Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Red blood cells of type O and A2 have large amounts of A carefully prepared and supervised blood transfusion is another antigen called H substance which is genetically quite safe purchase wellbutrin 300 mg otc bipolar depression cant get out of bed. Immunologic transfusion reactions may be against red blood and anti-H) purchase 300 mg wellbutrin with amex depression sous jacente definition, the red cells are not agglutinated by the antisera wellbutrin 300mg without prescription anxiety 9 to 5. Non-immune transfusion reactions include circulatory prepared by immunising rabbits with red cells from a Rhesus overload, massive transfusion, or transmission of an monkey. The corresponding antigens are similarly these are as under: named Cc, Ee and only D since no d antigen exists. The symptoms include restlessness, B B Anti-A anxiety, flushing, chest or lumbar pain, tachypnoea, O O Anti-A, Anti-B tachycardia and nausea, followed by shock and renal failure. The clinical manifestations are circulation, whereas a healthy individual is at lesser risk. The complication of thrombophlebitis but shock and renal failure may rarely occur. Such delayed reactions are generally developing thrombophlebitis is further enhanced if the the result of previous transfusion or pregnancy (anamnestic transfusion is continued longer than 12 hours at a single site. The body has no other means of getting aggregate in pulmonary micromutation and release rid of extra iron except iron excretion at the rate of 1 mg per mediators of increased vascular permeability resulting in day. A unit of whole blood (400 ml) contains about 250 mg acute pulmonary oedema and signs and symptoms of of iron. This direct collection of large excess of platelets from a single category includes the following adverse effects: donor. Circulatory overload resulting in Applications of these blood components in clinical use pulmonary congestion and acute heart failure is the most are as under: important and most common complication that may result 1. The risk of circulatory capacity of blood and are used in normovolaemic patients overload is particularly high in patients with chronic of anaemia without cardiac disease. Optimally, transfused to bleeding patients exceeds their normal blood platelet transfusions can be given to a patient with platelet volume, it results in dilutional thrombocytopenia and count below 10,000/? Coombs (antiglobulin) test is generally negative, and is less severe than the latter. Rh incompatibility tibility in its severest form may result in intrauterine death occurs when a Rh-negative mother is sensitised to Rh from hydrops foetalis. This results most often from a Rh-positive with severe anaemia and jaundice due to unconjugated foetus by passage of Rh-positive red cells across the placenta hyperbilirubinaemia. Sensitisation is more likely if the causes only severe anaemia with or without jaundice. Cord blood shows variable degree of anaemia, reticulo anti-C and anti-E, and rarely anti-c alone. The practice of administration of anti-Rh (heterozygous), there is a 50% chance of producing a Rh-D immunoglobulin to the mother before or after delivery has negative child. Naturally-occurring anti-A and anti-B antibodies, remove red cells susceptible to haemolysis and antibodies which are usually of IgM class do not cross the also to lower the bilirubin level. The capsule and the structure trilineage stem cells further divide to form three types of cell within the lymph node are connected by supportive delicate lines: erythroid progenitor cells (discussed in Chapter 12), reticulin framework (Fig. In this chapter, lymphocyte zones: we will discuss the abnormalities pertaining to the remaining B-cell zone lies in the follicles in the cortex, the mantle two cell lines?granulocyte-monocyte cell line and the zone and the interfollicular space, while plasma cells are also lymphoid cell lines, besides discussion on all haematopoietic present in the interfollicular zone. Both these cell lines constitute leucocyte pool in T-cell zone is predominantly present in the medulla. This concept holds more true for lymphoid mount immune response in the body, and to perform the cells in particular, which are present in circulation as well as function of active phagocytosis for particulate material. The follicular centre is a very active zone where maturation in peripheral lymphoid organs and thymus lymphocytes from peripheral blood continuously enter and (Chapter 4). Thus, relationship of haematopoietic tissues and leave, interact with macrophage-histiocytes and endothelial lymphoreticluar tissues is quite close. Each lymph node v) Immunoblasts (in paracortex) is covered by a connective tissue capsule. At the convex vi) Convoluted cells or lymphoblasts (in paracortex) surface of the capsule several afferent lymphatics enter which vii) Plasma cells. The cortex consists