Download 09_ Alimentary tract illnesses and abdominal region glands

GASTRITISES
ULCEROUS ILLNESS
APPENDECITIS
V.Voloshyn
Gastritis is inflammation of mucus membrane
of stomach.
According to flowing can be acute and
chronic.
Acute gastritis:
• Develops as a result of irritation of a mucus
membrane by alimentary products, toxic and
microbal factors
According to the features of morphological changes
there are selected the followings forms of acute
gastritis:
• CATARRHAL (can be with erosions)
• FIBRINOUS (crupous, diphteretic)
• FESTERING (phlegmonic)
• NECROTIZING (chemical)
Erosive gastritis
• Hemorrhagic
inflammation of
mucus membrane of
stomach in a patient
at the frequently using
of nonsteroid antiinflammatory
preparations
• (endoscope research)
Chronic gastritis
Violation of regeneration and structural
transformation of mucus membrane
take part in the morphogeny of chronic
gastritis .
• According to etiology and pathogeny
features there are selected gastritises A, B
and C.
Gastritises B prevail in the people (80 %).
Gastritis A
• Autoimmune gastritis. Related to appearance of
antibodies to lipoprotein of parietal cells and internal
factor. This antibodies lock the connection of parietal
cells lipoprotein and internal factor with the B12
vitamin.
• Often meets with other autoimmune diseases
(Thyroiditis, Adisson illness).
• It is localized in a fundal part.
• Mainly in the children and old men.
• There are characterized by fall-off (decreasing of
HCl secretion (inacidity), hyperplasia of G-cells and
gastrinaemia.
Gastritis B (unimmune 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 an antrum part
(can spread to all stomach)
(i.e. variants: antral, fundal,
pangastritis)
• According activity: acutining,
unacutening (remissing)
According to on a morphological picture
select superficial (no atrophy)
and atrophy gastritis
Superficial Gastritis:
Limpho-plasmocells infiltrates take place
in the superficial layers of mucus
membrane of stomach on the level of
rollers
Prognosis is favourable. Some time can
pass to the gastratrophia
Atrophic
Gastritis
• A mucus membrane is
refined, the amount of
glands is diminished.
• In an own plate there are
limphoid-plasmocells
infiltrates, expressed
sclerosis.
• Characteristic structural alteration with appearance of
focuses of intestinal and pyloric metaplasia. Intestinal
viiles appear in place of intestinal rollers. 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
Menetrier's Disease
• Hypertrophy gastritis
Gastritis C (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 not changed.
Ulcerous illness
• It is the chronic 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.
Pathogeny of ulcerous illness
• Hypertone of vagus with the increase of
acid-peptic factor activity
• Dysmotility stomach and duodenum
• Increase of level ACTH and glucorticoid
hormones
• Considerable predominance of acid-peptic
aggression factor above the factors of
mucus membrane defense
Morphogeny of chronic ulcer
• A forming of chronic ulcer passes the stages of
erosion and acute ulcer.
• Erosion is a superficial defect which arises up as
a result of mucus membrane necrosis.
• A 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 rounded-oval form and soft edges
Morphology of chronic ulcer
• In a stomach more frequent is
localized on small curvature, in
duodenum on a back wall of a
bulb.
• Has the appearance of deep
defect of oval or rounded form,
taking 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.
A microscopic picture depends on the
stage of ulcerous illness
• In the remission stage: The
cicatrical tissue situated on
the ulcer bottom and ousts
the muscle layer with single
sclerosed and obliterated
vessels.
• In the stage of acuteening:
The 4 layers differentiate
expressly on the ulcer
bottom: fibrin-festering
exsudate, fibrinoid necrosis,
granulation and fibrotic
tissue whith sclerosed
vessels.
The complications of ulcerous illness
•
•
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•
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Ulcerous-destructive:
perforation of ulcer
penetration (in a pancreas, wall of colon, liver)
bleeding
Inflammatory:
Gastritis, perigastritis
Duodenitis, periduodenitis
Ulcerous-cicatrical:
Stenosis of the entrance and initial openings of stomach
Stenosis and deformation of duodenum bulb.
• Malignisation of gastric ulcer
•
Combined complications
The diseases which are belong the
group of enhanceable risk of stomach
cancer origin:
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Adenoma of stomach (adenomatous polypus)
Chronic atrophic gastritis
Pernicious anaemia (Adisson-Birmer disease)
Chronic ulcer
Stump of stomach
• Heavy dysplasia epithelium is the
precancer processes in a stomach
Тубулярна аденома
• Leiomyoma of
stomach
Classification of stomach cancer
According to localization:
• According to the location gastric
carcinoma may be:
• 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%).
Clinic-anatomic (macroscopic ) forms of stomach
cancer
Macroscopic forms of cancer
Cancer with mainly
exophitic expansive
growth:
• Superficial spreading type
(like plate)
• Polypoid type
• Fungating (resembling a
mushroom) type
• Ulcerative type (primaryulcerative, like source
(Cancer-ulcer), cancer from
chronic ulcer (Ulcer-cancer).
Macroscopic forms of cancer
(continue)
Cancer mainly with
endophytic infiltrating
growth
• Ulcerative-invasive
(infiltrating) type;
• Diffusely spreading type
(Linitis plastica).
• Diffuse
• Carcinoma with exophytic
and endophytic growth.
(Mixed types of carcinoma).
According to the histological signs there are
the following types of gastric carcinoma
• 1. Adenocarcinoma: tubular, papillary, mucoid,
trabecular (well-differentiated).
• Undifferentiated carcinoma.
• Squamous-cell carcinoma.
• Adenosquamous carcinoma.
• Solid carcinoma (poorly-differentiated).
• Undifferentiated (scirrhous) carcinoma
(endophytic growth, diffuse form).
Signet-ring cell
Adenocarcinoma
Adenocarcinoma (is
the form of more
differentiated cancer)
and situated at
exophytic growth of
tumour more
frequently
Metastases ways of stomach
cancer
• Lymphogenic.
Haematogenic and
implant ways
• The first metastases
arise up in regional
lymphatic ways along
large and lesser
curvature of stomach
Metastatic carcinoma (paraaortic)
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)
Implant metastases
• Implant metastases
result to
canceromatosis of
peritoneum, pleura,
pericardium,
diaphragm.
• Haematogenic
metastases arise up
in a liver and in lungs
Haematogenic metastases
Appendicitis – the inflammation of
appendix vermiformis of cecum
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).
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 festering
inflammation in a
mucus membrane
Morphological forms (continous)
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Phlegmonous
Phlegmonous-ulcerous
Apostematic
Gangrenous (at a thrombosis and
thrombembolus of artery - is primary
gangrenous; at periappendicitis and
festering mesemteriolitis - secondary
gangrenous
Complication of acute
appendicitis
•
Perforation
• With development of festering 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
Chronic Appendicitis
• Develops after the
acute appendicitis
• It is characterized by
sclerotic and atrophy
processes, lymphhistiocells infiltration
• Polypuses of large
intestine at an
ulcerous colitis
• Nipple adenoma of
colon
• Gangrene of bowel
Family polyposis
Hyperplastic polypus
of colon
•Thank you for
attention!