302
UNIT 3
Organ Systems
Figure 15-20A.
Ulcerative Colitis.
H&E,
3
97
Ulcerative colitis
is an
infl ammatory bowel disease
that causes
ulcers
in the lining of the
colon
and
rectum
characterized by intermittent exacerbations alternating with
complete symptomatic remission. Major symptoms include
abdominal pain, diarrhea, anemia, weight loss, bleeding
from the rectum, and passage of mucus. Pathologically, the
infl
ammation
is predominantly conF
ned to the
mucosa
and
submucosa
in contrast to
Crohn disease
, which is transmu-
ral. Grossly, ulcerative colitis produces shallow ulcers and
pseudopolyps
. Histologic features include
acute
and
chronic
colitis
,
crypt abscesses
,
atrophy
of
glands
, and loss of mucin
in
goblet cells
. Treatment includes anti-infl ammatory drugs
and immunosuppressants to control the symptoms and
achieve remission. The risk for the development of adeno-
carcinoma is high in patients with ulcerative colitis, so sur-
veillance
colonoscopy
with
biopsy
is necessary to detect
early dysplasia of the glandular epithelium. Surgical removal
of the colon is necessary in severe refractory cases or in cases
where severe dysplasia or adenocarcinoma is detected.
Figure 15-20B.
Crohn Disease.
H&E,
3
97
Crohn disease
is a
chronic autoimmune infl ammatory
disease
of the
gastrointestinal tract
that may affect any location, from
the oral cavity to the anus, but mostly involves the
distal
small intestine
and
colon
. Crohn disease is characterized by
asymmetric and segmental infl ammation extending through
the intestinal wall (
transmural
) from the
mucosa
to the
serosa
. Crohn disease characteristically involves areas of the
bowel separated by intervening uninvolved areas or “
skip
lesions
. Symptoms include abdominal pain, diarrhea, vom-
iting, and weight loss. Pathologic changes include mucosal
neutrophil and mononuclear cell inF ltration, ulceration,
mucosal F ssures, F
stulae, serosal adhesions, abscesses,
pseu-
dopolyps
, and noncaseating granulomas. Treatment focuses
on relieving symptoms through immunosuppressive agents
to prevent relapse and complications. This image shows
colonic mucosa with depletion of goblet cells,
noncaseating
granulomas
within the lamina propria, chronic infl amma-
tion, and neutrophils invading the crypt cells.
Intestinal metaplasia
: the reversible change of one mature type of epithelium to an intestinal type epithelium; may be seen
in chronic gastritis when goblet cells are present within the gastric mucosa; considered a risk factor for the development of
gastric adenocarcinoma (±ig. 15-8B).
Dyspepsia
: general term for abdominal pain or indigestion associated with the intake of food (±ig. 15-10C).
Gastric metaplasia
: the reversible change of one mature type of epithelium to a gastric type epithelium; seen in peptic
duodenitis when the normal epithelial lining with goblet cells is replaced with a gastric foveolar–type mucosa in response
to exposure to increased levels of stomach acid (±ig. 15-10C).
Pseudopolyp
: found in cases of chronic infl ammatory bowel disease; consists of polypoid mounds of mucosa created by
regenerating glandular epithelium; not considered true polyps, hence the name (±igs. 15-18A and 15-20A,B).
Crypt abscess
: an aggregate of neutrophils present within a colon crypt, usually associated with infl
ammatory bowel
disease, particularly ulcerative colitis (±ig. 15-20A).
Cryptitis
: an indicator of acute colitis; appreciated histologically by the inF
ltration of neutrophils with the crypt cells of
the colon (±ig. 15-20B).
SYNOPSIS 15-1
Pathological and Clinical Terms for the Digestive Tract
CLINICAL CORRELATIONS
Crypt
abscess
Acute and
chronic
inflammation
A
Cryptitis
Noncaseating
granulomas
B
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