Download - GrosS LARGE BOWEL DR N P TIWARI
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Gross presentation –bowel loop
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Anatomy Large bowel
• Forms three sided frame around SI leaving inferior area open to the pelvis.
• Approx. 1.5 m in length & extend from lleum to anus.
• Diameter dec from caecum (7cm) to sigmoid colon (2.5cm).
• Divided into 4 segments-cecum,colon,rectum & anus.
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Types of bowel resection
• Total colectomy.• Right hemicolectomy.• Transverse colectomy. • Left hemicolectomy.• Low anterior resection.• Abdominoperineal resection.
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Procedure
• Weigh & measure the specimen• Sample lymph nodes, & remove the mesentry
while the specimen is fresh.• Two options are there:-
A) Open the bowel longitudinally, pin on a corkboard & fix it overnight.
B)Injecting formalin through one end when the other end is tied, then tying off the injected end.
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• Take photographs .• In cases with deep penetration by tumor,
dissect the veins carefully for possible tumor invasion.
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Description • Part of bowel removed & length of specimen .• Mucosa- type of lesion,extent,ulceration(linear or
transverse),depth, pseudoplyps,hemorrhage,fissures.• Wall thickening (focal or diffuse),atrophy ,fibrosis,
necrosis.• Serosa- fibrin, pus,fibrosis,adherence of mesentry.• Diverticulum- number, size, location in relation to
teniae,content, evidence of inflammation, hemorrhage or perforation.
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Description for tumor
Tumor • size (including thickness).• Shape (fungating,flat,ulcerating)• Extent through bowel wall• Serosal involvement,satellite nodules.• Areas of necrosis & hemorrhage.• Evidence of blood vessel invasion & invasion of
adjacent organs.
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• Distance of tumor to each line of resection. • Estimate the no. of lymph nodes found,
whether or not nodes appear to be involved by tumor, size of largest node.
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Sections for histology
For non tumoral conditions:-• As many as necessary to sample abnormal areas.• Proximal & distal lines of resection in cases of colitis.• Appendix, if included in specimen.
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For tumoral conditions:-• 3 sections from tumor.• Representative section of subserosal connective
tissue, fat & blood vessel around tumor.• Both surgical margins.• Bowel b/w tm & distal line of resection.
• Appendix if included in the specimen.
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• Lymph nodes:-
A) around tumor.
B)distal to tumor.
C)proximal to tumor.
D)at high point of resection(areas surrounding ligated vessels)
• In abdominoperineal resections:- anorectal junction.
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Meckels diverticulum
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Crohns disease
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Ulcerative colitis Pseudo polyps
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Tuberculosis Typhoid
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Mesentric embolism Carcinoid tumor
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Diverticular disease Diverticulitis
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Chronic ischaemic colitis
Pseudomembranous colitis
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Amebic dysentery
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Tubular adenoma
Villous adenoma
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Familial polyposis coli
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MELANOSIS COLI
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Endometriosis
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Ulcerating rectal carcinoma
Fungating rectal carcinoma
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Annular stenosing rectal carcinoma
Caecal carcinoma
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Hirschsprung disease
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SPEAKER DR N. P. TIWARITHANK YOU
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