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Morphology Experiment Pathology of Digestive Disease ZHANG WEI (张伟) Associate Professor, Ph.D. Institute of Pathology & Forensic Medicine Department of Pathology & Patho-physiology Zhejiang University School of Medicine [email protected] Morphology Experiment Pathology of Digestive Disease Purpose • Master the classification and morphological features of Chronic Gastritis. • Master the morphological features and complications of Digestive Ulcer. • Familiar with the classification and morphological features of Gastric Carcinoma. • Familiar with the classification and morphological features of Esophageal Carcinoma. Contents 1. Slides 2. Specimens • • • • • • 1 Gastritis 2 Peptic ulcer 3 Appendicitis 4 Carcinoma of esophagus 5 Carcinoma of stomach 6 Carcinoma of large intestine Anatomy and histology of the stomach Peptic ulcer of the duodenum • In ulcers with ongoing necrosis, four zones are demonstrable: • (1) the base and margins have a superficial layer of non-specific inflammatory infiltrate, with neutrophils predominating炎症层; • (2) beneath this layer is a zone of necrotic debris坏死层; • (3) in the deeper layers,there is active granulation tissue infiltrated with mononuclear leukocytes 肉芽组织层; • (4) the granulation tissue rests on a more solid fibrous or collagenous scar. 疤痕层 Complications of Peptic Ulcer Disease 1. Bleeding • Occurs in 15% to 20% of patients • Most frequent complication • May be life-threatening • Accounts for 25% of ulcer deaths • May be the first indication of an ulcer 2. Perforation • Occurs in about 5% of patients • Accounts for two thirds of ulcer deaths • Rarely, is the first indication of an ulcer 3. Obstruction from edema or scarring • Occurs in about 2% of patients • Most often due to pyloric channel ulcers • May also occur with duodenal ulcers • Causes incapacitating, crampy abdominal pain • Rarely, may lead to total obstruction with intractable vomiting 4. Malignant transformation Intestinal metaplasia • Refers to the replacement of gastric epithelium with columnar and goblet cells of intestinal variety. • Gastric intestinal type carcinomas appear to arise from dysplasia of this metaplastic epithelium. Appendicitis • Acute simple appendicitis • Acute phlegmonous appendicitis • Acute gangrenous appendicitis Acute appendicitis