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 (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 by 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 deviations from the ordinary that 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 are 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 iamging. 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; 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) |
