Terminal ileum biopsy

Biopsy

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Tissue biopsy of terminal ileum.

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Terminal Ileum Biopsy - Comprehensive Medical Test Guide

Why is it done?
- Test Purpose: A terminal ileum biopsy involves obtaining tissue samples from the terminal portion of the small intestine (ileum) through colonoscopy for microscopic examination to diagnose inflammatory, infectious, or malignant conditions.
- Diagnosis of Inflammatory Bowel Disease (IBD): Suspected Crohn's disease or ulcerative colitis to assess inflammation, mucosal changes, and characteristic histological findings
- Investigation of Chronic Diarrhea: Evaluation of persistent diarrhea of unknown origin, malabsorption syndrome, or chronic gastrointestinal symptoms
- Detection of Infections: Identification of infectious organisms including tuberculosis, mycobacteria, viral infections, parasites, or fungal infections
- Malignancy Evaluation: Assessment for adenocarcinoma, lymphoma, or other neoplastic conditions of the terminal ileum
- Celiac Disease Investigation: Confirmation of celiac disease or assessment of mucosal healing on a gluten-free diet
- Monitoring Disease Progression: Follow-up assessment of known IBD to evaluate disease activity, response to treatment, or dysplasia surveillance
- Timing: Typically performed during colonoscopy, which may be scheduled urgently for acute symptoms or electively for screening and diagnostic purposes
Normal Range
- Normal Histology: Intestinal mucosa with normal columnar epithelium, intact crypts, minimal to absent chronic inflammation in lamina propria, and normal mucosal architecture
- Normal Inflammatory Cell Count: Less than 5-7 eosinophils per high-power field (hpf), minimal lymphocytes and plasma cells in lamina propria, rare neutrophils
- Normal Features: No ulceration, granulomas, dysplasia, malignancy, or microorganisms; no active inflammation; smooth mucosal surface with regular pit pattern
- Negative for Special Stains: Negative for acid-fast bacilli (AFB), fungal organisms, parasites, and other pathogenic agents when special staining is performed
- Interpretation: Normal results indicate healthy terminal ileal mucosa without evidence of inflammatory, infectious, or neoplastic disease; patient has no acute or chronic pathology affecting this region
Interpretation
- Crohn's Disease: Non-caseating granulomas (present in 30-50% of cases), transmural inflammation, fissuring ulcers, skip lesions (areas of diseased tissue separated by normal mucosa), increased chronic inflammation; findings support Crohn's diagnosis
- Ulcerative Colitis: Continuous inflammation limited to mucosa and submucosa, goblet cell depletion, crypt distortion, surface ulceration, increased neutrophils; primarily affects colon but may extend to terminal ileum
- Celiac Disease: Villous atrophy, increased intraepithelial lymphocytes, crypt hyperplasia, increased plasma cells in lamina propria; severity correlates with degree of gluten exposure; may also be seen in terminal ileum in some patients
- Infectious Organisms: Acid-fast bacilli (tuberculosis or atypical mycobacteria), fungal elements, parasites (Cryptosporidium, Giardia), viral cytopathic changes; identification guides antimicrobial therapy
- Malignancy: Adenocarcinoma with dysplastic cells, lymphoma with abnormal lymphoid infiltration, neuroendocrine tumor; assessment of margins, grade, and stage informs treatment planning
- Dysplasia: Low-grade dysplasia (LGD) shows increased nuclear-to-cytoplasmic ratio and nuclear stratification; high-grade dysplasia (HGD) shows severe nuclear abnormalities; finding indicates increased cancer risk in IBD patients
- Other Findings: Eosinophilic colitis (elevated eosinophils >20 per hpf), lymphoid hyperplasia, reactive changes from prior biopsies or thermal injury
- Factors Affecting Results: Number and location of biopsies, biopsy depth, active inflammation timing, medication use (immunosuppressants may alter findings), sampling error, and proper tissue fixation all influence interpretation accuracy
Associated Organs
- Primary Organ System: Terminal ileum (distal small intestine), which is the final portion of the small bowel connecting to the colon; part of the gastrointestinal tract responsible for nutrient absorption and immune function