of considered elsewhere in the textbook along with description several rounded aggregates of lymphocytes called lymphoid of these primary diseases. The follicle has a pale-staining germinal centre discussed below while the subject of lymphoid neoplasms surrounded by small dark-staining lymphocytes called the including plasma cell disorders and Langerhans cell mantle zone. The deeper region of the cortex or paracortex is histiocytosis is discussed under haematologic neoplasms. The lymphoid follicles are prominent with presence Lymph nodes undergo reactive changes in response to a wide of many mitoses and phagocytosis. In more severe cases, variety of stimuli which include microbial infections, drugs, necrosis may occur and neutrophil abscesses may form. However, the most common Chronic Nonspecific Lymphadenitis causes of lymph node enlargement are inflammatory and Chronic nonspecific lymphadenitis, commonly called reactive immune reactions, aside from primary malignant neoplasms lymphoid hyperplasia, is a common form of inflammatory and metastatic tumour deposits. Those due to primary reaction of draining lymph nodes as a response to antigenic inflammatory reaction are termed reactive lymphadenitis, and stimuli such as repeated attacks of acute lymphadenitis and those due to primary immune reactions are referred to as lymph from malignant tumours. Depending upon the pattern in chronic nonspecific Reactive lymphadenitis is a nonspecific response and is lymphadenitis, three types are distinguished, each having categorised into acute and chronic types, each with a few its own set of causes. However, mixed patterns may also be seen in which case one of the patterns Acute Nonspecific Lymphadenitis predominates over the others. Most common causes are microbiologic infections or lymph nodes are usually enlarged, firm and non-tender. Most frequently involved lymph lymphoid hyperplasia are as under: nodes are: cervical (due to infections in the oral cavity), axillary 1. Follicular hyperplasia is the most frequent pattern, (due to infection in the arm), inguinal (due to infection in the particularly encountered in children.
Acute necrotising haemorrhagic leucoencephalitis is a iii) Amyloid angiopathy is deposition of the same amyloid rare disease occurring more often after a respiratory infection buy discount wellbutrin line la depression test. Leucodystrophies?are diseases of white matter charac neuromelanin pigment from neurons and accumulation terised by diffuse demyelination and gliosis purchase wellbutrin 300mg with amex anxiety uncertainty management theory. Some of the by deficiency of one of the enzymes required for formation residual neurons in these areas contain intracytoplasmic 300mg wellbutrin with mastercard anxiety worksheets for adults, and maintenance of myelin. That is why these conditions eosinophilic, elongated inclusions called Lewy bodies. Acquired or secondary metabolic diseases are the these include the following: disturbances of cerebral function due to disease in some other 1. Anoxic-ischaemic encephalopathy organ system such as the heart and circulation, lungs and 2. Hypoglycaemic encephalopathy respiratory function, kidneys, liver, endocrine glands and 3. Uraemic encephalopathy storage, degenerative changes, and sometimes parenchymal 8. The predominant types of hereditary and acquired All these conditions have already been discussed in the metabolic disorders are as under: relevant chapters. In the United States and Europe, however, nutritionally-induced disease is chiefly found in association with chronic alcoholism or due to defect in absorption, transport or metabolism of dietary nutrients. Some of the common neurologic diseases included in the category of deficiency diseases are as under: 1. Astrocytomas (including Glioblastoma Multiforme) ii) Pleomorphic xanthoastrocytoma. It is also called as fibrillary astrocytoma and hemispheres, and occasionally in the spinal cord. In children is the most common form of glioma occurring in 3rd to and young adults, pilocytic astrocytomas arise in the optic 4th decades of life. Astrocytomas have Grossly, it is a poorly defined, grey-white tumour of tendency to progress from low grade to higher grades of variable size. Low-grade astrocytomas evolve slowly over tissue and merges with the surrounding tissue. Based on the type of the diagnosis of various types of astrocytomas can be astrocytes, three subtypes are distinguished: fibrillary, generally made by routine H & E morphology but in difficult protoplastic and gemistocytic astrocytoma. Although its nomenclature prognosis and includes special histologic entities which means its origin from embryonal cells but now it is mainly occur in children as under: known that this tumour arises by neoplastic transfor i) Juvenile pilocytic astrocytoma. It is the most aggressive of young adults in the cerebellum, third ventricle and optic astrocytomas. Grossly, it