GASTRITIS ULCER DISEASE Аss. Prof. Datsko T.V.

Еrosive gastritis The 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.

Erosions 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.

Nonerosive 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.

Autoimmune 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 stomach Lack of or minimal involvement of the antrum Antibodies to parietal cells Significant reduction in or absence of gastric secretion

Infectious gastritis Is 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.

Reflux gastritis Refers 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.

Аtrophic gastritis This 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.

Menetrier 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

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

Pathogenesis Environmental factor Genetic factor Psychological factor Hydrochloric acid Physiologic factors in duodenal ulcers Physiologic factors in gasric ulcers The role of H. pylori Associated diseases

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

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

Complications Hemorrhage Perforation Pyloric obstruction Development of combined ulcers Malignant transformation of a benign gastric ulcer

Low 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

The major types of gastric cancer

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

Acute appendicitis

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