PATHOLOGY

HEMATOLOGY

Bone marrow aspirate Bone marrow biopsy

Key words : microcytic hypochromic anemia , Key words : pancytopenia, no
not responding to oral iron hepatosplenomegaly
Persian blue stain Aplastic anemia

•;le,ig• Z/Joo· • •
Sideroblastic anemia

.•• • ~- • '1eQ
t 1 • !(# • •
• 0 • • ••
• • o. ••
,\. • :!.o
o

• _!I~
PBS
Illectomy history
Megaloblastic anemia (B12 deficiency)
Jejunectomy - B9 deficiency
Celiac disease - B9 deficiency
Spherocytes
D/D : hereditary spherocyt osis -
hepatosplenomegaly
AIHA - adult females . associated AI disease
G6PD deficiency - has bite cells (h/o Ab use)
 e
_.. .;,9
0
Bite cells in G6PD deficien cy anemia Target cell and tear drop cell - dot in central
Hemoglobinuria after starting antibiot ics pallor
Tear drop/ dacrocy te - myelofi brosis

f Chipmonk faces/ Thalcem ic f acies , due to

I expansion of bone marrow
Crew cut appeara nce / hair on end
appearance
Hemolysis in bone marrow
Seen in thalasse mia

e e-4 • G~
oo·
0• . . v&~·
•••
0 ~~·- ~ 4 e
°of© __P-__,
Oo .
o •
Sickle cell - sickle cell anemia____ _,____,_--:-K:--e-y_w_o_r~d~s -: _m_y_c_o-pl-a-sm
_ a_p_n_e_u_m_o-ni_a_p_a_t-ie_n_t_ __J
I Cold hemagg lutinin - IgM produce d in
mycoplasma
Clumping of RBCs
Dose not require Comb's test - it is done in
I G mediate d AIHA

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Starry sky appearance Owl eye appearance

Burkitt lymphoma Hodgkin's lymphoma
Key words : abdominal mass, fever, night Also seen in CMV but have basophilic inclusion
sweats = high grade Key words : cervical lymph node
Increase Ki67 = high rode Etio: EBV

INICET Key wor d : 4y/ o fever + hepatosplenomega.lly

Key words : elderly anemia, recurrent ALL - 1st decade B ALL, 2nd - TALL
infection · AML - 3rd 4tti 5 th CML - 5th 6 t h
I I j I

Smudge cells CLL - beyond 6th

- - - - - - 1 -Lymphoblasts
/
with
1
Agranular cytoplasm
'c -- ' - - - - - - 4

-~

key words : 55y/o with backache h/o DIC with pancytopenia

Mott cell - grape like inclusions AML M3
Multiple myeloma PML-RARA mutation
Rx: Bortezomlil, dexamethasone Rx : ATRA
Cytoplasm vlue, eccentric nucleus Good prognosiis
Pha ot cell, multi le aeur rod cells

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Key words down syndrome, pancytopenia Langerhans cell histiocytosis

BMA Associated with central DI
AML- M7 Key word - 2yr/ o, lytic lesion in skull
C toJ)lasmic blebs - megakarroblasts
ANEMIA

ANEMIA APPROACH RETICULOCYTE INDEX (RI)

History of Jaunice, Haemoglobinu ria

Pneumonic: SITA MAA HEMOLmc ANEMIA

S-Sideroblastic
I-Iron Deficiency
T-Thalassemla
A- Anemia of Chronic Disease
M-Meploblast lc Anemia
A- A~aastic/Dysp lastk Anemia
A-Anemia of CRf
A-Acute hemolysis/ blood loss

HEMOLYTIC ANEMIA

AGE OF ONSET
HEMOLYTIC ANEMIA
APPROACH

INHERITED ACQUIRED
HEMOLmc ANEMIA
,.
HEMOLmC ANEMIA

Oumplng Associated w ith

Spherocyte thrombocytopen ia /
Spherocytes,
Autolmmu n cytopenla
Osmotic fragility
l Heredftilry Spherocytosls
I
history
AIHA
PNH

