GASTRITISES

ULCEROUS ILLNESS

APPENDECITIS

V.Voloshyn

Gastritis is inflammation of mucus membrane of stomach.According to flowing can be acute and chronic.

Acute gastritis:• Develops as a result of irritation of a mucus

membrane by alimentary products, toxic and microbal factors

According to the features of morphological changes there are selected the followings forms of acute gastritis:

• CATARRHAL (can be with erosions)• FIBRINOUS (crupous, diphteretic) • FESTERING (phlegmonic)• NECROTIZING (chemical)

Erosive gastritis

• Hemorrhagic inflammation of mucus membrane of stomach in a patient at the frequently using of nonsteroid anti-inflammatory preparations

• (endoscope research)

Chronic gastritis

Violation of regeneration and structural transformation of mucus membrane take part in the morphogeny of chronic gastritis .

• According to etiology and pathogeny features there are selected gastritises A, B and C.

Gastritises B prevail in the people (80 %).

Gastritis A • Autoimmune gastritis. Related to appearance of

antibodies to lipoprotein of parietal cells and internal factor. This antibodies lock the connection of parietal cells lipoprotein and internal factor with the B12 vitamin.

• Often meets with other autoimmune diseases (Thyroiditis, Adisson illness).

• It is localized in a fundal part.• Mainly in the children and old men.• There are characterized by fall-off (decreasing of

HCl secretion (inacidity), hyperplasia of G-cells and gastrinaemia.

Gastritis B (unimmune gastritis )• Etiology: Helicobacter pilori,

which it is found out in 100% of patients.

• Association with the varied endogenous and exogenous factors (intoxication, violation of nutrition, alcohol abuse

• It is localized in an antrum part (can spread to all stomach) (i.e. variants: antral, fundal, pangastritis)

• According activity: acutining, unacutening (remissing)

According to on a morphological picture select superficial (no atrophy)

and atrophy gastritis

Superficial Gastritis:Limpho-plasmocells infiltrates take place

in the superficial layers of mucus membrane of stomach on the level of

rollersPrognosis is favourable. Some time can

pass to the gastratrophia

Atrophic Gastritis

• A mucus membrane is refined, the amount of glands is diminished.

• In an own plate there are limphoid-plasmocells infiltrates, expressed sclerosis.

• Characteristic structural alteration with appearance of focuses of intestinal and pyloric metaplasia. Intestinal viiles appear in place of intestinal rollers. Mucus membrane consist of intestinal epithelium with numerous goblet cells

• There are focuses of displasia often. The cancer of stomach can develop at heavy epithelium displasia

Menetrier's Disease

• Hypertrophy gastritis

Gastritis C (reflux-gastritis)

• Related with regurgitation of duodenum maintenance into the stomach.

• Often arises up in people which had the stomach resection

• It is localized in antrum part

• The secretion of HCl is not damaged and the amount of gastrinum is not changed.

Ulcerous illness• It is the chronic disease. The chronic

recurrence ulcer of stomach or duodenum is the morphological substrate of this disease.

Symptomatic ulcers:

endocrinal; discirculatoric-hypoxic; toxic; allergic; specific; iatrogenic.

Pathogeny of ulcerous illness

• Hypertone of vagus with the increase of acid-peptic factor activity

• Dysmotility stomach and duodenum

• Increase of level ACTH and glucorticoid hormones

• Considerable predominance of acid-peptic aggression factor above the factors of mucus membrane defense

Morphogeny of chronic ulcer

• A forming of chronic ulcer passes the stages of erosion and acute ulcer.

• Erosion is a superficial defect which arises up as a result of mucus membrane necrosis.

• A acute ulcer is more deep defect, which takes place not only in a mucus membrane but also other membranes of stomach wall. It has a wrong rounded-oval form and soft edges

Morphology of chronic ulcer• In a stomach more frequent is

localized on small curvature, in duodenum on a back wall of a bulb.

• Has the appearance of deep defect of oval or rounded form, taking mucus and muscular membranes.

• The edges of ulcer are dense. Proximal edge is towered and a mucus membrane is hanged over ulcer. Distal one is declivity and has the appearance like terrace.

A microscopic picture depends on the stage of ulcerous illness

• In the remission stage: The cicatrical tissue situated on the ulcer bottom and ousts the muscle layer with single sclerosed and obliterated vessels.

• In the stage of acuteening: The 4 layers differentiate expressly on the ulcer bottom: fibrin-festering exsudate, fibrinoid necrosis, granulation and fibrotic tissue whith sclerosed vessels.

