Page 421 - Concise Pathology for Exam Preparation ( PDFDrive )

406
406 SECTION II Diseases of Organ Systems

• Plasma cells, lymphocytes, macrophages, and mast cell infiltration in lamina propria
Note: The above pathological findings are characteristic of celiac sprue but nonspecific and
can be seen in tropical sprue as well. Mucosal histology reverts to normal after excluding
gluten from the diet.

Q. Enumerate the ulceroinflammatory diseases of small and large
intestine.
Ans. Small intestine
• Crohn disease
• Typhoid ulcer
• Tuberculous ulcer
• Ulcers due to Campylobacter spp.
• Drug-induced ulcers
Large intestine
• Ulcerative colitis
• Shigella-induced ulcers
• Ulcers due to Campylobacter spp.
• Amoebic ulcers

Q. Write briefly on the pathology and complications of intestinal
tuberculosis.
Ans. Intestinal tuberculosis may be primary (caused by Mycobacterium bovis ingested via
unpasteurized milk) or secondary (in a patient of active pulmonary tuberculosis, swallow-
ing of coughed up material results in secondary tuberculosis of intestine).

Salient Features
• It mainly occurs in terminal ileum; colon is rarely involved.
• Primary tuberculosis of intestine mainly involves mesenteric lymph nodes, which are
enlarged, caseous and matted, and usually heal by fibrosis and calcification.
• Intestinal lesions are more prominent than nodal lesions in secondary tuberculosis.
Lesion starts as a small ulcerative lesion, which progressively enlarges to form a large
transverse ulcer, perpendicular to the long axis of the bowel (as it spreads through lac-
teals or lymphatics, which are transversely oriented). Serosa may also exhibit tubercles.
• Hyperplastic caecal tuberculosis is a variant of secondary intestinal tuberculosis involv-
ing caecum (sometimes ascending colon), which is commonly palpable as a lump
(called hyperplastic because the tuberculous granulation tissue formed in this lesion
masquerades as a lump).

Complications
• Tuberculous peritonitis may occur as a part of disseminated tuberculosis or result from
a tuberculous lesion in close proximity to the peritoneum. It may manifest as effusion
or as fibrosis (doughy abdomen).
• Fibrous stricture occurs due to transverse or circumferential ulceration and can lead to
intestinal obstruction.

Q. Differentiate between tuberculous and typhoid ulcer of intestine.
Ans. Differences between tuberculous and typhoid ulcer are listed in Table 14.5.

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