shows variegated appearance, with some areas Grossly, it is usually cystic or solid and circumscribed. The fusiform pilocytic astrocytes having unusually long, wavy surrounding normal brain tissue is distorted and fibrillary processes. It occurs in the cerebral hemispheres, most commonly in the frontal lobes or within the ventricles. Grossly, oligodendro glioma is well-circumscribed, grey-white and gelatinous mass having cystic areas, foci of haemorrhages and calcification. Microscopically, the tumour is characterised by uniform cells with round to oval nuclei surrounded by a clear halo of cytoplasm and well-defined cell membranes. Typically, there are varying degree of endo thelial cell hyperplasia and foci of calcification. Ependymoma Ependymoma is not an uncommon tumour, derived from the layer of epithelium that lines the ventricles and the central Figure 30. It occurs chiefly in children and the tumour is densely cellular having marked pleomorphism. Characteristically, the tumour has areas of necrosis which are surrounded young adults (below 20 years of age). Other locations are the lateral ventricles, the third ventricle, and in the case of adults, the spinal cord in the region of Histologically, the features are as under (Fig. Clinically, by virtue of their frequent location i) It has highly anaplastic and cellular appearance. The in the floor of the fourth ventricle, ependymomas are asso cell types show marked variation consisting of fusiform ciated with obstructive hydrocephalus. The usual biologic cells, small poorly-differentiated round cells, pleomorphic behaviour is of a slow-growing tumour over a period of years. Microscopically, the tumour is composed of uniform epithelial (ependymal) cells forming rosettes, canals and Oligodendroglioma perivascular pseudorosettes. Most tumours are well-differentiated but anaplastic metastases to extraneural sites such as to lungs, liver, 889 variants are also recognised. Two variants of ependymoma deserve special mention: myxopapillary type and subependymoma. Grossly, the tumour typi cally protrudes into the fourth ventricle as a soft, grey Myxopapillary ependymoma. Microscopically, medulloblastoma is composed of small, Characteristically, it occurs in the region of cauda equina poorly-differentiated cells with ill-defined cytoplasmic and originates from the filum terminale. True to its name, processes and a tendency to be arranged around blood it contains myxoid and papillary structures interspersed vessels and occasionally forms pseudorosettes (Homer in the typical ependymal cells. Haemangioblastoma Haemangioblastoma is a tumour of uncertain origin and Choroid Plexus Papilloma constitutes about 2% of all intracranial tumours.
The treatment of osteoporosis is often complex and in severely affected patients should be coordinated with an endocrinologist wellbutrin 300 mg without prescription anxiety icd 9. Treatment should include exercise cheap wellbutrin 300 mg fast delivery anxiety vs heart attack, which has been shown to wellbutrin 300mg without prescription depression diagnosis test online increase bone mass and to slow the decline of skeletal mass. Men and women over age 60 are at risk for 482 the Spine spontaneous osteoporotic fractures of the thoracic spine; the extent of vertebral deformity and multiple fractures appears linked with pain intensity. Is there a role for thoracic spine manipulation in the treatment of mild compressive cervical myelopathy? Browder and colleagues described the use of intermittent cervical traction and manipulation of the thoracic spine in a series of patients with mild cervical compressive myelopathy attributed to herniated disk. They noted a substantial reduction of pain and a decreased level of disability following this protocol. The presenting symptoms of a 35-year-old man include pain and stiffness in the thoracic region, which is worse in the morning. Chest expansion is measured at the fourth intercostal space in men and below the breasts in women. The presenting symptoms of a 44-year-old man include pain in the right T7-T9 region slightly below the inferior lateral angle of the scapula. Further questioning determines that the symptoms are worse 2 to 3 hours after a meal. Pain from cholecystitis (inflamed gallbladder) typically occurs 1 to 2 hours after ingestion of a heavy meal, with severe pain peaking at 2 to 3 hours. Right upper quadrant or epigastric pain is charac teristic, but pain often is referred to the angle of the scapula on the right side. The T4-T7 thoracic segments frequently have been implicated as the source for initiation of pseudoanginal pain. Hamburg and Lindahl reported six cases of anginal pain relieved by manipulation of the midthoracic segments. The disease also is known as juvenile kyphosis, vertebral osteochondritis, and osteochondritis deformans juvenilis dorsi. Despite the fact that the basic deformity is not corrected,?maintenance and improvement