Pathology of the Alimentary Tract 1 (Oral Cavity & Oesophagus)

melian.yates
Mind Map by , created almost 6 years ago

Doctorate Pathology (Systems Pathology) Mind Map on Pathology of the Alimentary Tract 1 (Oral Cavity & Oesophagus), created by melian.yates on 12/03/2013.

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melian.yates
Created by melian.yates almost 6 years ago
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Pathology of the Alimentary Tract 1 (Oral Cavity & Oesophagus)
1 Alimentary Tract
1.1 Normal Histology (Alimentary Tract)
1.1.1 Stratified Squamous epithelium
1.1.1.1 Mouth
1.1.1.1.1 Oesophagus
1.1.1.1.1.1 Non-glandular part of stomach: Pigs, Horses
1.1.1.1.1.1.1 Forestomachs: Ruminants
1.1.1.1.1.1.1.1 Anus:
1.1.1.1.1.1.1.1.1 Keratinized: Ruminants, Horses, Pigs
1.1.1.1.1.1.1.1.2 Non- Keratinized: Dogs & Cats
1.1.2 Simple columnar glandular epithelium
1.1.2.1 Stomach; Abomasum
1.1.2.1.1 Surface epithelium
1.1.2.1.1.1 Simple tubular glands
1.1.2.1.1.1.1 Chief (peptic, zymogen) cells: Pepsinogen
1.1.2.1.1.1.1.1 Parietal (oxyntic) cells: HCl
1.1.2.1.1.1.1.1.1 Neuroendocrine cells
1.1.2.1.1.1.1.1.1.1 Stem cells: Neck of gland
1.1.2.2 Small intestine
1.1.2.2.1 Progenitor cells: Crypts
1.1.2.2.1.1 Enterocytes: Villi
1.1.2.2.1.1.1 Mucous (goblet) cells
1.1.2.2.1.1.1.1 Neuroendocrine cells
1.1.2.3 Large Intestine
1.1.2.3.1 Enterocytes: Crypts, surface epithelium
1.1.2.3.1.1 Mucous(goblet) cells
1.2 Defense Mechanisms (Alimentary Tract)
1.2.1 GI tract sterile at birth -> becomes colonized w/ bacteria
1.2.2 Routes of Entry:
1.2.2.1 Oral ingestion
1.2.2.1.1 Secretions swallowed from the respiratory tract
1.2.2.1.1.1 Haematogenous dissemination
1.2.2.1.1.1.1 Parasite migration
1.2.3 Secretions
1.2.3.1 Saliva
1.2.3.1.1 Mucous
1.2.3.1.1.1 Inhibits contact w/ mucosa, protects surface
1.2.3.1.1.2 Acid
1.2.3.1.1.2.1 Parietal cells in stomach
1.2.3.1.1.2.2 Digestive enzymes
1.2.3.1.1.2.2.1 Salivary amylase, Pepsin from gastric chief cells, pancreatic & SI enzymes
1.2.3.1.1.2.2.2 Bile secretions
1.2.3.1.1.2.2.2.1 Kill some pathogens
1.2.3.1.2 Flushing effect & antibacterial components (Ex. lysozyme, secretory IgA)
1.2.4 Epithelium
1.2.4.1 Mucosal barrier
1.2.4.1.1 Stomach, Intestine
1.2.4.1.2 Tight junctions (b/w epithelial cells)
1.2.4.1.2.1 Prevent entry of macromolecules & pathogens (but allows ions & H2O to diffuse through)
1.2.4.1.3 Very high cell turnover
1.2.4.1.4 Stratified Squamous epithelium
1.2.4.1.4.1 Oral cavity
1.2.4.1.4.2 Multilayered
1.2.4.1.4.3 Relatively high cell turnover
1.2.4.1.4.4 Keratinized surface layer at some sites
1.2.5 Commensal Flora
1.2.5.1 Act as barrier to pathogens
1.2.5.1.1 Secrete VFAs & compete w/ pathogens for nutrients
1.2.5.1.1.1 Essential for digestion in herbivores
1.2.5.1.1.1.1 Any disequilibrium of microflora can lead to disease
1.2.6 Movement
1.2.6.1 Continuous movement/peristalsis discourages persistence of insult/agent
1.2.7 Cell-mediated & Humoral Defenses
1.2.7.1 Lamina propria:
1.2.7.1.1 Macrophages, B & T Lymphocytes, Plasma cells, mast cells
1.2.7.1.2 Epithelium:
1.2.7.1.2.1 Intraepithelial lymphocytes (T lymphocytes)
1.2.7.1.2.2 Lymphoid Aggregates:
