1. GASTROINTESTINAL PATHOLOGY LAB #1 January 10, 2013

2. CASE 1 / GROUP 1 Gastrointestinal Pathology

3. 1. Identify the following anatomic regions: a. esophagus, gastroesphageal junction, stomach, pyloric region Image Source – Utah Web Path – The Internet Pathology Laboratory for Medical Education

4. Image Source – Utah Web Path – The Internet Pathology Laboratory for Medical Education Describe the findings seen in this endoscopic photo of the esophagus and correlate them to the normal histology.

5. Compare and contrast the normal histologic features of the esophageal and gastric mucosa in this section for the GE junction. Image source: histology world

6. Image Source – Utah Web Path – The Internet Pathology Laboratory for Medical Education Endoscopy: normal appearance of the gastric fundus

7. CASE 2 / GROUP 2 Gastrointestinal Pathology

8. CASE 2 CHIEF COMPLAINT: “I feel like my stomach is burning after I drink coffee or eat.” HISTORY: A 54 year-old male presents with burning epigastric pain radiating to the chest. The pain is worse post-prandially or in a supine position. He says he frequently has a “sour” taste in his mouth and feels better after taking an antacid. PHYSICAL EXAMINATION: Vital signs: BP 130/90, HR 90/min, RR 18/min, T 98°F The patient is an obese male, alert and in no apparent distress, who uses an open hand to indicate the area of burning pain in his upper abdomen. The abdomen is soft and non-tender with no palpable masses or organomegaly. Rectal exam is done – stool is brown and occult blood negative.

9. List at four key findings of the history and physical that may help you to create a differential diagnosis? 1 2 3 4

10. Develop a differential diagnosis for this patient.

11. Describe the histologic findings seen in our patient?

12. What it the diagnosis based on the gross and microscopic findings combined with the history of our patient?

13. What are the potential complications / sequela of this diagnosis?

14. Describe the gross findings seen here.

15. Describe the histologic findings

16. CASE 3 / GROUP 3 Gastrointestinal Pathology I

17. Case 3 HISTORY: A 65 year-old male has a long standing history of GERD diagnosed over 10 years prior. He comes today for follow-up esophageal endoscopy. PHYSICAL EXAMINATION: Vital signs: BP 130/90, HR 90/min, RR 18/min, T 98°F The patient is an obese male, alert and in no apparent distress.

18. Image Source – Utah Web Path - The Internet Pathology Laboratory for Medical Education Describe the endoscopic findings seen here in contrast to a normal endoscopy.

19. Describe the gross exam findings from an autopsy performed on a patient with the same disease here. Image Source – Utah Web Path - The Internet Pathology Laboratory for Medical Education

20. Describe the histologic findings seen here.

21. Describe the relationship between the these gross findings and the histologic changes. What is your final diagnosis?

22. What complication(s) can occur with these diagnoses?

23. CASE 4 / GROUP 4 Gastrointestinal Pathology I

24. CASE 4 CHIEF COMPLAINT: “Food sticks in my throat when I swallow.” HISTORY: 72 year-old male has dysphagia which gradually progressed from solids to soft foods then to liquids. He has fatigue and a 20 lb weight loss over 6 months. He has a 30 pack year smoking history and a history of heavy alcohol use. He has been abstinent for the past 10 years. PHYSICAL EXAMINATION: BP 140/80, HR 85/min, RR 19/min, T 98°F Alert, extremely thin male in no apparent distress who has enlarged, firm, fixed cervical lymph nodes. The remainder of the physical examination is unremarkable. LAB TESTS: Hgb 11gm/dl, Hct 33%, MCV 82 Stool hemoccult is positive

25. What are the major clinical problems?

26. Formulate a differential diagnosis for these problems.

27. Image Source – Utah Web Path –The Internet Pathology Laboratory for Medical Education Describe the endoscopic findings seen here.

29. Describe the gross findings of this surgical specimen Image Source – Utah Web Path - The Internet Pathology Laboratory for Medical Education

30. Describe the histologic findings seen in the specimen taken from the specimen.

31. What is your diagnosis?

32. Correlate the following clinical findings with the pathology Difficulty passing food: Cervical lymphadenopathy: Weight loss: Microcytic anemia

33. What are risk factors the for development of this lesion? Lifestyle Dietary factors Esophageal disorders Genetic predisposition

34. CASE 5 / GROUP 5 Gastrointestinal Pathology 1

35. CASE 5 CHIEF COMPLAINT: “My stomach hurts unless I eat something.” HISTORY: 37 year-old male truck driver presents with epigastric pain, which is relieved by eating. His social history is significant for a 20-pack year smoking habit. He notes that he is extremely tired lately and that he has noticed intermittent passage of black tarry stool. PHYSICAL EXAMINATION: BP 145/90, HR 80/min, RR 18/min, T 98°F Alert and oriented male in no apparent distress. The abdomen is soft with mild epigastric tenderness. No palpable masses or organomegaly are noted. Rectal exam shows black stool which is hemoccult positive LAB TESTS: Hgb 10g/dl Hct 35% MCV 78

36. What are the main clinical problems?

37. Differential diagnosis of clinical problems?

38. Describe the endoscopic and gross findings

39. Describe gross findings in this photo. Image Source – Utah Web Path - The Internet Pathology Laboratory for Medical Education

40. Describe the histologic findings seen here in sections of our patient

41. What is your diagnosis?

42. What are associated risk factors? Infectious: Life style: Iatrogenic:

43. Describe the histologic findings from this high power photo

44. Describe the test available for the previous findings?

45. Describe the gross findings of one of the complications this patient may encounter.. ? Image Source – Utah Web Path - The Internet Pathology Laboratory for Medical Education