GI Pathology I, Case 3 37-year-old man presents with epigastric pain relieved by eating. Stool is positive for occult blood

Identify the organ(s) and labeled structures Describe the gross morphologic changes Diagnosis?

A Pylorus B Pyloric Ring C Ulcer Peptic Ulcer (Duodenum) The surgical specimen (opened) of the distal stomach and proximal duodenum reveals an irregular ulcer of the duodenal mucosa. The ulcer is filled with clotted blood. The duodenal mucosa is stained with blood.

Identify the structures

Peptic Ulcer (Duodenum) A Artery B Ulcer Bed Peptic Ulcer (Duodenum) A close up view of the duodenal mucosa reveals a sharply demarcated peptic ulcer. The ulcer bed contains a ruptured small artery.

Identify the organ. Describe the histologic findings

Duodenal mucosa Brunner’s Glands Ulcer

Floor of ulcer with granulation tissue fibrosis Superficial surface of ulcer with debris, acute inflammatory cells

Ulcer surface neutrophils

Identify the organs and structures Diagnosis?

Peptic Ulcer (Duodenum) A Esophagus B Liver C Gallbladder D Spleen E Stomach Peptic Ulcer (Duodenum) Description: This autopsy specimen of the upper gastrointestinal tract, liver, and spleen, reveals a perforated (probe) peptic ulcer of the proximal duodenum. The probe passes from the gastric lumen to the exterior of the duodenum. The liver is folded back to reveal the gall bladder and ulcer.

Identify the abnormality

Free air in the abdomen (air under the right diaphragm) Associated with a perforated viscus (example: perforated peptic ulcer)

What is the most probable diagnosis?

The specimen consists of a black tarry stool passed per anus. Melena The specimen consists of a black tarry stool passed per anus. Note the mahogany color at the edge of the specimen (filter paper).