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Ebook Pathology for surgeons in training (3/E): Part 2

(BQ) This extensively revised new edition is presented in a compelling new style and in a larger format. Beginning with a 'route-map' showing 'how to use this book', the text offers concise accounts of the core topics in pathology required of surgeons in training. There is particular emphasis on tissue pathology but full account is taken of relevant aspects of microbiology, haematology, immunology and clinical chemistry. Tables of normal laboratory values are included. | Hypothermia destroys the frozen cells. The procedure is repeated when a maximum effect is sought. Capillaries and small vessels in the ‘ice ball’ are eradicated. Blood in large arteries may freeze but does not coagulate. Neither the blood nor the arterial walls show evidence of injury when thawing is allowed. A normal circulation can be restored. Since nerve endings are ablated, cryosurgery is relatively painless. I ILEUM AND JEJUNUM Biopsy diagnosis of small intestinal disease See p. 40. DEVELOPMENTAL AND CONGENITAL DISORDERS The most frequent sites of atresia or stenosis are the distal ileum and the duodenum adjoining the papilla of Vater. There may be an association with Down’s syndrome (p. 92). Malrotation of the small intestine in utero is occasionally recognised.The caecum lies in the left iliac fossa with the entire small intestine to the right of the midline. There is a long, narrow mesentery so that the intestine is prone to torsion and volvulus. Duplications and enterogenous cysts are common. Although symptomless, haemorrhage, obstruction or intussusception are recognised complications. Meckel’s diverticulum Meckel’s diverticulum is the most common congenital abnormality of the small intestine. The diverticulum is the persisting, proximal end of the vitello-intestinal duct. It is situated on the anti-mesenteric border of the ileum and is present in ~2% of people.The defect lies within 1m of the ileo-caecal valve and is ~50 mm in length.The diverticulum is usually 164 free but may be connected to the umbilicus by a fibrous cord, the residue of the vitello-intestinal duct. Several categories of disorder complicate Meckel’s diverticulum.The lining mucosa is of a small-intestinal, mucin-secreting form but an island of ectopic gastric epithelium is sometimes present.When this is the case, a peptic ulcer may form and be complicated by bleeding and perforation. Neuro-endocrine tumours and carcinoma occasionally develop. Infection and intestinal obstruction