in range of motion and function may be achieved. Patients with more severe postural abnormalities of the thoracic, cervical, and shoulder regions have a signi? T4 syndrome describes a group of symptoms including dysfunction within the T2-T7 segments. The clinical presentation includes various combinations of pain in the upper limbs, neck, upper thoracic, and scapular region with cranial headaches. In addition, patients may report glovelike paresthesias and numbness in one or both hands, often nocturnal in nature. McGuckin (not peer-reviewed) reported 90 cases in which the syndrome occurred more frequently in women (4:1) than men, with a typical presentation between 30 and 50 years. In another case report, two cases of apparent T4 syndrome of 6 to 12 months duration that were treated successfully by two sessions of T3-T4 manipulation. The lateral branches of the dorsal rami of lower thoracic and upper lumbar segments become cutaneous over the buttocks, and greater trochanter pain in this region can be referred from the thoracic spine. When obtaining a medical history for patients over age 50 who have thoracic spine pain not associated with trauma, why is it important to identify red flags associated with cancer? Metastatic lesions in the skeleton are much more common than primary tumors of bone (overall ratio = 25:1). Metastases occur more commonly in the axial skeleton than in the appendicular skeleton. In addition, skeletal metastases from tumors of prostate, lung, thyroid, kidney, rectum, and uterine cervix are quite common. Postherpetic neuralgia is pain that persists for longer than 1 month after the rash of acute herpes zoster (reactivated chickenpox virus) resolves. The pain can be lancinating or manifest as a steady 484 the Spine burning or ache along a thoracic dermatomal pattern. Segmental mobilization or manipulation to improve extension may result in immediate improvement of lower trapezius muscle activation. The mechanism is unclear; it could be secondary to localized pain that inhibits maximal muscle? If the patient demonstrates inhibition of the serratus anterior muscle or has dif? In the absence of long thoracic neuropathy, the therapist should screen the T3-T7 vertebral segments for flexion restrictions. Segmental mobilization or manipulation to improve flexion often results in immediate improvement of serratus anterior muscle activation. The mechanism is unclear; it may be secondary to localized pain that inhibits maximal muscle? The cervical zygapophyseal joints, especially those at the C5-C6 and C6-C7 spinal levels, and the cervical intervertebral disks and nerve roots, especially at the C5-C6 and C6-C7 spinal levels, commonly refer pain into the middle region of the back. Assessment and treatment of the thoracic spine should be performed in patients presenting with this syndrome. Thoracic spine manipulation has been used in this population with subsequent reduction in pain and dystrophic symptoms.
Gross photograph on right shows replacement of the cervix by irregular grey white friable growth (arrow) extending into cervical canal as well as distally into attached vaginal cuff buy wellbutrin with a mastercard anxiety 4 weeks pregnant. The peak incidence of invasive cervical cancer is in 4th to purchase 300mg wellbutrin fast delivery depression definition google scholar Histologically order wellbutrin 300 mg on line depression symptoms thoughts of death, the following patterns are seen: 6th decades of life. Grossly, invasive cervical comprises vast majority of invasive cervical carcinomas carcinoma may present 3 types of patterns: fungating, (about 70%). The fungating or exophytic the most common pattern (70%) is moderately pattern appearing as cauliflower-like growth infiltrating differentiated non-keratinising large cell type and has the adjacent vaginal wall is the most common type better prognosis (Fig. Characteristically, cervical carcinoma arises Next in frequency (25%) is well-differentiated kerati from the squamocolumnar junction. Common histologic type is epidermoid (squamous cell) carcinoma showing the pattern of a moderately differentiated non-keratinising large cell carcinoma. Involvement of the vagina endometrium consists of 3 structures: the endometrial limited to upper two-thirds. The from cuboidal to tall columnar appearance at ovulation tumour invades the lower third of vagina. The evidence of ovulation is taken from the appearance of convolutions in the glands and sub nuclear vacuolation in the cells indicative of secretions. Adenocarcinomas comprise about the secretory changes remain prominent for the next 7 20-25% of cases. These may be well-differentiated mucus days after ovulation for implantation of the ovum if it has secreting adenocarcinoma, or clear cell type containing been fertilised. The remaining 5% cases are a variety of other secretions and a frayed and ragged luminal border of the patterns such as