- Associated Organ Systems: Entire colon and small intestine (affected in IBD), liver (complication in IBD), pancreas (inflammation possible in Crohn's disease), skin and eyes (extraintestinal manifestations), lymph nodes (regional involvement)
- Common Pathologic Conditions: Crohn's disease, ulcerative colitis, celiac disease, tuberculosis, Mycobacterium avium complex (MAC), histoplasmosis, coccidioidomycosis, cryptosporidiosis, adenocarcinoma, lymphoma, carcinoid tumors, ischemic colitis, infectious colitis
- Complications from Abnormal Results: Severe IBD may lead to intestinal obstruction, perforation, toxic megacolon, sepsis, malabsorption with nutritional deficiencies, anemia, and protein loss; malignancy requires surgical intervention; infections may spread systemically
- Risks of Biopsy Procedure: Perforation (rare, <1:1000), bleeding (especially if coagulopathy or anticoagulant use), infection, sedation complications, post-polypectomy syndrome if polyp removed simultaneously
Follow-up Tests
- If Crohn's Disease Diagnosed: CT enterography or MR enterography for assessment of disease extent, inflammatory markers (C-reactive protein, fecal calprotectin), complete blood count and metabolic panel, colonoscopy of remaining colon with additional biopsies
- If Ulcerative Colitis Diagnosed: Complete colonoscopy with biopsies from multiple sites, assessment of disease extent, inflammatory markers, surveillance colonoscopy every 1-2 years for dysplasia detection
- If Infection Identified: Culture and sensitivity testing, nucleic acid amplification testing (NAAT), chest X-ray for tuberculosis, additional biopsies from other colonic sites, immunologic studies if immunocompromised
- If Malignancy Detected: Immunohistochemistry and molecular testing, CT chest/abdomen/pelvis for staging, oncology consultation, additional colonoscopy for assessment of margins and disease extent
- If Dysplasia Found: Confirmation biopsy from different location, colonoscopy with high-definition and chromoendoscopy, more frequent surveillance colonoscopy, consideration for colectomy if high-grade dysplasia or multiple dysplasia foci
- Routine Monitoring for IBD: Serial fecal calprotectin, periodic CBC for anemia monitoring, metabolic panel for electrolytes and liver/kidney function, repeat colonoscopy with biopsies every 1-3 years for surveillance, assessment of treatment response
- Complementary Tests: Serologic testing for IBD (ASCA, pANCA), intestinal permeability testing, genetic testing if familial IBD suspected, vitamin and micronutrient levels (B12, folate, iron, vitamin D), tissue culture for organisms when needed
Fasting Required?
- Fasting: YES - Fasting is required
- Fasting Duration: 8-12 hours prior to the procedure; typically nothing to eat or drink after midnight if procedure scheduled for morning; if afternoon procedure, light breakfast may be allowed with specific instructions
- Clear Liquids: Clear liquids (water, apple juice without pulp, broth, tea without milk) may be allowed up to 2-4 hours before procedure depending on facility protocol
- Bowel Preparation: Polyethylene glycol (PEG) solution or other bowel cleanser as instructed 24 hours prior; complete colon evacuation essential for adequate visualization and biopsy sampling
- Medications to Avoid or Adjust: Anticoagulants (warfarin, apixaban, rivaroxaban) - typically stop 3-5 days before unless high thrombotic risk; antiplatelet agents (aspirin, clopidogrel) - usually continue but may hold on procedure day; NSAIDs - discontinue 3-5 days prior; iron supplements - stop 48-72 hours before (causes residual staining)
- Specific Medication Guidance: Diabetic medications (metformin) - hold on procedure day; insulin - adjust based on fasting; continue cardiac and blood pressure medications unless instructed otherwise; confirm all medication adjustments with gastroenterologist and other physicians
- Other Pre-Procedure Requirements: Arrange transportation (sedation administered during procedure); informed consent; disclose allergies, medical conditions, prior adverse reactions to sedation; remove dentures, jewelry, hearing aids; obtain baseline vital signs; empty bladder before procedure; wear loose, comfortable clothing
- Post-Procedure Instructions: Resume normal diet after full recovery from sedation; mild bloating/cramping expected; contact physician if severe abdominal pain, bleeding, fever, or difficulty breathing develops

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