1.2.7.1.2.2.1 Peyer's Patches (esp. ileum), GALT
1.2.7.1.2.2.2 Ab production (esp. secretory IgA)
1.2.7.1.2.2.2.1 Regional Lymph Nodes
1.2.7.1.2.2.2.1.1 Omental macrophages
1.3 Inflammation in the Alimentary Tract
1.3.1 Vascular changes
1.3.1.1 Hyperaemia (Congestion)
1.3.1.1.1 Reddening, Oedema
1.3.1.1.1.1 Haemorrhage: Petechiae, Ecchymoses
1.3.2 Exudates
1.3.2.1 Serous/Mucous/Seromucous: Catarrhal
1.3.2.1.1 Suppurative (Purulent)
1.3.2.1.1.1 Mucopurulent
1.3.2.1.1.1.1 Diptheritic: Fibrin & Necrotic material, secondary bactrerial invasion
2 Oral Cavity
2.1 Defense Mechanisms (Oral Cavity):
2.1.1 Taste buds
2.1.1.1 Normal bacterial flora
2.1.1.1.1 Saliva (flushing, coating, lysozyme & Igs)
2.2 Developmental Anomalies (Oral Cavity)
2.2.1 Brachygnathia superior/inferior
2.2.1.1 Short maxilla/mandible
2.2.2 Prognathia
2.2.2.1 Abnormal prolongation of maxilla/mandible
2.2.3 Cleft palate/palatoschisis
2.2.3.1 Inadequate growth of palatine shelves leaves a central defect
2.2.3.2 Communication of nasal & oral cavities may result in aspiration pneumonia & problems w/ suckling
2.2.3.3 Affects hard &/or soft palate
2.2.4 Hare lip/cheiloschisis
2.2.4.1 Absence of part of lip rostral to nasal septum
2.3 Inflammatory Lesions (Oral Cavity)
2.3.1 Inflammation predominates in Chronic lesions of bacterial or fungal origin
2.3.2 Granulomatous inflammation
2.3.2.1 Actinobacillosis ("Wooden togue")
2.3.2.1.1 Actinobacillus lignieresii
2.3.2.2 Actinomycosis ("Lumpy jaw")
2.3.2.2.1 Actinomyces bovis
2.3.2.2.2 Mandible becomes enlarged due to chronic osteomyelitis
2.3.3 Eosinophilic Inflammation
2.3.3.1 Oral eosinophilic granuloma (Cats)
2.3.4 Necrotizing Inflammation
2.3.4.1 Calf diptheria
2.3.4.1.1 Fusobacterium necrophorum
2.3.4.1.2 Coagulative necrosis & surrounding granulation tissue affecting the gingival & oral mucosa
2.3.5 Vesicular Inflammation
2.3.5.1 Often viral
2.3.5.2 Vesicular, ulcerative or proliferative patterns may also co-exist or progress (e.g. vesicles -> ulcers)
2.3.5.3 Foot & mouth disease
2.3.5.4 Feline calcivirus
2.3.6 Erosive Inflammation
2.3.6.1 Ulcers may progress from vesicles, but can also be caused by: some bacterial & immune-mediated diseases, trauma
2.3.6.2 Feline calcivirus & Feline herpesvirus
2.3.6.2.1 Causes mouth ulceration
2.3.6.3 Mucosal Disease
2.3.6.3.1 Bovine viral diarrhoea virus (BVDV)
2.3.6.3.2 Causes ulceration of oral cavity, muzzle & more distal alimentary ytact
2.3.6.4 Immune - mediated diseases
2.3.6.4.1 Autoantibodies directed against epithelial cell surface Ags
2.3.6.4.2 Ex. Pemphigus vulgaris, bullous pemphigold (Dogs, Cats & Horses)
2.3.7 Papular Inflammation
2.3.7.1 Proliferative (papular) lesions
2.3.7.2 Contagious pustular dermatitis ("orf")
2.3.7.2.1 Firm, raised papules & pustules on lips & oral mucosa
2.3.7.2.2 Sheep & Goats
2.3.7.2.3 Hydrophobic degeneration, mixed inflammatory cell infiltration & secondary bacterial invasion
2.4 Neoplasia (Oral Cavity)
2.4.1 Epithelial Tumors
2.4.1.1 Papillomas
2.4.1.1.1 Benign
2.4.1.1.2 Raised, sometimes cauliflower-like lesions (Lips & Oral Mucosa)
2.4.1.1.3 Thick squamous epithelium over a branching pedunculated fibrous stroma