adenosquamous carcinoma, verrucous cells lining the glands. Classification of cervical cancer away at menstruation followed by beginning of the fresh described by the Cancer Committee of the International cycle (Fig. However, decidual reaction the myometrium is the thick muscular wall of the uterus may be suggested in the absence of pregnancy due to which is covered internally by uterine mucosa called the extreme response to progesterone. The endometrium extends above the level of impossible to distinguish an advanced progestational the internal os where it joins the endocervical epithelium. In addition to the changes that take place during the normal the lesions pertaining to the corpus uteri and the menstrual cycle, the endometrium undergoes morphologic endometrium are numerous and constitute vast majority of changes when hormonal preparations are administered, or gynaecologic conditions. Oestrogen and Progesterone as it is generally called, is thin and atrophic with inactive glands and fibrous stroma. However, some of the glands Oestrogen produces the characteristic changes of may show cystic dilatation. Sometimes, retrogressive proliferative phase at the time of menopause and in young hyperplasia is seen which is characterised by Swiss-cheese women with anovulatory cycles as occurs in Stein-Leventhal pattern of glands resembling endometrial hyperplasia but syndrome. The therapeutic addition of progesterone composed of inactive retrogressive lining epithelium. There produces secretory pattern in an oestrogen-primed is intermingling of cystic and dilated glands with small and endometrium. Postmenopausal endometrium may show hormonal therapy is employed for control of conception. The endometrial glands are enlarged function is just beginning (menarche) or when it is waning with abundant glandular secretions and the stromal cells off (menopause). Anovulation is the result of prolonged and become more plump, polygonal with increased cytoplasm excessive oestrogenic stimulation without the development termed decidual reaction. The causes for anovulation at diffe extrauterine pregnancy show hyperactive secretory state rent ages are as follows: called Arias-Stella reaction. In pre-puberty: precocious puberty of hypothalamic, hyperchromatic, atypical, tall cells lining the glands and the pituitary or ovarian origin. In adolescence: anovulatory cycles at the onset of which may be mistaken for an adenocarcinoma. In reproductive age: complications of pregnancy, endo Menopause metrial hyperplasia, carcinoma, polyps, leiomyomas and the onset of menopause is heralded with hormonal adenomyosis. Most commonly, the senile endometrium, endometrial hyperplasia, carcinoma and polyps. It has been observed that women who ovulate may also occasionally have anovulatory cycles. In such cases, the premenstrual endometrial biopsy shows histologic lag of more than 2 days. Chronic form is more common and occurs by the same causes which result in acute phase. The endometrial glands are present endometritis is an example of specific chronic inflammation, deep inside the myometrium (arrow). In acute endometritis and logically benign endometrial tissue within the myometrium myometritis, there is progressive infiltration of the endo alongwith myometrial hypertrophy. The term adenomyoma metrium, myometrium and parametrium by polymorphs is used for actually circumscribed mass made up of and marked oedema. Adenomyosis is myometritis are characterised by infiltration of plasma cells found in 15-20% of all hysterectomies. The possible underlying endometritis is almost always associated with tuberculous cause of the invasiveness and increased proliferation of the salpingitis and shows small non-caseating granulomas endometrium into the myometrium appears to be either a (Fig. Clinically, the patients of adeno myosis generally complain of menorrhagia, colicky dysmenorrhoea and menstrual pain in the sacral or sacrococcygeal regions. On cut section, there is diffuse thickness of the uterine wall with presence of coarsely trabecular, ill-defined areas of haemorrhages. Microscopically, the diagnosis is based on the finding of normal, benign endometrial islands composed of glands as well as stroma deep within the muscular layer.
