Lecture 24 diseases of alimentary system

Prof.Dr.
Khalil Hassan Zenad
Aljeboori
Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Lecture 24
DISEASES OF ALIMENTARY
SYSTEM

Ascites:
transudate in peritoneal cavity in which specific gravity 1.010 ,
protein ( 3 g/100ml)or less.
Causes:
1. Cardiac failure.
2. Nephritic syndrome
3. Portal hypertension.
4. Inflammatory fluid in case of exudates in which:
1) Sp.Gravity 1.020or more.
2) Protein 4gm/100 ml or more.
Diseases of Periton:

Blood in periton due to:
1. Trauma especially rupture of spleen, liver, kidney.
2. Ruptured tubal pregnancy
3. Ruptured corpus luteum
4. Ruptured abdominal aneurysm
5. Hemorrhagic diathesis with any disease in abdomen.
Intraperitoneal hemorrhage:

1. Acute peritonitis:
Serous, fibrinous, hemorrhagic, purulent type of acute peritonitis, Causes:
1. Penetrating wound
2. Hematogenous due to Pnemococcosis
3. Inflamed organs, appexdix, salpinx.
4. Perforated peptic ulcer
5. Perforated intestine e.g typhoid, chron’s disease.
6. Acute pancreatitis in which release of lipolytic and proteolytic anzyme affect peritoneal cavity.
7. Biliary perforation, by trauma surgery
8. Strangulated bowel due to hernia, volvulus, and intussusception.
2. Chronic peritonitis:
Occur in association with tuberculosis of intestine, salpinx or follow blood borne, there is ascites, adhesion or in case
of polyserositis may be due to T.B. the periton is thick, fibrous and increase risk of strangulation of bowel by bands.
Peritonitis:

1. Mesothelioma-primary tumor
2. Carcinoma-secondary tumor in periton occur with stomach carcinoma,
large intestine, ovary and breast.
3. Myxoma in which periton filled with gelatinous material. Also peritoneal
seeding of from ruptured mucinous cyst adenoma or
cystadenocarcinoma of ovary and intestine and follow appendicular
mucocele.
Tumors:

Etiology:
1. Constipation, straining of defecation.
2. Cirrhosis in liver, hemorrhoids occur due anastomosis between portal and systemic circulation.
3. Manifestation of rectum carcinoma.
Complication:
1. Hemorrhage
2. Inflammation with pain
3. Portal pyemia it is serious occur following septic thrombi carried to the liver.
Hemorrhoids (piles)
There are varicose veins at lower end of anal canal either external covered by skin or internal covered
by mucous membrane.

Causes:
1. Chronic nonspecific infection such as ischiorectal abscess open into
skin or into the bowel.
2. Tuberculosis.
3. Malignant disease such as carcinoma of rectum, tissue destruction and
tract formation due to tumor growth.
Anal vistula: Occur in region of perineum

Etiology:
Remnants of neoro-enteric duct, infolding of epithelia of skin or simple penetration of
hair with chronic inflammation. The wall of sinus shows many hair follicles,
inflammatory cells mononuclear cells ( lymphocytes, plasma cells and macrophages)
complete excision is necessary to prevent the recurrence.
Malabsorption syndrome:
Is characterized by impaired intestinal absorption especially of fats, and manifested
by diarrhea, bulky foul stool and abdominal distention and malnutrition with vitamin
deficiency
Pilonidal sinus:
It is cover sacrococcygeal region opening few centimeters behind the anus, discharging serous fluid or pus.

The cases of malabsorption syndrome subdivided into primary or secondary groups, among the
secondary malabsorption causes:
1. Cystic fibrosis of pancreas.
2. Chronic incomplete intestinal obstruction.
3. Surgical resection of significant segment of GIT.
4. Infections.
5. Antibiotics.
6. Biliary tract disease.
7. Scleroderma.
8. Whipple’s disease.
9. Parasites infestation.
10. Regional ileitis.
11. Tumors lymphoma.

Celiac diseases and sprue:
Celiac diseases:
Is primary malabsorption or steatorrhea are celiac disease of infants and
children. Non tropical sprue or tropical sprue in adults. The first two
condition is occurring of sensitivity to or intolerance to of gluten, in this
case elimination of gluten from diet relieve the symptoms and permit the
normal development, although not cure the defect. The small intestine in
this case has flat surface lacking villi, mucosal crypts appear elongated,
dilated and widely spaced than normal, epithelial lining were cuboidal or
low columnar with irregular nuclei, the lesion mostly occur in upper
jejunum less in ileum and duodenum.

Tropical sprue:
Is very similar to non-tropical sprue clinically, morphologically. Pathological lesion no
marked and reversible by folic acid therapy but they are unaffected by elimination of
gluten from the diet, macrocytic anemia is usually a feature.
Protein losing-enteropathy (exudative enteropathy):
Is associated with serum protein loss in intestine, steatorrhea, serum level of both
globulin and albumin are abnormally low. It may be secondary to some specific gastro
enteric diseases or congestive heart failure or idiopathic.

1. Gastric hypertrophy.
2. Sprue.
3. Regional ileitis.
4. Ulcerative colitis.
5. Constructive pericarditis.
Idiopathic protein loss enteropathy, lymphatic dilation and
lymphangiectasia in intestinal wall and mesentery.
Among the diseases associated with marked protein loss are:

A disorder of intestinal function involving lipid metabolism, it is considered systemic
disease, aggregation of large pale macrophages bearing intracytoplasmic inclusions in
intestinal mucosa and mesenteric lymph nodes, but similar deposits have been described
in every organ, lipid deposits are also stricking in lymph nodes of mesentery. The
inclusions described sickle-form react positively with periodic acid Schiff staining.
Clinically the disease (whipples disease) is characterized by diarrhea, wasting
polyarthritis, although wipples disease no longer regard a disorder of lipid metabolism.
It is etiology. Is still far from settled.
Whipples disease (intestinal lipodystroply):

•Proliferation neoplastic possibly of reticuloendothelial cells
synthesize abnormal protein carbohydrate complex.
•Macrophages phagocytosing abnormal materials as in storage
disease.
•Cells laden with microorganisms.
The disease is usually progressive and fatal but remissions may
occur following corticosteroid therapy.
The specific cells represent:

Malabsorption Effects
Fat Steatorrhea, fat in faces
Protein Loss of weight, edema,hypoproteinemia, osteoporosis
Calcium and Vit D,
Vit B1
Rickets, osteomalacea, tetany peripheral neuritis, beriberi
Nicotinic acid Glossitis, pellagra….
Riboflavin Cheilosis, keratitis, glossitis
Vit B12 Macrocytic megaloblastic anemia
Vit A Xeropthalmia, night blindness
Folic acid
iron
Macrocytic megaloblastic anemia
Hypochronic anemia
Vit K Hypoprothrombinemia, heamorrage diseases
Salt and water Dehydration, salt depletion
potassium hypokalemia
Results of malabsorption syndrome:
Is associated with deficiency of followings:

Lecture 24 diseases of alimentary system

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