Thalassemia SJdde cell Anemia

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NON- HEMOLYTIC ANEMIA SITAMAAA

APPROACH

Slze of RBC

MACROCYTIC (fMCVJ MICROCYTIC (! MCVJ

NORMOCTIC ( MCV
NORMAL]
CHALLENGE ORAL IRON

Responding

IDA
lf DO IRON PROFlLE
f t J
AU . EXCEPT ALLf EXCIPT ALL

CONTINUE ORAL
BC S.FERRmN TIBC NORMAL
I!
IRON FOR6-9
MONTHS
I IDA
I ACO SIDEROBLASTIC j THAL minor
11!
Iron injections RX the cause Vitamin 86 HPt.C
J

MACROCYTIC ANEMIA

Present Not present

Non megaloblastic Macrocytosls

Neurological manifestations
, ileal disease, vegetarian,
autoimmune disease (atrophic
gastritis), gastrectomy
Increased methyl Melanoic acid
Not eating fruits and vegetables, Liver, Thyroid, autoimmune
celiac tropical sprue, diseases
malignancies, inflammation,
increased FIGLU

Vitamin B12 defldency folic add deficiency

Schllllngs test Rx Follc add and

Vitamin B12

Rx Vitamin 812

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NORMOCYTIC ANEMIA
Retie count <1%

Present pancytope:nla Not present

Bonemanow
hypocellular /
---Acut--•-b-lood--1-oss_/_ _ _.l'-Ane
__m_la_of_Chron
__ ic_re_n_a_l_fa_O_u_re....!
hemodilution _
acellular L-

Aplastic anemla

Some times RBC can be

macrocytic

PANCYTOPENIA

Hypersplenism Present Not present

Myelopthys'\.. ~
BM HYPERCEWJlAR
.
BM HYPOCRWlAR

Myelodysplastlc syndrome •
( Dysplasla on. BMA}
! +
Aplastic Anemia
L--_I_ _ _ _ _ __.....
ap "

Leuuemlas ! Myaloflbrosls ! Metastatic

carcinoma

-Leukaemia

Slow/ Gnadual bpld/ $Udden{ weeks to

(months to years) months) )

+ +
Lymphocytes
Chronic leukaemia

Increased
. Acute leukaemia

/:,~
Child
.~
Adult
r

Increased BasophU/Monocyta/
Platefet/RBC +
tivonic
lymphocytfc J netks pr
All
Scant cytoplasm
AML
Abundant
cytoplasm

J ~cs
leukaemia

+ +
Philadetphia +ve Philadelphia -ve

Flow cytometiy Flow cytometry

CML PCV
ET

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LYMPHOMA

- 'iREGIONAL LN
LY MPHOMA APPROACH NO EXTRA NODA NODAL

HODGKIN NON HODGKIN

CD20&C045+
EBVLMP -ve

NODULAR LYMPHOCYTE a.ASSICAL

PREDOMINANT © nj
©

BACKGROUND LESS
_COUAG
_ _ _EN_N_o_D_u_LES
lACUNAR CEUS_ __.l_ •I _BA_CKG
_ R_o_u_N_D_M_tx_m
_ _, L_e_A_ac_G_R_o_u_N_D_ce_us
ONLY LYMPHOCYTES _ ___. LYMPHOCYTES
... PI.EOMORPHIC RS CELLS

