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PROF.DR. MAGESHKUMAR’S UNIT Dr.Aarthy.J ,[object Object]
20  Year old young girl presented with , ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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CHRONIC DIARRHEA ,[object Object],[object Object],[object Object],[object Object],[object Object]
  Causes of Chronic Diarrhea According to Predominant Pathophysiologic Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
  Causes of Chronic Diarrhea According to Predominant Pathophysiologic Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differential diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
APPROACH TO CHRONIC DIARRHEA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INVESTIGATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
DIFFERENTIAL DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
 
 
DDUODENAL BIOPSY
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
LYMPHOMA OF SMALL INTESTINE ,[object Object],[object Object],[object Object],[object Object]
PRIMARY INTESTINAL LYMPHOMA ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
ANN ARBOR STAGING STAGE FEATURE I Involvement of a single lymph node region or lymphoid structure (e.g., spleen, thymus, Waldeyer's ring) II Involvement of two or more lymph node regions on the same side of the diaphragm  III Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm IV Involvement of extranodal site(s) beyond that designated as "E“ More than one extranodal deposit at any location Any involvement of liver or bone marrow A No symptoms B -Unexplained weight loss of >10% of the body weight during the 6 months before staging investigation -Unexplained, persistent, or recurrent fever with temperatures >38°C during the previous month -Recurrent drenching night sweats during the previous month E Localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow
INTERNATIONAL PROGNOSTIC INDEX FOR NHL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal  marginal zone B cell  of MALT type  Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving  5 years 74 46 25 45
CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal  marginal zone B cell  of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal  marginal zone B cell  of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal  marginal zone B cell  of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
IMMUNOPROLIFERATIVE SMALL INTESTINAL DISEASE (IPSID) ,[object Object],[object Object],[object Object],[object Object]
REFERENCES: ,[object Object],[object Object],[object Object]
 

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A Case of Chronic Diarrhoea

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  • 33. ANN ARBOR STAGING STAGE FEATURE I Involvement of a single lymph node region or lymphoid structure (e.g., spleen, thymus, Waldeyer's ring) II Involvement of two or more lymph node regions on the same side of the diaphragm III Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm IV Involvement of extranodal site(s) beyond that designated as "E“ More than one extranodal deposit at any location Any involvement of liver or bone marrow A No symptoms B -Unexplained weight loss of >10% of the body weight during the 6 months before staging investigation -Unexplained, persistent, or recurrent fever with temperatures >38°C during the previous month -Recurrent drenching night sweats during the previous month E Localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow
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  • 36. CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal marginal zone B cell of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
  • 37. CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal marginal zone B cell of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
  • 38. CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal marginal zone B cell of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
  • 39. CHARACTERISTICS OF COMMON TYPES OF NHL INVOLVING GIT TYPE OF NHL Extranodal marginal zone B cell of MALT type Diffuse large B cell Peripheral T cell Burkitt Gastrointestinal involvement % 50 18 15 11 Median Age, years 60 64 61 34 Stage I/II vs III/Iv 67 vs 33 54 vs 46 20 vs 80 62 vs 38 B symptoms % 19 33 50 22 Bone marrow involvement % 14 16 36 33 Chemotherapy regimen Chlorambucil CHOP/ R CHOP CHOP CHOP % surviving 5 years 74 46 25 45
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