Medical autopsy - gastrointestinal

Question 1

upper GI bleeding - think of… (6)

Answer 1

peptic ulcers

reflux

varices

Mallory-Weiss tear

carcinoma

blood or vessel problem

Question 2

lower GI bleeding - think of… (4)

Answer 2

haemorrhoids

carcinoma/polyp

colitis

angiodysplasia

Question 3

GI ulcers

Answer 3

1. peptic ulcer: esp H. pylori, punched out, +/- perforation, sample to exclude ca
2. Crohn disease: linear ulcers, thickened wall, cobblestoning
3. UC: distal, broad based ulcers, thin wall
4. carcinoma: heaped up edge, mass lesion

Question 4

causes of ischaemic bowel

Answer 4

hypoperfusion: cardiac, dehydration, shock, vasculitis

acute obstruction: atherosclerosis, aortic aneurysm, hypercoagulation, emboli

Question 5

locations of injury in ischaemic bowel

Answer 5

mucosal in hypoperfusion, transmural in obstruction

‘watershed’ zone are esp vulnerable (splenic flexure, sigmoid and rectum)

Question 6

pathology of gut ischaemia

Answer 6

macro: patchy, ulcers, oedema, mucosal haemorrhage/necrosis
micro: sloughing of surface epithelium, neutrophils if reperfused