Download Chronic gastritis

GASTRITISES
ULCEROUS ILLNESS,
CANCER of STOMACH,
APPENDECITIS
V.Voloshyn
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Gastritis is inflammation of mucus membrane of
stomach.
According to motion can be acute and chronic
forms.
Acute gastritis:
• Develops as a result of irritation of a mucus membrane by
alimentary products, toxic and microbial factors.
According to the features of morphological changes there are
selected following forms of acute gastritis:
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CATARRHAL (can be with erosions)
FIBRINOUS (crupous, diphteretic)
PURULENT (phlegmonous)
NECROTIZING (chemical)
According to affected area there are distinguished:
—Acute diffuse gastritis;
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—Acute focal gastritis, (fundal part, antral, piloroantral and pyloroduodenal).
Erosive gastritis
• is erosive hemorrhage
damage of gastric
mucosa. The reason of
it can be frequent use
of nonsteroidal antiinflammatory drugs.)
(endoscope research)
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Erosive gastritis
(gross)
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Chronic gastritis
• Chronic gastritis (gastritis chronica) – multi-etiologic
inflammatory-dystrophic diseases of the stomach,
which is displayed by violation of the physiological
regeneration of the epithelium, atrophy of the mucous
membrane, disorders of secretory, motor and
endocrine function
• Violation
of
regeneration
and
structural
transformation of mucus membrane take part in the
morphogeny of chronic gastritis. Such changes leads
to slow of parietal cells differentiation. Immature cells
appear. They die quickly before completion of their
differentiation. That is why chronic gastritis is NOT
inflammatory process, but a manifestation of
degeneration and violation of regeneration.
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Morphological classification of
chronic gastritis
• According to topography principle: chronic gastritis is
divided into fundal, antral and diffuse
• According to Houston classification :there are 3 types
of chronic gastritis:
nonatrophic, atrophic and special forms.
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Clinical-morphological forms of chronic gastritis
According to etiology and pathogeny features there are selected gastritis A, B and C.
• Autoimmune gastritis (chronic gastritis type A, “A” chronic
gastritis) is more rarer than H.pylori gastritis (in 1-15% cases). The
main etiological factor of “A” chronic gastritis is a present of
antibodies against parietal cells of stomach or/and again intrinsic
factor of Castle’s – gastromucousprotein.
• Chronic gastritis which caused by Helicobacter pylori, belongs to
H. pylori or bacterial (type B). It occurs in about 80% of all cases
of chronic gastritis.
• Chronic reflux-gastritis (chronic chemical gastritis, type C
gastritis) is developed at regular regurgitation of bile into stomach in
patients after operations on the stomach antrum and at pyloric
sphincter deficiency.
• Special forms of chronic gastritis, such as disease of Menetries,
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lymphocytic, eosinophilic, granulomatous gastritis.
Gastritis A
• Autoimmune gastritis . Called at appearance of
antibodies to gastroprotein of parietal cells (intrinsic
factor of Castle’s ). This antibodies block the
connection of parietal cells gastroprotein with
B12 vitamin.
• One often meets with other autoimmune diseases
(Thyroiditis, Adisson illness).
• It is localized in a fundal part of stomach.
• It is observed mainly in the children and old men.
• It is characterized by fast decreasing of hydrochloric
acid secretion (anacidity, achlorhydria), hyperplasia
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of G-cells and gastrinemia.
Gastritis B (unimmune, bacterial 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 antrum part,
but can spread to all stomach
(i.e. variants: antral, fundal,
pangastritis);
• According activity: acute,
remission.
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Gastritis C
(chemical) 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 norm.
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According to morphological manifestation
thay select superficial (no atrophy)
and atrophy gastritis
Superficial Gastritis is characterized by
presence of limpho-plasmocell infiltrates in
superficial layers of mucus membrane of
stomach on the level of platens.
Prognosis is favourable. Some time can pass
into the gastratrophia.
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Atrophic Gastritis
morphological manifestation
• A mucus membrane is
refined, the amount of
glands is diminished.
• There are limphoidplasmocell infiltrates in
an own plate and
expressed sclerosis.
• Characteristic structural alteration with focuses of intestinal
and pyloric metaplasia appearance. Intestinal villi appear
on the place of rugal folds. 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.
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Menetrier Disease (Hypertrophy gastritis)
- is a special form of chronic gastritis.
The mucous membrane
is considerably
thickened and has the
form of brain gyri.
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Ulcerous illness
This is independent (primary) 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.
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Pathogeny of ulcerous illness
• Hypertone of vagus nerve with increasing
of activity of acid-peptic factor.
• Dysmotility stomach and duodenum.
• Increasing of level of ACTH and
glucorticoid hormones.