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This focal perilesional steatosis buy wellbutrin 300mg on line depression definition political, likely due to effective wellbutrin 300mg depression quotes about love the localized effects of insulin from the functioning metastases discount wellbutrin online american express depression definition political, is a rare but recognized manifestation of metastatic insulinomas. Needle aspiration of the mass at ultrasound yielded fluid that had few cells and no elevated tumor markers. The mass has a mixture of densities, including higher attenuation material that could represent solid tissue or blood products, as well as extensive calcification? Based on appearance alone, this mass is indistinguishable from a neuroendocrine tumor. This combination of findings is typical of renal and pancreatic involvement from non-Hodgkin lymphoma. Note that the entire pancreatic body is displaced anteriorly by a large, hypodense, periaortic mass? Given this lymphadenopathy, the appearance of the pancreas represents diffuse lymphomatous infiltration of the pancreas in a patient with B-cell lymphoma. While the imaging features are strongly suggestive of pancreatic cancer, this turned out to be a colon cancer metastasis. As in this case, these tumors often mimic the appearance of neuroendocrine tumors, albeit with less hyperenhancement. While the appearance suggests adenocarcinoma, this is a rare pancreatoblastoma in an adult patient, a tumor much more common in children. The mass is quite simple in appearance, with only a few linear strands interspersed in the midst of fat density. Note that the mass is homogeneously enhancing and conforms to the contours of adjacent structures. The appearance would be more typical for an aggressive neuroendocrine tumor, but the mass was found at biopsy to be an acinar cell carcinoma. Abdominal calcifications, differential diagnosis, 67 Abdominal neoplasms, malignant Abdominal cavity, embryology and anatomy, 66 abdominal mesothelioma. Abdominal manifestations of systemic conditions, 4?63 Abdominal surgery amyloidosis. Acute appendicitis esophageal carcinoma associated with, 230 mucocele of appendix vs. Acute cholecystitis, Mirizzi syndrome associated with, 920 mucinous macrocystic adenoma. See also Atypical staging, grading, & classification, 891 and rare pancreatic tumors. Barrett esophagus, 170?171 Bicuspid insufficiency, portal hypertension and varices differential diagnosis, 171 associated with, 116 drug-induced esophagitis vs. See Lymphangioma gas in bile ducts or gallbladder, differential (mesenteric cyst). Benign esophageal neoplasms Biliary anomalies, choledochal cyst associated with, 876 extrinsic mass, differential diagnosis, 157 Biliary atresia, choledochal cyst associated with, 876 fibrovascular polyp, 226 Biliary cirrhosis, primary, 652?657 inflammatory polyp, 227 associated abnormalities, 654 intraluminal mass, differential diagnosis, 157 autoimmune hepatitis vs. Biliary ductal stricture, anastomotic: ischemic bile duct Benign small intestine neoplasms injury vs. See Biliary-enteric anastomosis, gas in biliary tree due to: Hamartomatous polyposis syndrome. Biliary papillomatosis, 965 imaging approach, 854?861 differential diagnosis, 965 anatomy (graphic images), 857 mucin-secreting. See Partial gastrectomy: Bilroth abdominal, differential diagnosis, 67 procedures. Chronic gastroesophageal reflux, esophageal webs gangrenous associated with, 178 gallbladder hydrops and empyema vs. Cirrhosis, 642?651 gallbladder carcinoma associated with, 957 arterioportal shunt associated with, 697 milk of calcium bile associated with, 929 ascites associated with, 86 Cholera, toxic megacolon associated with, 471 biliary. Closed loop bowel obstruction diverticulosis, 488?491 ischemic enteritis associated with, 413 colonic polyps vs. Collar sign, in traumatic diaphragmatic rupture, 121 pneumatosis, differential diagnosis, 344 Colocolic fistula, 406 pressure gradient between lumen and serosa Colon, 452?541 colonic diverticulitis associated with, 494 appendicitis. Colon neoplasms, malignant dilated, differential diagnosis, 855 adenocarcinoma distal metastatic, metastatic melanoma vs. See Colonic ileus and Ogilvie Congenital mesenteric anomaly, paraduodenal hernia syndrome. See portal hypertension and varices associated with, 116 Mucinous cystic pancreatic tumor. Coughing, Boerhaave syndrome associated with, 217 mucinous cystadenoma or cystadenocarcinoma. See Courvoisier gallbladder, gallbladder hydrops and Mucinous cystic pancreatic tumor. See Cystic duct, stone impaction in, Mirizzi syndrome Hamartomatous polyposis syndrome. Diabetic lipodystrophy, associated with abdominal incision small bowel, 351 and injection sites, 127 traction, 208 Diabetic neuropathy, Chagas disease of esophagus vs. Duodenal fistula, 406 enteric fistulas and sinus tracts associated with, 406 Duodenal flexure pseudotumor, 314 hepatic flexure, acute calculous cholecystitis vs. See Duodenal Down syndrome, umbilical hernia associated with, 103 metastases and lymphoma. Drain cleaner, caustic esophagitis associated with, 173 secondary invasion, duodenal metastases and Dropped gallstone, gallstone ileus vs. Duodenal stricture Duodenal atresia, malrotation of small intestine duodenal ulcer vs. See Duodenal neoplasms, benign; Duodenal Entamoeba histolytica, hepatic amebic abscess associated neoplasms, malignant. Eosinophilic gastroenteritis, 176 traction diverticulum, 208 Epidermoid cyst, splenic cyst associated with, 573 differential diagnosis, 208 Epidermolysis and pemphigoid of esophagus, 177 pulsion diverticulum vs.