GASTRITISGASTRITIS

ULCER DISEASEULCER DISEASE

ААss. Prof. Datsko T.V.ss. Prof. Datsko T.V.

ЕЕrosive gastritis rosive gastritis

The typical case of The typical case of erosive gastritis is erosive gastritis is characterized grossly characterized grossly by widespread by widespread petechial hemorrhages petechial hemorrhages in any portion of the in any portion of the stomach or regions of stomach or regions of confluent mucosal or confluent mucosal or submucosal bleeding. submucosal bleeding.

Erosions vary in size from 1 to 25 mm across and Erosions vary in size from 1 to 25 mm across and appear occasionally as sharply punched-out appear occasionally as sharply punched-out ulcers. Microscopically, patchy mucosal necrosis ulcers. Microscopically, patchy mucosal necrosis extending to the submucosa is visualized adjacent extending to the submucosa is visualized adjacent to normal mucosa. The necrotic epithelium is to normal mucosa. The necrotic epithelium is eventually sloughed, and deeper erosions and eventually sloughed, and deeper erosions and hemorrhage may be present. In extreme cases hemorrhage may be present. In extreme cases penetrating ulcers are associated with necrosis penetrating ulcers are associated with necrosis extending through to the serosa. Depending on extending through to the serosa. Depending on the age of the process, there may by mild the age of the process, there may by mild inflammation, initially neutrophilic and then inflammation, initially neutrophilic and then mononuclear. Healing is usually complete within a mononuclear. Healing is usually complete within a few days. few days.

Nonerosive gastritisNonerosive gastritis(chronic gastritis)(chronic gastritis)

Nonerosive gastritis refers to chronic Nonerosive gastritis refers to chronic inflammatory diseases of the stomach that inflammatory diseases of the stomach that range from mild superficial involvement of range from mild superficial involvement of the gastric mucosa to severe atrophy.the gastric mucosa to severe atrophy.

Autoimmune gastritis (type A)Autoimmune gastritis (type A) Autoimmune gastritis refers to a chronic, diffuse Autoimmune gastritis refers to a chronic, diffuse

inflammatory disease of the stomach is restricted inflammatory disease of the stomach is restricted to the body and fundus and is associated with to the body and fundus and is associated with autoimmune phenomena. This disorder typically autoimmune phenomena. This disorder typically exhibits the following:exhibits the following:

Diffuse gastritis in the body and fundus of the Diffuse gastritis in the body and fundus of the stomachstomach

Lack of or minimal involvement of the antrumLack of or minimal involvement of the antrum Antibodies to parietal cellsAntibodies to parietal cells Significant reduction in or absence of gastric Significant reduction in or absence of gastric

secretionsecretion

Infectious gastritisInfectious gastritisIs a chronic inflammatory disease of Is a chronic inflammatory disease of

the antrum and body of the the antrum and body of the stomach causes by Helicobacter stomach causes by Helicobacter pylori. pylori.

The curved rods of H.pylori are The curved rods of H.pylori are found in the surface mucus of the found in the surface mucus of the epithelial cells and in the gastric epithelial cells and in the gastric foveolae. Active gastritis features foveolae. Active gastritis features polymorphonuclear leucocytes in polymorphonuclear leucocytes in the neck glands and inlamina the neck glands and inlamina propria. It has been claimed that propria. It has been claimed that chronic infectious gastritis caused chronic infectious gastritis caused by H. pylori can lead to gastric by H. pylori can lead to gastric atrophy and intestinal metaplasia. atrophy and intestinal metaplasia. In addition, infection with H.pylori In addition, infection with H.pylori has been linked to the has been linked to the development of gastric development of gastric adenocarcinoma.adenocarcinoma.

Reflux gastritisReflux gastritis Refers to chronic gastric injury that results from Refers to chronic gastric injury that results from

the reflux of alkaline duodenal contens and bile the reflux of alkaline duodenal contens and bile into the stomach, usually following partial into the stomach, usually following partial gastrectomy. Whereas conspicuous reflux gastritis gastrectomy. Whereas conspicuous reflux gastritis is most common after surgery, a milder form is is most common after surgery, a milder form is often identified in intact stomachs from patient with often identified in intact stomachs from patient with gastric ulcer, postcholecystectomy syndrome, and gastric ulcer, postcholecystectomy syndrome, and various motor disturbances of the distal stomach.various motor disturbances of the distal stomach.

The term gastritis , as applied to chronic The term gastritis , as applied to chronic gastroduodenal reflux , is something of a gastroduodenal reflux , is something of a misnomer, since it is not primarily an inflammatory misnomer, since it is not primarily an inflammatory disorders. The gistologic appearance is disorders. The gistologic appearance is dominated by foveolar hyperplasia, edema, dominated by foveolar hyperplasia, edema, vasodilatation and congestion, and a paucity of vasodilatation and congestion, and a paucity of inflammatory cells.inflammatory cells.

