Intestinal Ulcers and Infections - NEET PG Pathology

Intestinal ulcers and infections are common conditions encountered in clinical practice, significantly impacting morbidity and mortality. Many other gastrointestinal conditions may present symptoms like intestinal ulcers and infections. And thus, it is important to have a thorough understanding of the etiology, pathophysiology, clinical features, and management of these conditions. 

Read this blog further to get a quick overview of this important pathology topic for NEET PG exam preparations.

Tuberculosis

• The ulcers found in intestinal tuberculosis are transverse ulcers.
• Intestinal tuberculosis is seen secondary to the development of pulmonary tuberculosis.
• Pathogen: the pathogen associated with intestinal tuberculosis is Mycobacterium bovis.

Enteric fever/typhoid

• Pathogen associated with typhoid is Salmonella typhi.
• It is an infection that spreads through the intake of contaminated water and food.
• Typhoid fever is associated with the development of longitudinal ulcers. 
• This kind of an ulceration is likely to be associated with bleeding, usually in the third week; but less likely to be associated with a stricture formation.

Hints to look for

• Fecal-oral transmission
• History of involvement of abdominal pain and fever.
• Involvement of ileum. Because the ulcers are usually found at the level of the Peyer’s patches.
• Microscopically, there will be the presence of erythrophagocytosis.

Amoebiasis

• Spreads through the ingestion of contaminated water.
• CAUSATIVE ORGANISM: Entamoeba histolytica.
• LOCATION: intestine 

Important information

• Since the ulcer is unable to enter the muscle layer, it takes a “flask-shape” (flask shaped ulcer formation)

• MICROSCOPIC VIEW:

• The trophozoite form is going to have the presence of a round nuclei.
• Some of them might have ingested RBCs.
• The trophozoites can get access to the portal circulation and thereby reach the liver. In the liver, they can be responsible for the formation of amoebic liver abscess.

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Psuedo membraneous colitis

• CAUSATIVE ORGANISM: Clostridium difficile.

Most commonly seen in patients who have been taking third generation Cephalosporins for a long period of time.

• The toxin released by C. difficile leads to the accumulation of a necrotic material which is responsible for the formation of a puss containing material (necrotic material) on the membrane of the intestine.
• ENDOSCOPIC VIEW : A pseudomembrane formation can be seen in the endoscopy, due to the formation of the pus containing material on the intestinal membrane. The presence of this pseudo membrane gives this disease its name.
• MICROSCOPIC VIEW: 

Important information

• The presence of Necrotic debris and neutrophils arising from the epithelial lining of the intestine can be seen, forming a “Mushroom-like” appearance or “volcanic eruption” form in the microscopic view.
• TREATMENT:
  • Vancomycin
  • Fidaxomicin 
  • Metronidazole

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Frequently Asked Questions

Q: ‘Anchovy sauce” pus can be seen in which disease?

Answer: Amoebiasis

Q: What is the most common cause of Pseudomembranous colitis?

Answer: Excessive antibiotic use

Q: What is the treatment of Amoebiasis?

Answer: Antibiotics like metronidazole are used for the treatment of Amoebiasis.

Q: Which organism causes Intestinal tuberculosis?

Answer: Mycobacterium bovis.

To study intestinal ulcers and infections in detail, you can download the PrepLadder app and find in-depth video lectures on the topic. In addition to that, also find relevant study notes and MCQs for practice and strengthen your NEET PG exam preparations.