Difference between revisions of "Pseudomembranous colitis"
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| Line 4: | Line 4: | ||
| Width = | | Width = | ||
| Caption = Colonic pseudomembrane. [[H&E stain]]. | | Caption = Colonic pseudomembrane. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = ''C. difficle colitis'' commonly used as synonym by clinicians - ''not'' the same from the same for the perspective of pathology | ||
| Micro = heaped necrotic surface epithelium (described as "volanco lesions"), [[PMN]]s in lamina propria, +/-capillary fibrin thrombi | | Micro = heaped necrotic surface epithelium (described as "volanco lesions"), [[PMN]]s in lamina propria, +/-capillary fibrin thrombi | ||
| Subtypes = | | Subtypes = | ||
| Line 20: | Line 20: | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = diarrhea, abdominal pain, fever | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = | | Bloodwork = | ||
| Line 26: | Line 26: | ||
| Endoscopy = pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly | | Endoscopy = pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly | ||
| Prognosis = dependent on comorbidities | | Prognosis = dependent on comorbidities | ||
| Other = | | Other = ''C. difficile'' toxin test positive (may be negative) | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = dependent on underlying cause, antibiotics in ''C. difficle'' - occasionally surgical resection | | Tx = dependent on underlying cause, antibiotics in ''C. difficle'' - occasionally surgical resection | ||
| Line 44: | Line 44: | ||
Etiology: | Etiology: | ||
*Anything that causes a severe mucosal injury. | *Anything that causes a severe mucosal injury. | ||
Epidemiology of ''[[C. difficle]]'' pseudomembranous colitis: | |||
*Antibiotics prior to onset (classic history).<ref name=pmid23253319>{{Cite journal | last1 = Bassetti | first1 = M. | last2 = Villa | first2 = G. | last3 = Pecori | first3 = D. | last4 = Arzese | first4 = A. | last5 = Wilcox | first5 = M. | title = Epidemiology, diagnosis and treatment of Clostridium difficile infection. | journal = Expert Rev Anti Infect Ther | volume = 10 | issue = 12 | pages = 1405-23 | month = Dec | year = 2012 | doi = 10.1586/eri.12.135 | PMID = 23253319 }}</ref> | |||
==Gross== | ==Gross== | ||
Revision as of 02:15, 13 January 2014
| Pseudomembranous colitis | |
|---|---|
| Diagnosis in short | |
 Colonic pseudomembrane. H&E stain. | |
|
| |
| Synonyms | C. difficle colitis commonly used as synonym by clinicians - not the same from the same for the perspective of pathology |
|
| |
| LM | heaped necrotic surface epithelium (described as "volanco lesions"), PMNs in lamina propria, +/-capillary fibrin thrombi |
| LM DDx | cap polyposis, signet ring cell carcinoma (uncommonly), ischemic colitis in general |
| Site | colon |
|
| |
| Symptoms | diarrhea, abdominal pain, fever |
| Prevalence | uncommon |
| Endoscopy | pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly |
| Prognosis | dependent on comorbidities |
| Other | C. difficile toxin test positive (may be negative) |
| Treatment | dependent on underlying cause, antibiotics in C. difficle - occasionally surgical resection |
Pseudomembranous colitis an inflammation of the colon (colitis) with a characteristic endoscopic/gross appearance. It is closely associated with C. difficle infectious; however, may be seen in a number of different situations.
General
- Pseudomembranous colitis is a histomorphologic description which has a DDx. In other words, it can be caused by a number of things.
DDx of pseudomembranous colitis:[1]
- C. difficile.
- Known as C. difficile colitis.
- Ischemic colitis.
- Volvulus.
- Other infections.
Etiology:
- Anything that causes a severe mucosal injury.
Epidemiology of C. difficle pseudomembranous colitis:
- Antibiotics prior to onset (classic history).[2]
Gross
Features:[3]
- Pseudomembranes:
- Pale yellow (or white) irregular, raised mucosal lesions.
- Early lesions: typical <10 mm.
- Interlesional mucosa often near normal grossly.
Images
Pseudomembranous colitis. (WC)
Microscopic
Features:[1]
- Heaped necrotic surface epithelium.
- Described as "volanco lesions" - this is what is seen endoscopically.
- PMNs in lamina propria.
- +/-Capillary fibrin thrombi.
Notes:
- Pseudomembranes arise from the crypts.
- Rarely have (benign) signet ring cell-like cells.[4]
DDx:
- Cap polyposis - very rare.
- Signet ring cell carcinoma.
- Ischemic colitis - in general.
Images
Pseudomembranes - low mag. (WC/Nephron)
Pseudomembranes - intermed. mag. (WC/Nephron)
www:
See also
References
- ↑ 1.0 1.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 837-8. ISBN 0-7216-0187-1.
- ↑ Bassetti, M.; Villa, G.; Pecori, D.; Arzese, A.; Wilcox, M. (Dec 2012). "Epidemiology, diagnosis and treatment of Clostridium difficile infection.". Expert Rev Anti Infect Ther 10 (12): 1405-23. doi:10.1586/eri.12.135. PMID 23253319.
- ↑ URL: http://radiology.uchc.edu/eAtlas/GI/1749.htm. Accessed on: 22 May 2012.
- ↑ Abdulkader, I.; Cameselle-Teijeiro, J.; Forteza, J. (Apr 2003). "Signet-ring cells associated with pseudomembranous colitis.". Virchows Arch 442 (4): 412-4. doi:10.1007/s00428-003-0779-1. PMID 12684766.