2.4.1.2 Squamous cell carcinoma
2.4.1.2.1 Malignant
2.4.1.2.2 Most common oral malignancy (Cats)
2.4.1.2.3 Ventrolateral tongue
2.4.1.2.3.1 Locally invasive +/- metastases
2.4.1.2.3.1.1 Composed of elevated firm, white plaques or nodules that may ulcerate
2.4.1.2.3.1.1.1 Irregular masses & cords of squamous epithelium invading the lamina propria
2.4.1.2.3.1.1.1.1 May be circular pearls of keratin
2.4.2 Melanoma
2.4.2.1 Tumor of pigment producing melanocytes
2.4.2.2 Most common oral neoplasm (Dog)
2.4.2.3 Nearly always Malignant (in oral cavity)
2.4.2.4 Grow rapidly & are not always pigmented
2.4.2.5 Oval or spindle-shaped melanocytes w/ variable melanin content
2.4.3 Epulis
2.4.3.1 Group of benign neoplasms of peridontal origin affecting gingivae
2.4.3.2 Particularly in brachycephalic Dog breeds (boxer)
2.4.3.3 Firm lesions on gums, surrounding teeth, esp. carnassial/canine region
2.4.3.4 Dense collagenous & sometimes ossified tissue covered with stratified squamous epithelium (descends into dermis in cords)
3 Oesophagus
3.1 Congenital Anomalies
3.1.1 Segmental aplasia
3.1.1.1 Rare failure of fusion
3.1.1.1.1 Band of fibrous tissue where distal oesophagus should be
3.1.2 Achalasia
3.1.2.1 Failure of cardiac sphincter to open
3.2 Functional (Neuromuscular) Disorders
3.2.1 Megaesophagus
3.2.1.1 Dilated oesophagus lacks peristalsis
3.2.1.1.1 Accumulates ingesta due to underlying neuromuscular disorder (or obstruction), but lower oesophageal sphincter is usually normal
3.2.1.1.1.1 Aspiration pneumonia may be a sequel
3.2.1.2 Idiopathic
3.2.1.2.1 Developmental disorder of vagus nerve/motor nucleus (esp. Great Dane, German shepherd, Siamese cat)
3.2.1.3 Acquired
3.2.1.3.1 Neurological
3.2.1.3.1.1 Dysautonomias (ex. Equine grass sickness, feline dysautonomia), Myaesthenia gravis
3.2.1.3.2 Muscular
3.2.1.3.2.1 Myodegeneration (ex. nutritional myopathy (Vit. E/ selenium deficiency in cattle)
3.3 Obstruction
3.3.1 Intraluminal
3.3.1.1 Foreign bodies ("Choke")
3.3.1.1.1 Ex. Root vegetable, sugar beet pulp, bone
3.3.1.2 Most likely sites are narrow areas: Thoracic inlet, base of heart & cardiac sphincter
3.3.1.3 May cause inflammation, pressure necrosis, ulceration & perforation
3.3.1.4 Obstruction of Ruminant oesophagus may cause bloat
3.3.1.5 Healing may cause narrowing (Stricture)
3.3.2 Intramural (w/in wall of oesophagus)
3.3.2.1 Inflammatory lesion (abscess, granulation tissue), fibrosis or neoplasm => Narrowing
3.3.3 Extrinsic ( outside the oesophagus)
3.3.3.1 Vascular ring anomaly (persistent RT. aortic arch constricts oesophagus & leads to megaoesophagus cranially)
3.3.3.2 Also pressure from abscess, haematoma, neoplasm
3.4 Inflammation (Oesophagitis)
3.4.1 Reflux Oesophagitis
3.4.1.1 Damage from gastric acid due to gastric-oesophageal reflux or vomiting
3.4.1.1.1 => Erosion of epithelium (may progress to ulcers)
3.4.2 Infectious Agents
3.4.2.1 Ex. Actinobacillosis, feline calcivirus
3.5 Neoplasia
3.5.1 Papillomatosis
3.5.1.1 Cattle: Bovine papillomavirus type 4 (transforms squamous cell carcinoma w/ bracken fern toxins)
3.5.2 Squamous cell carcinoma
3.5.2.1 Cats
3.5.3 Leiomyoma
3.5.3.1 Benign tumor of smooth muscle