NODULAR SQ.EROSIS HL MIXED CELLULARITY HL LYMPHOCYT RICH HL LYMPHOCYTE DEPLETED HL

NON HODGKIN LYMPHOMA

NHL APPROACH
co17 \
co20+ A o3•

B CELL NON HODGKIN -i---T-CE_LL_N_O_N_H_O_DG_K_

JN----,1

CD 10, Ba.6+ let> 10 Tt>T +! CD!5, CD10 and CD23 -

BUR~\KJ67

DLISQ. (HIGH)
I FOWCULAR I ls!ri_J MARSINAL ZONE L
MALTOMA
LYMPHOPLASMACYTOID L

CD23+

8-Cl.l/Sll

MANTLE CELL L
CYCUN 01-VE
MANTLE CELL L
L..JI .
!
SOX 1l +VE

BLEEDING DISORDERS
BLEEDING MENIFESTATION

PATECHAE, PURPURA ECOtVMOSIS, HEMARTHROSIS HEMATOMA

INCREASED BLEEDING TIME INCREASED CLOTTING TIME

· 1 Primary plug (PLATELET) DISORDER COAGULATION DISORDER

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 Prima ry plus (PlAT ElET) DISORDER

l"iiilonnal
+
Platel et count
De~a sed

As.socl1tcd with hema turi1/ htmp tysis? ?

Throm bocyt openl a

+
1-. .!--11 17-,- -
Yes No
Lmmat ure platelet fractio n

lnet'l!'ased (>6%) Not lnc~1 sed (<6%)

Abno rmal Ristocetin ~ n Abno nnal ADP & Collaaen Aurq atlon
Mepb ryocy tk Ame pbryo cvtlc
Tlvam bcxyt openl a Throm bocyt openl a
(l'TP, TIP, OfC) (leub emla ,
Aaia ptlon Dlsor den
VWO ,Bern ard •plast ic)
Gaanz mann throm basth enla
Soulli er Syndr ome
Aspir in

Smal t vesse l vasculitis

Purpu ra, hema turia, hemo ptysis , arthra lgia etc

Age

Mala rrash
1/d
Sadd le Nose
" '\ ~ Asthm a No Specific
Child

+
( Heno ch Scho nlein Purpura I
Gran ulom as eosin ophili a histo ry
Child or youn g Adult s
Post respi ratory tract
@]
ANA+
l___ (W~-PAers_)

C-ANCA
_I I EGPA
(Churg Strau ss)
....-?-Good--pa-stu-re--,I
,1
LINEAR PATTERN ON IF
Infec tion
Incre ased lgA a

P-ANCA

Fact or 7 has the smal lest t ½ ther efor e only PT is dete cted f irst (sam e conc ept in
warf arin monitorin g)

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COAGULATION DISORDER COAGULATION DISORDER

PT& APTT

ONLY PTf ONLY APTT f BOTH PT & APTT

NORMAL
TT (THROMBtN TIME)
7 DEFIOENCY
(VIT K) 13 DEFIOENCY

CHILD ?DIC

BOY

D-DIMERS

CH~ I Hern=I~ C, l APLA

FACTOR
DIC
(FDP)=NORMAL

11 AABRINOGENEMIA I
INHIBITORS(ACQUIRED
.. Factor U HEMOPHILIA)

Anything starting from A is not a B cell lymphoma :

Anaplastic large cell lymphoma
- Angiocentric
- Angio immunoblastic lymphoma
- Mycosisis fungoids : cutaneous T cell syndrome - if spread in blood Sezary syndrome

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Cardiac muscle
Brown pigment in heart - lipofuschin,
hemosiderin
Cirrhosis history - hemochromatosis
Thalassemia died of cardiac failure -
hemosiderin
90y/o died of small heart - lipofuschin
Lipofushin - sudan black stain

i-.---------------------t,, Hemosiderin - purshian blue

-
quamous me aplasia ..:
~ .
·--- •~ ---~
.
· . - .._

sec Key word : heart burn

Arises from center of lung Barrett's esophagus
Can compress· - recurrent laryngeal, Adeno ca
hoarseness In lower segment
Adeno arises from periphery = type 2 Long segment > 3cm
pneumocytes involved Short segment
Longer length more dysplasia
Intestinal metaplasia
Alcian blue - mucin stain

f'

Key words : fever, weight loss KEY WORD : LVH, STOKE

Granuloma Fibrinoid necrosis
Caseous necrosis
TB

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r~!W'
..
. .••~~·- -
•.

