Week 7: Ischemic Bowel, Infections, Diverticulosis, and Appendix Flashcards
An 85-year-old male with a history of myocardial infarctions presents with severe left lower abdominal pain, diarrhea, nausea, bloating. He has fear of eating because of subsequent pain and had a bowel movement with maroon blood mixed with stool. What do you think his bowel resection would show?
Ischemic Bowel
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Ischemic Bowel
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Ischemic Bowel
Withered crypts (green ellipse), superficial pseudomembrane (red ellipse), and hyalinized lamina propria (cyan arrow)
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Ischemic Bowel
Erythematous serosa (left image) and mucosa lined by greenish material (right image)
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Pseudomembranous Colitis (PMC)
Clostridioides difficile is a common etiologic agent
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Pseudomembranous Colitis (PMC)
adherent layer of inflammatory cells and debris at sites of colonic mucosal injury (open black arrow)
A 78-year-old male had recently completed a course of levofloxacin for treatment of pneumonia, presents with fever, abdominal pain and reports numerous watery bowel movements each day which recently became blood-tinged and contained some mucous. What do you think his bowel resection would show?
Pseudomembranous Colitis (PMC)
A 54-year-old female presents with chronic arthralgias and was diagnosed with seronegative rheumatoid arthritis. For almost 7 years she was treated with immunosuppressive therapies. The patient also had chronic diarrhea, which suddenly intensified leading to fatal hypovolemic shock. What most likely caused this?
Whipple’s Disease caused by Tropheryma whipplei
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Whipple’s Disease caused by Tropheryma whipplei
organism-laden macrophages accumulate within the small intestinal lamina propria (green oval)
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Whipple’s Disease caused by Tropheryma whipplei
organism-laden macrophages accumulate within the small intestinal lamina propria (yellow oval); definitive diagnosis for T. whippelii
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Whipple’s Disease caused by Tropheryma whipplei
bacteria are highlighted in lamina propria by a Periodic Acid Schiff with Diastase (PASD) special stain (yellow circles). Goblet cells (yellow arrow) stain fuchsia pink in this stain
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Diverticulum
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Diverticular Disease
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Diverticular Disease
Not a true diverticula and does not have the muscularis externa/propria included (yellow arrows). Psuedo Diverticulum
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True Diverticulum
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Pseudo Diverticulum
Is this a true diverticulum?
Yes, we see all layers around the out pouch
Example shown is Meckel’s Diverticulum. Note gastric mucosa
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Diverticular Disease
Pseudo Diverticulum (cyan ellipse)
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Appendicolith
black arrow
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Acute Appendicitis
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Pinworm caused by Enterobius vermicularis
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Low grade carcinoid tumor of the Appendix
they are highlighted by synaptophysin and chromogranin staining
