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Path: Stomach (i) inflamm disorders (PUD (gross appearance (round/oval,…
Path: Stomach (i) inflamm disorders
acute gastritis
causes
alcohol
drugs
NSAIDs (esp aspirin)
steroids
smoking
corrosives
herbicides
acids
alkalis
stress
shock
trauma
iscahemia
burns
uraemia (raised blood urea levels)
gastric irradiation (gastric mucosa v sensitive)
presentation
asymp
epigastric pain
nausea, vomiting, haematemesis, melena (bleeding can cause anaemia)
influx of neutrophils (polylobed nucleus + oedema)
chronic gastritis
chronic mucosal changes leading to mucosal atrophy + epithelial metaplasia (intestinal, more goblet cells), usually in the absences of erosions
epithelial changes may become dysplastic + progress to carc
3 main types...
helicobacter-associated
any age
affects antrum + corpus
H pylori: urease producing gram -ve rod, seen in superficial mucous layers (PAS stain)
urease generates ammonia + protease - epithelial damage, acute + chronic inflamm, lymphoid aggregates
diffuse antral gastritis, duodenal ulcers
gastric ulcers (PUD) + cancer
multifocal atrophic gastritis
intestinal metaplasia
gastric -> SI epithelium
may become dysplastic - increased risk of carc
surveillance endoscopy
Dx
urea breath test (not sensitive)
biopsy
serology
culture
AI
mostly in elderly
autoAbs against parietal cells + intrinsic factor
pernicious anaemia (megaloblastic anaemia due to decreased vit B12)
hypochlorhydria (parietal feels secrete HCl) - increased carc risk
a/w other AI disorders: Hashimoto's thyroiditis + Addison's
gland destruction + mucosal atrophy of body + fundic mucosa
less intense antral damage
loss of acid + intrinsic factor production production
esp in fundus + cardia
chemical (reflux)
reflux of duodenal fluid + bile
commonest with previous gastric surgery
foveolar hyperplasia (increased mucus-producing cells)
vasc ectasia (dilation)
fibromuscular lamina propria (protection from bile)
infiltration by lymphocytes + plasma cells
PUD
due to gastric acid (acid-peptic juices)
5 sites
duodenum (usually 1st part)
stomach
oeso (OGJ)
gastric anastomosis (bypass)
Meckel's diverticulum (congenital, contains ectopic gastric mucosa)
in patients with Zollinger-Eillison syndrome (tumours in pancreas/SI cause stomach to produce too much acid)
ulcer = breach in mucosa of alimentary canal which extends through the muscularis mucosae into the submucosa or deeper
gross appearance
round/oval, sharply punched out
relatively straight walls
margins usually level with surrounding mucosa
base is smooth + clean
surrounding gastric mucosa = oedematous + reddened
ensure it's not malignant, but don't biopsy - perfoation risk)
microscopic appearance
ulcer with fibrosis in the base + walls
3 zones
superficial slough (necrosis)
chronically inflamed granulation tissue
deep fibrous or collagenous scar
vessel walls within the scarred area are thickened by the inflamm + are occasionally thrombosed
gastric ulcer clinical presentation
epigastric pain
anorexia, weightloss
nausea, vomiting, bloating, belching
tends to be worse @ night, 1-3 hrs after food
duodenal ulcer clinical presentation
pain may be relieved by eating/alkalis
penetrating ulcers: pain referred to the back/chest/LUQ
iron-deficiency anaemia
melaena
complications
penetration + intractable pain
obstruction from oedema + scarring (pyloric stenosis)
malignant change (rare)
often recur
Acute gastric ulcers
stress ulcers
usually develop from areas of acute erosive gastritis
due to severe stress/shock
Cushing's
Curling's ulcer (complication from severe burns when reduced plasma vol leads to ischaemia + necrosis of gastric mucosa)
extensive burns/trauma
shock: stomach is not a critical organ so blood diverted elsewhere
on microscopy range from erosion to ulceration
<1mm in size
single or multiple
no scarring or thickening of blood vessels (would need to be chronic for this to happen)
outcomes
severe bleeding (v bad if person is already shocked)
heal without scarring (takes days-several wks)
progress to chronic peptic ulcer
most important determinant of outcome = ability to correct the underlying condition