Der Internist
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Polyps of the gastrointestinal tract encompass a variety of epithelial and non-epithelial tumour-like conditions. The most common polyps are epithelial lesions. In the upper gastrointestinal tract, reactive inflammatory changes and hyperplastic polyps dominate, whereas true neoplastic polyps, like adenomas, are much more common in the colorectum. ⋯ The risk of malignancy is determined by the histological subtype of polyp, as well as the size, presence and degree of dysplasia. The term "dysplasia" has been reintroduced for adenomas in the current 2019 World Health Organization (WHO) classification and replaces "intraepithelial neoplasia". A further change is the term "sessile serrated lesion" with and without dysplasia, which was formerly known as sessile serrated adenoma.
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Hepatitis viruses A-E cause acute and chronic liver inflammation and thus lead to significant morbidity and mortality worldwide. They differ significantly in their biology, course of disease and therapy options. While hepatitis A virus only causes acute infection, hepatitis B can become chronic, even reactivate or occur as coinfection with hepatitis D virus. ⋯ However, new direct antiviral agents reliably lead to cure of chronic hepatitis C. Hepatitis E virus frequently causes acute or-in case of immunosuppression-even chronic hepatitis. Continual screening of patients with elevated liver enzymes or risk groups using simple serological markers can enable virus-specific therapy of mostly asymptomatic chronic virus hepatitis, preventing the development of liver cirrhosis and hepatocellular carcinoma.
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Case Reports
[Right upper abdominal pain, vomiting, weight loss and icterus in a 20-year-old male refugee].
Tuberculosis (TB) is one of the most common infectious diseases worldwide. The case of a 20-year old male refugee from Somalia, who initially presented with right-sided upper abdominal pain, vomiting, weight loss and jaundice with suspected cholecystitis is reported. In the course of further diagnostics, pyloric stenosis surprisingly appeared, which, like the cholestasis, was caused by compressing peripancreatic lymph nodes. Lymph node cytology finally showed evidence of caseating necrosis with evidence of TB pathogens.
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Gastrointestinal polyposis syndromes are the second most common cause of hereditary colorectal carcinomas after Lynch syndrome (hereditary non-polyposis colon cancer, HNPCC). The detection of a causal germline mutation in an affected family member serves for differential diagnosis, assessment of the recurrence risk and predictive testing of healthy individuals at risk. ⋯ Early detection and correct classification of polyposis is crucial for adequate prevention and therapy. Access to multidisciplinary expert centres is useful for the care of families.