ААtrophic gastritistrophic gastritis This condition may evolve from superficial gastritis, but This condition may evolve from superficial gastritis, but

there is no sharp distinction between them. Like superficial there is no sharp distinction between them. Like superficial gastritis, active atrophic gastritis is characterized by gastritis, active atrophic gastritis is characterized by prominent chronic inflammation in the lamina propria. prominent chronic inflammation in the lamina propria. However, lymphocytes and plasma cells extend onto the However, lymphocytes and plasma cells extend onto the deepest reaches of the mucosa as far as the muscularis deepest reaches of the mucosa as far as the muscularis mucosae. Occasionally, lymphoid cells are arranged as mucosae. Occasionally, lymphoid cells are arranged as follicles, an appearance that has led to an erroneous follicles, an appearance that has led to an erroneous diagnosis of lymphoma or pseudolymphoma. Involvement diagnosis of lymphoma or pseudolymphoma. Involvement of the gastric glands leads to degenerative changes in their of the gastric glands leads to degenerative changes in their epithelial cells and ultimately a conspicuous reduction in epithelial cells and ultimately a conspicuous reduction in the number of glands, hence the name atrophic gastritis. the number of glands, hence the name atrophic gastritis. Eventually the inflammatory process may ablate, leaving Eventually the inflammatory process may ablate, leaving only a thin atrophic mucosa, in which case the term gastric only a thin atrophic mucosa, in which case the term gastric atrophy is applied.atrophy is applied.

Menetrier disease Menetrier disease (hyperplastic (hyperplastic gastropathy)gastropathy)

Is an uncommon disease of Is an uncommon disease of the stomach characterized the stomach characterized by enlaged rugae. It is often by enlaged rugae. It is often accompanied by a severe accompanied by a severe loss of plasma proteins loss of plasma proteins (including albumin) from the (including albumin) from the altered gastric mucosa.The altered gastric mucosa.The cause of this disorder is cause of this disorder is unknown.unknown.

The folds of the stomach are The folds of the stomach are increased in height and increased in height and thickness, forming a thickness, forming a convoluted surface similar to convoluted surface similar to that of the brainthat of the brain

Peptic ulcer diseasePeptic ulcer disease

Refers to breaks in the mucosa of the Refers to breaks in the mucosa of the stomach and small intestine, principally the stomach and small intestine, principally the proximal duodenum, that are produced by proximal duodenum, that are produced by the action of gastric secretions.the action of gastric secretions.

PathogenesisPathogenesis

Environmental factorEnvironmental factor Genetic factorGenetic factor Psychological factorPsychological factor Hydrochloric acidHydrochloric acid Physiologic factors in duodenal ulcersPhysiologic factors in duodenal ulcers Physiologic factors in gasric ulcersPhysiologic factors in gasric ulcers The role of H. pyloriThe role of H. pylori Associated diseasesAssociated diseases

Gastric ulcer. The Gastric ulcer. The stomach has been opened stomach has been opened to reveal a sharply to reveal a sharply demarcated, deep peptic demarcated, deep peptic ulcer on the lesser ulcer on the lesser curvature curvature

Duodenal ulcerDuodenal ulcer

A sharply punched-out A sharply punched-out peptic ulcer of the peptic ulcer of the duodenum situated duodenum situated immediately below the immediately below the pylorus. pylorus.

ComplicationsComplications

HemorrhageHemorrhage PerforationPerforation Pyloric obstructionPyloric obstruction Development of combined ulcersDevelopment of combined ulcers Malignant transformation of a benign gastric Malignant transformation of a benign gastric

ulcerulcer

Low socioeconomic settings:Low socioeconomic settings: These situations pose an increased risk of These situations pose an increased risk of

gastric cancer, an observation that has been gastric cancer, an observation that has been used to explain the high freguency of the used to explain the high freguency of the tumor among American blacks and the fact tumor among American blacks and the fact that the incidence of the disease in that that the incidence of the disease in that population has not declined as rapidly as it population has not declined as rapidly as it has among whites.has among whites.

Atrophic gastritis, pernicious anemia, subtotal Atrophic gastritis, pernicious anemia, subtotal gastrectomy, and gastric adenomatous polyps gastrectomy, and gastric adenomatous polyps have been discussed earlier as factors have been discussed earlier as factors associated with a high resk of stomach cancerassociated with a high resk of stomach cancer

The major types of gastric cancerThe major types of gastric cancer

Infiltrating gastric Infiltrating gastric carcinoma. The wall of carcinoma. The wall of the stomach is the stomach is thickened and thickened and indurated by diffusely indurated by diffusely infiltrating cancerinfiltrating cancer

Acute appendicitisAcute appendicitis

Mucocele of the Mucocele of the appendix. The appendix. The appendix is appendix is conspicuously dilated conspicuously dilated by mucinous material by mucinous material secreted by a secreted by a mucinous mucinous cystadenomacystadenoma