, ._.
...
• l, ir
-.
r:C • I, ;,,, '
1.
'L •
• -,
..
, .. e

' '~l "}.J ~- , • I J.,• ..~'-··

'I •
•• t,_
.."I, ' • - ---.,,•
f ~ II , - _.. 'iJWI\- I

rit•' _.7 (,• ,'"'i l · ,· .,.r-?!ls;, J

t' ,
#

•c.. •f
• • • ' "

u r •~ ....II'' -' ~r,,:; t I

• -.. • I
I ,:J ..., •• I
l J I :.a~l~ L ..... ,., .. .....

DNA electrophoresis I H/o RA for 8yrs now presenting with renal

A - normal DNA failure
B =Stepladder =apoptosis Congo red stain
C - smear = necrosis Portal triad - 2 vessels and 1 bile duct
Amyloid

Sago grain appearance

Sago s leen- amyloidosis
Nutmeg liver
eve of liver
Red areas are necrosis - red infarct = zone
Pale areas are viable
Zone 3 = centrilobular necrosis

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>
• •

\ ..t
'f •,
.,

,, -..
~ - Red infact lung
Black - melanin/ coal
Antharacosis CWP Liver also
Hemosiderin laden macrophages - heart failure cells in lung
biopsy
Oysplast1c ~prth~loum
Normal r pithrllum • Hiah NC ratio
• Pleomorphlsm
• Hyperchramu ia
• No invasion

-~•~1~,; '.. ~~-----~-..,....

Dysplasia

. , ... ~,, ~ ...

