and backwards position, the blood vessels to the stomach are compressed and/or torn. Early treatment can reduce this complication.
- Within minutes, the blood flow becomes compromised. Over time, this causes stomach tissue discolouration and irreversible damage. The bloated stomach presses on the caudal vena cava, causing decreased blood return to the heart and shock.
What are the potential consequences of gastric dilation and volvulus?
- Gastric infarction > congestion, oedema, necrosis, may lead to gastric rupture
- Venous obstruction from volvulus and pressure on surrounding tissues (vena cava) > reduced venous return from portal vein and caudal vena cava > circulatory shock
- Respiratory compromise from increased intra-abdominal pressure on the diaphragm
- Acid-base and electrolyte disturbances
- Cardiac arrhythmias
- Death
What are the causes of stomach obstruction?
Displacements and volvulus
Foreign bodies
Impaction
Pyloric stenosis
What are the primary and secondary causes of stomach obstruction in horses and cattle?
Primary – high roughage feed, low water intake
Secondary – consequences of GI obstruction or impaired motility
How does pyloric stenosis cause gastric obstruction?
Benign muscular pyloric hypertrophy/congenital pyloric stenosis = muscle of pyloric walls become thickened and causing an obstruction
Pyloric stenosis secondary to diseases causing pyloric obstruction
What diseases can pyloric stenosis be secondary to?
- Inflammatory disease
- Neoplasia
- Foreign bodies
- Chronic hypertrophic pyloric gastropathy – hypertrophy of the pyloric mucosa and/or muscle layer
What are the causes of gastritis/abomastitis?
- Foreign bodies
- Chemical/toxic - irritant/corrosive/toxic chemicals or plants, bile reflux from the duodenum
- Hypersensitivity reaction
- Secondary to systemic diseases – uraemia, septicaemia
- Idiopathic
- Infectious - BVD, clostridium septicum, helicobacter, fungi, ostertagia
- Stress, diet, NSAIDs and glucocorticoids, hypoxia and ischaemia, paraneoplastic effects and gastric neoplasia
What are the features of gastritis?
- Hyperaemia (reddening)
- Thickening or swelling – oedema, inflammatory cell infiltrate, hypertrophy/hyperplasia, bocilated (cobblestone appearance)
- Necrosis, erosion/ulceration
- Haemorrhage
- Fibrosis and atrophy
Outline the pathogenesis of stomach ulceration.
- Increased acid and pepsin
- Decreased mucosal integrity and protection
- Ulceration