The complications of ulcerous illness Ulcerous-destructive:• perforation of ulcer• penetration (in a pancreas, wall of colon, liver)• bleeding Inflammatory:• Gastritis, perigastritis• Duodenitis, periduodenitis Ulcerous-cicatrical:• Stenosis of the entrance and initial openings of stomach• Stenosis and deformation of duodenum bulb. • Malignisation of gastric ulcer• Combined complications

The diseases which are belong the group of enhanceable risk of stomach

cancer origin:

• Adenoma of stomach (adenomatous polypus)• Chronic atrophic gastritis• Pernicious anaemia (Adisson-Birmer disease)• Chronic ulcer• Stump of stomach

• Heavy dysplasia epithelium is the precancer processes in a stomach

Тубулярна аденома

• Leiomyoma of stomach

Classification of stomach cancerAccording to localization:• According to the location gastric

carcinoma may be:• 1. Pyloric (50%) gastric

carcinoma.• 2. Lesser curvature of the

stomach (27%) with the transition on back and front walls

• 3. Cardial gastric carcinoma (15%).

• 4. Greater curvature of the stomach (3%).

• 5. Fundal gastric carcinoma (2%).

• 6. Total gastric carcinoma (3%).

Clinic-anatomic (macroscopic ) forms of stomach cancer

Macroscopic forms of cancerCancer with mainly

exophitic expansive growth:

• Superficial spreading type (like plate)

• Polypoid type• Fungating (resembling a

mushroom) type• Ulcerative type (primary-

ulcerative, like source (Cancer-ulcer), cancer from chronic ulcer (Ulcer-cancer).

Macroscopic forms of cancer (continue)

Cancer mainly with endophytic infiltrating growth

• Ulcerative-invasive (infiltrating) type;

• Diffusely spreading type (Linitis plastica).

• Diffuse• Carcinoma with exophytic

and endophytic growth. (Mixed types of carcinoma).

According to the histological signs there are the following types of gastric carcinoma

• 1. Adenocarcinoma: tubular, papillary, mucoid, trabecular (well-differentiated).

• Undifferentiated carcinoma.• Squamous-cell carcinoma.• Adenosquamous carcinoma.• Solid carcinoma (poorly-differentiated).• Undifferentiated (scirrhous) carcinoma

(endophytic growth, diffuse form).

Signet-ring cell Adenocarcinoma

Adenocarcinoma (is the form of more differentiated cancer) and situated at exophytic growth of tumour more frequently

Metastases ways of stomach cancer

• Lymphogenic. Haematogenic and implant ways

• The first metastases arise up in regional lymphatic ways along large and lesser curvature of stomach

Metastatic carcinoma (paraaortic)

Retrograde metastases have the role as the diagnostic moment among distant lymphogenic metastases:

• In both ovaries (Krukenberg tumor)

• In a pararectal tissue (Shnitsler metastases)

• In the left supraclavicular lymphnode (Virchow's gland)

Implant metastases

• Implant metastases result to canceromatosis of peritoneum, pleura, pericardium, diaphragm.

• Haematogenic metastases arise up in a liver and in lungs

Haematogenic metastases

Appendicitis – the inflammation of appendix vermiformis of cecum

Acute appendicitis• Obstruction of appendix

with the resistance decline of mucus membrane and the wall invasion by microorganisms

• Unobstructive appendicitis can arise as the secondary at generalized infectious diseases (viral).

Morphological forms

• Simple (it is accompanied by disorders of blood circulation, small hemorrhages, a little leucocytes accumulation – primary affect

• Superficial is characteristic by hearth of festering inflammation in a mucus membrane

• Phlegmonous

• Phlegmonous-ulcerous

• Apostematic

• Gangrenous (at a thrombosis and thrombembolus of artery - is primary gangrenous; at periappendicitis and festering mesemteriolitis - secondary gangrenous

Morphological forms (continous)

Complication of acute appendicitis

• Perforation• With development of festering peritonitis• With development of periappendicular

abscess• Empyema of appendix• Spread of infection by portal vein

branches may propagate to the liver; this was formerly an important cause of portal pyemic abscesses in the liver

Chronic Appendicitis

• Develops after the acute appendicitis

• It is characterized by sclerotic and atrophy processes, lymph-histiocells infiltration

• Polypuses of large intestine at an ulcerous colitis

• Nipple adenoma of colon

• Gangrene of bowel

Family polyposis

Hyperplastic polypus of colon

•Thank you for attention!