1
White infarct s
High NC ~ t i_o_.__.-~__.
Pleomor phism

•. ,. ~~::~on
-,: .. .. ; • Hyperchromasia

~~~;1.
-!..z•'l ~~_., ~l A· . .
-r9"
~a
-
j
41
..
. ~:1
' l'~ .
~ ~ - ·.I

~' -a:.9.-~_;_~
Mitosis and F!leomorP-hism d'is losia and anaF!lasia

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Entosls
Emperipolesls

Plasma c:ells7

lymphocyte

Macrophage )

One cell type utinc other cell type (usually

hematolymphokl cell)
Ee ~ h a p uttnc Pasma cell or lymphocyte One cell utlnc slmllar cell
Seen In Rosal Dorfmann Disease Ec mallc,,at cells eatinc another maHcnant cell
Or lymphocyte eatfnc another lymphocyte

PEDIGREE ANALYSIS
Pedigree Analysis 1. Is there s[ pping of generations?~

No
·-----------
!
Dominant

Father to son transmission

Yes Recessive Sometimes Yes Sometimes No

l
Are females affected Selective parental transmission

~ '
No Yes Mother to Children Father to Child transmission only
1 1
No
I
Yes transmission only (50%) 1
Father to
Dau1hter
Autosomal
Dominant
•
X-Unked
!
Autosomal
/"-" . Paternal deletion of Maternal
imprinted gene ( Prader Willi)
transmission? Recessive Recessive Mother to Mother to 50%
100% Children children

l 1
100% <100% M itochondrial Maternal deletion of paternally
imprinted eene (An&elmann)
I
• 1
X-Linked Autosomal
Dominant Dominant

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1 2 3 4

II
1 2 3 4 5 6 7

Ill
1 2 3 4 5 6 7 8 9 10 11

IV
2 3 4 5 6 7 8
1
Skipping generations - recessive
Both affect ed - autosomal
Autosomal r ecessive

No skipping - dominant •
Fathe r to son - there fore not x linked
Autosomal dominant

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II

III

IV
1 2 3 4 5 6 7 I · 9 10

No skipping - dominant
Father to son transmission - no present
Father to daughter 100%
X linked dominant

1 2

II
1 2 3 s 6 7

III
1 2 3 7 g

IV
1 2 3 s
XLR - Recessive
All males on mothers side

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SKIPPING - RECESSIVE , autosomal

Some skip, some continuous

Check for selective parentral transmission
Mother to child - angelmann as not 100%

Fater to child yes

Mother to child skipping
Prader Willi syndrome

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 • • C .
• " ., ·•,

• • .•• ..
.,
•• •• " •• •• • . .
•
• • • •• • •• • • . • •• •
• • •• •• • •
• •
•• •• • •• ••
•
.••
• • •
• ..
0

• • .• •• •
. •• •• •• • • • • ,
• •· •
•• • • ••
•• •• •• .. • •• •• • • •• .
.. • • • • • • • • •• ••
•• • • •• ••
•·
••
• •• •
... . ..
Arr ay based comparative genomic hybrid isation

To identify multiple mutations in single test

)< }). I( ){ i(
. .
)( ;; ii \r ti I~ ~;
- ',. - -N- ir ft i et
.
;;
. ..
iff
..

120 130
G G T C TT A T T 'l3 G T C TT A T T T CC
5o . ~, ~e aa Ii
Sanger sequencing

!e ,,
,... I i J:
G bandin karyotype

'l
• •
.. -
•
,~
f~ .. .
•
•
r4
...:,. ~'
• Jf Ji 10
~; 11
t~
lJ

' m'- ' 1. ,1 r .1 ,

JI
'~!
14 ll
-,,-
16 II

-
11

Ii 6.
n ::D •• !1
~. I
!!
f'l I

C banding karyotype (chr omosaomal)

Used in dicntric chromosome
Classification of chromosomes

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.,,..,. I
- ~ /
1-__
- ,._::--
I
--

R value= time taken for initiation of fibr in

Thromboelastogram
Detects primary plug, secondary plug and
f ibrinolysis
·1. Normal
2. R increase, k normal - coagulation
factor deficiency except fibrinogen
3. R increases, Kincreases, MA increases
- DIC (platel and f ibrinogen)
4. LY30 increase - more f ibrinolysis
5. Increase MA - no LY30, thrombotic
disorder
When clot becomes 20mm t hick = k value,
alpha angle
Kvalue/ alpha angle indicate rate of fibrin
formation - indicates fibr inogen levels in
blood
Increase R = deficiency of coagulation factor
Kdecrease/ alpha increase = decreased
fibrinogen
MA = maximal thickness indicaes platelet
function
Decrease MA = reduced platelet count/
function
Eg: bernald scholier
After 30 mins of ·MA - decrease in thicknes =
LY30, if increases= increase fibrinolysis
Decrease = thrombosis

O.O A O . . . . . . - - - - - - - - - - - - - - ~ ~ - - - - - - - - - - -
C) V")
<(
0 .035 _a :c
:c
0 .000

LL.
_a
:c
0 .025

u
_a
0 .020
<( 0
