2Еrosive gastritisThe typical case of erosive gastritis is characterized grossly by widespread petechial hemorrhages in any portion of the stomach or regions of confluent mucosal or submucosal bleeding.
3Erosions vary in size from 1 to 25 mm across and appear occasionally as sharply punched-out ulcers. Microscopically, patchy mucosal necrosis extending to the submucosa is visualized adjacent to normal mucosa. The necrotic epithelium is eventually sloughed, and deeper erosions and hemorrhage may be present. In extreme cases penetrating ulcers are associated with necrosis extending through to the serosa. Depending on the age of the process, there may by mild inflammation, initially neutrophilic and then mononuclear. Healing is usually complete within a few days.
4Nonerosive gastritis (chronic gastritis) Nonerosive gastritis refers to chronic inflammatory diseases of the stomach that range from mild superficial involvement of the gastric mucosa to severe atrophy.
5Autoimmune gastritis (type A) Autoimmune gastritis refers to a chronic, diffuse inflammatory disease of the stomach is restricted to the body and fundus and is associated with autoimmune phenomena. This disorder typically exhibits the following:Diffuse gastritis in the body and fundus of the stomachLack of or minimal involvement of the antrumAntibodies to parietal cellsSignificant reduction in or absence of gastric secretion
6Infectious gastritisIs a chronic inflammatory disease of the antrum and body of the stomach causes by Helicobacter pylori.The curved rods of H.pylori are found in the surface mucus of the epithelial cells and in the gastric foveolae. Active gastritis features polymorphonuclear leucocytes in the neck glands and inlamina propria. It has been claimed that chronic infectious gastritis caused by H. pylori can lead to gastric atrophy and intestinal metaplasia. In addition, infection with H.pylori has been linked to the development of gastric adenocarcinoma.
7Reflux gastritisRefers to chronic gastric injury that results from the reflux of alkaline duodenal contens and bile into the stomach, usually following partial gastrectomy. Whereas conspicuous reflux gastritis is most common after surgery, a milder form is often identified in intact stomachs from patient with gastric ulcer, postcholecystectomy syndrome, and various motor disturbances of the distal stomach.The term gastritis , as applied to chronic gastroduodenal reflux , is something of a misnomer, since it is not primarily an inflammatory disorders. The gistologic appearance is dominated by foveolar hyperplasia, edema, vasodilatation and congestion, and a paucity of inflammatory cells.
8Аtrophic gastritisThis condition may evolve from superficial gastritis, but there is no sharp distinction between them. Like superficial gastritis, active atrophic gastritis is characterized by prominent chronic inflammation in the lamina propria. However, lymphocytes and plasma cells extend onto the deepest reaches of the mucosa as far as the muscularis mucosae. Occasionally, lymphoid cells are arranged as follicles, an appearance that has led to an erroneous diagnosis of lymphoma or pseudolymphoma. Involvement of the gastric glands leads to degenerative changes in their epithelial cells and ultimately a conspicuous reduction in the number of glands, hence the name atrophic gastritis. Eventually the inflammatory process may ablate, leaving only a thin atrophic mucosa, in which case the term gastric atrophy is applied.
9Menetrier disease (hyperplastic gastropathy) Is an uncommon disease of the stomach characterized by enlaged rugae. It is often accompanied by a severe loss of plasma proteins (including albumin) from the altered gastric mucosa.The cause of this disorder is unknown.The folds of the stomach are increased in height and thickness, forming a convoluted surface similar to that of the brain
10Peptic ulcer diseaseRefers to breaks in the mucosa of the stomach and small intestine, principally the proximal duodenum, that are produced by the action of gastric secretions.
11Pathogenesis Environmental factor Genetic factor Psychological factor Hydrochloric acidPhysiologic factors in duodenal ulcersPhysiologic factors in gasric ulcersThe role of H. pyloriAssociated diseases
12Gastric ulcer. The stomach has been opened to reveal a sharply demarcated, deep peptic ulcer on the lesser curvature
13Duodenal ulcerA sharply punched-out peptic ulcer of the duodenum situated immediately below the pylorus.
14Complications Hemorrhage Perforation Pyloric obstruction Development of combined ulcersMalignant transformation of a benign gastric ulcer
15Low socioeconomic settings: These situations pose an increased risk of gastric cancer, an observation that has been used to explain the high freguency of the tumor among American blacks and the fact that the incidence of the disease in that population has not declined as rapidly as it has among whites.Atrophic gastritis, pernicious anemia, subtotal gastrectomy, and gastric adenomatous polyps have been discussed earlier as factors associated with a high resk of stomach cancer