• Considerable predominance of acid-peptic
aggression factor above the factors of
mucus membrane defense.
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Morphogeny of chronic ulcer
A forming of chronic ulcer passes
the stages:
1-erosion, 2- acute ulcer,
3- chronic ulcer.
• Erosion is a superficial defect which arises up as a
result of mucus membrane necrosis.
• An 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 rounded16
oval form and soft edges
Morphology of chronic ulcer
• in a stomach is localized on
small curvaturen more frequent;
in duodenum - on a back wall of
a bulb.
• It has the appearance of deep
defect of oval or rounded form,
destroys 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.
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A microscopic manifestation
depends from stage of ulcer
• At the remission stage. The
cicatrice tissue situated on
the ulcer bottom and ousts
the muscle layer with single
sclerosed and obliterated
vessels.
• At the stage of acute
condition: 4 layers are
differentiated expressly on
the ulcer bottom: fibrinoidpurulent exsudate, fibrinoid
necrosis, granulation and
fibrotic tissue whith
sclerosed vessels.
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The complications of ulcerous illness
•
•
•
•
•
•
•
I. Ulcerous-cicatrical:
stenosis of the entrance and initial openings of stomach;
stenosis and deformation of duodenum bulb.
II. Ulcerous-destructive:
perforation of ulcer;
penetration (in a pancreas, wall of colon, liver);
bleeding .
III. Malignization of ulcer.
IV. Inflammatory:
Gastritis, perigastritis;
Duodenitis, periduodenitis.
V. Combined complications.
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Bleeding from ulcer
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The diseases which are belong to the group of
enhanceable risk of stomach cancer development :
•
•
•
•
•
Adenoma of stomach (adenomatous polypus);
Chronic atrophic gastritis;
Pernicious anaemia (Adisson-Birmer disease);
Chronic ulcer;
Stump of stomach.
ONLY HEAVY DYSPLASIA
of epithelium is the precancer
process in a stomach.
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Tubular Adenoma
Classification of stomach cancer
According to localization:
• 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%).
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Macroscopic forms of cancer
Cancer with mainly exophitic
expansive growth:
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Superficial spreading type (like
plate);
Pulipous type;
Fungating (resembling a
mushroom) type;
Ulcerative type (primaryulcerative, cancer-ulcer, ulcercancer (cancer from chronic
ulcer).
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Macroscopic forms of cancer (continue)
Cancer mainly with endophytic
infiltrating growth:
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Ulcerative-invasive; (infiltrating
type);
Diffusely spreading type (Linitis
plastica);
Diffuse;
Carcinoma with exophytic and
endophytic growth (mixed types
of carcinoma).
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According to the histological signs there are
the following types of gastric carcinoma
• Adenocarcinoma: tubular, papillary,
mucoid, trabecular (well-differentiated).
• Squamous-cell carcinoma.
• Adenosquamous carcinoma.
• Solid carcinoma (poorly-differentiated).
• Undifferentiated carcinoma (medullar,
fibrotic cancer – scirrhous (characterized
by endophytic diffuse growth forms).
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Adenocarcinoma
(is the form of
more differentiated
cancer) and
situated at
exophytic growth of
tumour more
frequently
Signet-ring cell Adenocarcinoma
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Clinic-anatomic (macroscopic ) forms of stomach
cancer
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Metastases ways of stomach cancer
There are:
-lymphogenic,
-haematogenic,
-implant ways
of metastases.
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The first metastases arise up in regional lymphatic ways
along large and lesser curvature of stomach.
Haematogenic metastases arise up in a liver and in
lungs.
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).
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Implant
metastases
Implant metastases result to
canceromatosis of peritoneum,
pleura, pericardium, diaphragm.
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Metastatic carcinoma (paraaortic)
Appendicitis – the inflammation of
appendix vermiformis of cecum
Reasens of 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).
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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 purulent inflammation
in a mucus membrane;
• Destructive (irreversible
damage of the wall of
appendix).
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Morphological forms (continuous)
Destructive forms:
•
•
•
•
Phlegmonous
Phlegmonous-ulcerous
Apostematic
Gangrenous (1- at a thrombosis and thrombembolus
of artery - is primary gangrenous; 2- at periappendicitis
and purulent mesenteriolitis - secondary gangrenous.
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Complication of acute appendicitis
Perforation
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With development of suppurative
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
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Chronic Appendicitis
• Develops after the acute
appendicitis.
• It is characterized by sclerotic
and atrophy processes,
lympho-histiocell infiltrations.
• Sometimes obliteration of
appendix leads to hydropsy or
Mucocele of Appendix.
Myxoglobules can be formed
in it (myxoglobulosis).
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