:c
0 .015

0 .010
<(
_a
- u LU ...0 ...0
_a
:c
:c :::i::: ,.

:::i:::
0 .005

0 .000

0 .00 1.00 2 .00 . 3.00 A.00 5 .00 6 .00 7.00 8 .00 9 .00

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HPLC : Hb variants

Hbf = F window
HbA0 = A window
A2 window = HbE + HbA2 (EQ)
HbS = S window
HbC = C window
A2 window >9% = HbE, <9% = HbA2
HbA2 < 3.1%, 5% in thalassemia
two peaks in HbAHbA2 (indicates HbE) HbE trait
+
th
100% HbA2 = 100% HbE = homogyzous HbE ,26 position glutamate replace by lysine
A2 50%, S 50% -double heterozygous

SYSTEMIC PATHOLOGY
Key words: patient died of basal ganglia haemorrhage and LVH on autopsy=
atherosclerosis

Hyaline arteriosclerosis Onion skin appearance (also seen in PSC)

Pink hyaline material in vessel wall Hyperplastic atherosclerosis
Benign HT Malignant HT
Key words: patient died of basal ganglia
haemorrhage and LVH on autopsy =
atherosclerosis
Flea bitten kidney = Small haemorrhage on
surface of kidney
Causes : malignant HT, infective
endocarditis, PAN. all PGN, leptospir osis,
SLE. HSP

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35y/o male blindness, headache, diplopia Key words: chronc HBV, HT, vessel biopsy
Vessel biopsy taken PAN
Takayasu arteritis ( < 50yrs) Only part of vessel is involved, partial
Giant cell > 50yrs dilatation

Saddle Nose (
Cartilage
destruction

Fibro cavitary lune

lnlons

Special stain -triphenyl tetra zolium chloride

Red: viable myocardium
Pale : infarct

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Keys word s: mitra l steno sis, migra tory H/o COV ID

polya rthrit is
Newb orn with resp irato ry distr ess

____
Asch off nodules
-
Rheumatic hear t d isease _,
Hyaline membrane disease
Causes : ARDS
I
..
; .

1_

-
H YPER ESON ANT LUNG
Alpha 1 antit ripsin defic iency Cough conti nuou s for 2 yrs, smok er
REED index - thick ness , submucosal gland
thick ness , e itheli um to cartil age

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....•,· "
Key words : sputum examination in 12y/o with episodic bronchitis
j

.. ,.
•
• •
,,

, •' .• •• -,;•
..,..
•'
•·"
·- ~.
..,,,,
Curschmann Spirals
f!IKV'
•: ... J
Charcot leyden Crystals

sloughed off epithelial cells

..
Beonchiectasis
Key word : post neumonia
Dilated and fibrotic bronchi

,...,"~'•~ ft.

\<~
-~ -]

,~l
,. (!j
- -t.'\ ·. J .._. , Baded Colden brown body
(asbestos body)

L~'-~ -1. ~ ~4
1,. • Carbon ( black) layden
~'\ 1lfl:
L
I macrophages
- =--·-., I o.

LN biopsy, H/O ulcer in leg - melanoma Pt in fire proogginf industry

Key words : breathlessness, 10cm fibrotic Key words : breathlessness, fibrotic patch in lung,
patch in lung, Dusk cells= carbon layden manufactures roof sheaths
macrophages a/w adeno ca of lung > mesothelioma
Com Ii coted CWP

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Key word : 35y/o female, hypercalcemia, weight loss, lung lesions= sarcoidosis

i•
Ii •
'

:~
l

~ ii
._ _____ ,__ ___ t#u.=~'_:_- ,~
........._.
Schwamann bodies
35y/o breathlessness, farmer
Farmer's lung
Hay fever, chronic bronchitis
Type 4 HSN pneumonitis

:-.-~•L-f
ma
- .,
r ..._
.-1-,...
- V ,.,-:

-ur, ac:,v ... .._..-......

Key Words : nonsmoker Female, weight loss,
peripheral lun1 lesion
Dlacnosts. Markers, Gen.tics

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 Key words : smoker , weight loss , confusion,
1
delirium
Small cell carcino ma lung
Marker s : chromo granin, synapto physin,
TTF1, genetic s: p53 , RB , MYC

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Wart hin starr y stain - H pylor i
Key words : diarrh oea, weigh t loss
Comma shaped oganisms
Hype rplas tic gastr ic fods
MAlto ma (100%) assoc iation
Mene tier's disease
Gastr ic cance r
Excessive TGF al ha
Key Words : Diarrhoea, Duodenal tumor
hlstoloev, Increa sed pstrlc folds
b1acnos1s

Dlacnosis:
Neuro endoa ine tumor

Zoll1ncer Ellson
Syndr ome

Diarrh oea, duodenal biopsy

Atrop hy of villous, hyper troph y of mucous
Malignancy from celiac
Reversal of crypt to villous ratio
Diagnosis : celiac disease
Glute n free diet
T cell lymphoma

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