gastritis and peptic ulcer 30 5-2016
TRANSCRIPT
GASTRITIS AND PEPTIC ULCER
Dept of path ology, C
HR
I.
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STOMACH - ANATOMY
Types of glands Cardiac glands – mucus secreting
cellsGastric or Oxyntic or Fundic glands –
found in fundus and body contain parietal cells, chief cells & a few endocrine cells
Antral/pyloric glands – contain mucus secreting & endocrine cells
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MUCOSAL PROTECTION
Mucus secretion – secretion of mucus with a low diffusion coefficient for H+
Bicarbonate secretion – secreted by surface epithelial cells
Epithelial barrier – intercellular tight junctions Rich mucosal blood flow Prostaglandin synthesis – PG inhibits acid secretion,
promotes bicarbonate and mucin secretion and improves blood supply
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ACUTE GASTRITIS
Definition: acute mucosal inflammatory process, usually transient & self-limited
NEUTROPILS PRESENT
↑sed acid secretion ↓sed HCO3 ( H.PYLORI, UREMIA) DECREASED PROSTAGLANDINS reduced blood flow (ELDERLY)
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Dept of path ology, C
HR
I.
ACUTE GASTRITIS
Asymptomatic epigastric pain nausea & vomiting painless bleeding
Gross diffusely hyperemic mucosa superficial, circular, small erosions
(<1 cm); dark brown due to acid digestion of extravasated blood
Erosion denotes loss of epithelium
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ACUTE GASTRIC ULCER STRESS ULCER
CURLING’S ULCER
CUSHING’S ULCER
Reduced splanchnic blood flow in ischemic / shock
Less than 1cm, sharply defined normal rugal folds , resolves completely
No scarring 10
Dept of path ology, C
HR
I.
11
Dept of path ology, C
HR
I.
CHRONIC (NON-EROSIVE) GASTRITIS
Definition: chronic inflammatory infiltration of gastric mucosa, often accompanied by mucosal gland atrophy and INTESTINAL metaplasia
Types of Chronic Gastritis• Autoimmune Gastritis (type A or Fundic)• Type B gastritis (H. Pylori and other causes)
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AUTOIMMUNE (TYPE A OR FUNDIC TYPE)
Involves body & fundus (~10% chronic gastritis)
Auto-antibodies to parietal cells, H+,K+-ATPase, gastrin receptor & intrinsic factor lead to loss of parietal cells, acid secretion, mucosal atrophy
Hyperplasia of the G cells with hypergastrinemia.
↑sed risk for gastric carcinoma & carcinoids
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TYPE B CHRONIC GASTRITIS
Predominantly Antral type with high acid secretion and increased risk of PEPTIC ulcer
Pan-gastritis with multifocal gastric atrophy, low acid secretion and increased risk for adenocarcinoma
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CHRONIC H.PYLORI GASTRITIS
Helicobacter pylori Spiral shaped curved organisms Colonise the mucus layer(don’t invade) Chronic than acute Flagella, urease, cytotoxins Symptoms: abdominal pain Complication: peptic ulcer INCREASED RISK OF ADENOCA
CHRONIC (NON-EROSIVE) GASTRITISActive Inflammation(LYMPHOID AGGREGATES IN
LAMINA PROPRIA)
INTRAEPITHELIAL NEUTROPHILS
PIT ABCESS
Intestinal metaplasia
H.PYLORI IN LUMEN
Atrophic gastritis
Normal
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PEPTIC ULCER
Includes duodenal and gastric ulcerCHRONIC M:F = 3:1 for DU & 1.5-2:1 for GUThey are remitting, relapsing lesions
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PEPTIC ULCER
The imbalances of mucosal defenses and damaging forces that cause chronic gastritis are also responsible for PUD
NSAID H.pylori Zollinger ellison syndrome
HELICOBACTER PYLORI
Infection is present in 90% of patients with chronic gastritis in all duodenal ulcer patients & 70% of gastric ulcer patients; but is
limited to stomachOnly 10-20% of infected develop peptic ulcer
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Stomach – usually antrum- LESSER CURVATURE (II most common)Duodenum – first portion (most common site)Multiple in patients with Zolinger-Elison syndrome
SITES OF PEPTIC ULCER
DUODENAL ULCER
4 times more common than gastric ulcers
Peak incidence is in 40's
Most duodenal ulcers occur within a few centimetres from pyloric ring
Anterior wall is affected more often than posterior wall
Irregular dietary habits
Pain releived with food intake
Weight gain
Contrasts wit gastric ulcer- increased risk of ca
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PEPTIC ULCER - GROSS Over 50% of ulcers are <2cm
• Round to oval• Punched-out area with clean
base• Margins are usually level with
surrounding mucosa or slightly elevated due to edema
• no heaping up of margins
• Gastric rughae converge upto the margin of ulcer( spoke wheel /cartt wheel appearance)
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DIFFEREWNCE BETWEEN PEPTIC AND MALIGNANT GASTRIC ULCER
ULCER – MICROSCOPIC FEATURES
Four zones:1. Superficial necrotic debris2. Zone of non-specific
inflammation with neutrophils predominating
3. Active granulation tissue with mononuclear infiltration
4. Zone of fibrosis
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HELICOBACTER PYLORI- DIAGNOSIS
Diagnostic tests: 1. serologic test for Ab 2. faecal bacterial detection 3.urea breath test 4. finding organisms or its DNA in tissues/culture
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COMPLICATIONS OF PEPTIC ULCER DISEASE
Bleeding – most frequent complication; occurs in 15 – 20% of patients; accounts for 25% of ulcer deaths; may be the first manifestation
Perforation, penetration & peritonitis; Obstruction Intractable pain
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Thank you!
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