Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.


Pathology Associates Of Lexington, P.A.
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        Esophago-gastro-intestinal Disease

The difference between histological normalcy and abnormal is significantly variable from esophagus through rectum. There are geographical and ethnic (dietary?) differences. Criteria have been set for gastric biopsies (example, Sydney System) so that more than a rare plasma cell defines "chronic gastritis" (provided that the gross pathology...the endoscopic features...are compatible with gastritis or gastropathy [one does not want to just diagnose "gastritis, for example, in a chest pain workup case when the histology is trivially abnormal]). Atrophic GI changes are greatly more difficult to discern histologically than they are endoscopically. So, proper interpretation of biopsies relies on the pathologist having knowledge of age, sex, the key clinical question to be addressed by the pathologist (for example, "watery diarrhea" workup or "celiac disease" workup), pertinent endoscopic positive or negative findings (the "gross pathology"), and the key question to be answered ("UC, r/o dysplasia").

Clinicians are often concerned that provision of this info will cause "expectation bias" in the pathologist's interpretation; the pathologist "controls" for expectation bias by looking at the biopsies while executing the excellent judgement implicit in "point-of service" style of pathology practice. When a pathologist uses the term "nonspecific" (for example, "nonspecific chronic gastritis"), it simply means that he/she is not in possession of enough histological or other information to achieve a more specific (helicobacter gastritis) diagnosis. A good website for GI endoscopy photos of entities is HERE (see their online atlas and links to others in "notable websites").

There are some histology deviations from the ordinary which pathologists note for which there is as-yet-to-be-determined significance. For example, one sometimes notes a prominant fatty increased thickness of GI submucosa...submucosal "adiposity" [L07-9424]. At autopsy, one fairly frequently notes some small bowel mesentery nodularity...especially in thick, fatty mesenteries...which has a tan-yellowish cut surface involving fatty nodes with some perinodal fatty discoloration..."nodular mesenteric adenopathy".

And there are named situations that are pretty much from "the past" that rarely represent anything of real significance because the thing that they heralded has usually been already long determined in our age of exquisite internal radiological imaging. Example, intra-abdominal malignancies in times past sometimes gave a first sign of recurrence as a "Sister Mary Joseph node", a palpable infraumbilical malignant metastatic mass [T07-130].

In biopsies or slides of any of the below, one might find (1) superficial brown epithelial cytoplasmic pigment of siderosis (a clue to oral intake of iron suppliments) or more limited to deep glandular cytoplasmic pigment (a clue to check for hemochromatosis in that patient [S07-12785, L08-9114]) or (2) calcinosis (too much Tums or other calcium intake or maybe patient has renal failure [S06-4610]). Endoscopic biopsy diagnosis is not JUST about benign vs. malignant vs. dysplasia vs. "-itis".

  • Esophageal disease:
  • gastric disease:
  • small bowel (duodenal, jejunal, ileal) disease:
  • vermiform appendix disease:
  • colonic disease:
  • diagnostic modalities:
    • blood tests
    • breath tests: for Helicobacter
    • stool tests: for Giardia antigen, for Helicobacter antigen, for C. dif. toxin, for leukocytes
    • nuclear medicine tests: gastric emptying (see stomach @ this link) time; gallbladder HIDA scan commences biliary visualization in 5-10 minutes (not more than 20 min.) & GB filling begins by 20-30 minutes & begins into duodenum by 30 minutes; with cholecystokinin (CCK) stimulation, should eject no less than 50%; reproduction of the abdominal pain at whatever % ejection suggests dyskinesia & ejection less than 50% suggests dyskinesia.
    • imaging tests:
      • capsule endoscopy (CE), a passive & wireless device swallowed
      • direct endoscopic visualization
      • radiological: classical X-ray; barium fluoroscopy of upper GI series with or without small bowel follow through; "sitzmarker test" (Sitz-Mark [Konsyl Pharmaceuticals] capsule digestion and sequential films over a period of days); CT scans; MRI; PET scans.
    • tissue (histology; histological) examinations 

(posted 9 February 2002; latest additions/update 25 November 2010)

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