Documente Academic
Documente Profesional
Documente Cultură
GASTROPATII
DEFINIIE
Gastritele :
afeciuni gastrice ac/cr
asociaz leziuni
inflamatorii
etiologie i patogenez
multipl
clinic
asimptomatice/simptome
nespecifice
Gastropatiile :
grup de leziuni mucosale
gastrice
dominant
epiteliale/vasculare
componenta inflamatorie
minim/absent
Criterii de
CLASIFICARE
A. Clinico-evolutive
1. Gastrite ACUTE :
2. Gastritele CRONICE:
B. Criterii endoscopice :
1. Formele endoscopice :
a)G. eritematoas eroziv :
eritem 2-3mm
diseminate pe muc. N
+/- acoperite exudat albicios
muscularis mucosae integr
b) G. maculo-eroziv :
pete eritematoase 3-15mm
ulceraii superficiale
detritus alb-cenuiu
halou periulceraie
leziuni acute
excavaie central-
varioliform
leziuni cronice
H.p. +
(corion) ,apoi
profund (moderat/sever)
2 forme :
inactiv (PMN-)
activ (PMN+) = n corion/ntre cel.
epit./glande
c. G. atrofic :
stadiul final de evoluie g. cr.
dispar glandele oxintice
+/- metaplazie intestinal
D. Etiologia:
a. G. infecioase :
baterii/vir./fungi/parazii
b. G. autoimun
c. G. medicamentoas : AINS, CST, Fe
d. G. specifice : B. Crohn, g. eozinofilic
.GASTRITA CRONICA
PREDOMINENT ANTRALA (B)
H.p. +
frecvent asimptomatic
EDS :
necaracteristic
N/eritem, maculo-eroziv
Histologia : gastrit superficial
II cr. difuz, PMN n lamina propria i
epiteliu
foliculi limfoizi
metaplazie intestinal
Helicobacter Pylori
germene G(-)
0,2-0, 5m
spiralat,
flagelat
colonizeaz
antrul/jonciu
nile intercel.
NU PTRUNDE N
CELULE
. GASTRITA CRONIC
ATROFIC MULTIFOCAL
GASTRITA CRONIC
ATROFIC CORPOREAL
DIFUZ(TIP A)
EDS :
Histo :
hiperplazie cel. G antrale
Ac anti F.I/ Ac anticel. parietale
gastrice- anemie pernicioas
+/- metaplazie int. incomplet (tip
colonic) :risc Neo G/ tumor carcinoid
aclorhidrie/hipergastrinemie sec.
GASTRITE INFECIOASE
1. Virale :
a. CMV :
imunodeprimai (neo, SIDA)
Clinic:epigastralgii, T0 ;Pclinic:
limfocitoz
EDS : mucoas edemaiat, congestiv
cu ulceraii, mas tumoral
Dgs. : CMV intracel. la biopsie
b. Herpesvirus :
simplex/zoster rar
imunodeprimai
EDS: ulceraii mici, multiple
2. Bacteriene
a. G. acut H.p. +
Morfologie : II PMN + n corion
Clinic :
epigastralgii acute/severe,grea,
vrsturi aclorhidrie
la copil/durat zile
Evoluie :
vindecare spontan/ cronicizare
Etiologia : Alcool/IARCS/SIDA
Clinic :
epigastralgii acute
peritonit ac. purulent
T0 , hTA,oc septic
EDS intraoperator :
perete ngroat, edemaiat
perforaii multiple
mucoas granular/exudat negruverzui/puroi
Histologie :
infiltrat intens PMN/germeni
tromboze/necroze extinse
Dg+ frecvent intraoperator
mortalitate 60%
Tratament : rezecie gastric + ATB
c. Gastrita emfizematoas
Clostridium welchii
apare dup :
chirurgie G-D
ingestie corozive
infarct gastrointestinal
3. Fungice :
Candida albicans :
imunodeprimai
eroziuni aftoide+ulceraii lineare
4. Parazitare :
Strongiloides stercoralis
-Ascarizi ghemHDS
GASTRITE
GRANULOMATOASE
Boala Crohn:
rar afectare S + intestin
grea, vrsturi, epigastralgii,G
Rx:
ngrori de mucoas stenoz antru
ulceraii aftoide
EDS :
ulceraii serpiginoase longitudinale
localizare antral preponderent
Histo : - granuloame, II cr., fibroz
submucoas
Sarcoidoza rar
Amiloidoza
Boala Wipple
GASTRITA LIMFOCITAR
(VARIOLIFORM)
Infiltrat limfocitar dens n epiteliu
EDS :
Histo :
GASTRITA EOZINOFILIC
(gastroenterita eozinofilic)
eozinofilie
infiltrat II cu Eoz n peretele Tr.
Dig.
GASTROPATII REACTIVE(C)
Definiie = G. Acute
nu apare II semnificativ
multiple
frecvent asimptomatice (50%)
dispesie, pirozis
2. Terapia cu Fe++ p.o. ,KCl, terapia antineo
i.a.
eritem, hemoragii subepiteliale
3. Alcoolul
hemoragii subepiteliale
NU inflamaie intens muc.
Frecvent asociaz gastrit cr. antral H.p
+
accentuare lez. + AINS
liposolubil = afecteaz membrana cel.
epiteliu
4. Cocaina
Eroziuni exudative difuze
HDS, perforaie gastric
5. Stresul : eroziuni/ulcerul de stres
6. Iradierea gastric ulcer antral
Gastrita
de
reflux
ICC;ASS;Maratoniti
9. Gastropatia portal-hipertensiv
60% din HTP
EDS :
a)forma uoar :
mozaicat (piele arpe)
hiperemic
rash scarlatiniforn
b)forma sever:
spoturi hemoragice difuze
sngerare difuz gastric
Localizare : fornix/orice zon a S
Histologic :
Ectazii vasculare n mucoas
II redus
GASTROPATIILE HIPERPLASTICE:
Boala Menetrier
Sindromul Zollinger-Ellison
BOALA MENETRIER(gastropatie
hipertrofic)
frecven redus
etiopatogenez necunoscut
Anat-pat:
pliuri hipertrofice gigante fornix+corp
1,5 x 1 cm/meninere la insuflare
aspect cerebriform-obstrucie antru
mucus n exces pe S2 pliurilor
eroziuni superficiale pe creste
Histologic:
hiperplazie foveolar masiv tip chistic
glande oxintice atrofiate
+/- metaplazie pseudopiloric
edem
TGF alfa:
- cel. mucosale
- cel. parietale
Clinica :
preponderent B peste 50 ani
disconfort epigastric
G, diaree, edeme
20%-100% hipoalbuminemie prin
pierdere la nivelul jonciunilor i.
Cel.
Tratament
anticolinergice
IPP/BRH2
eradicare H.p.
CST/octreotid
Ac monoclonali anti receptor TNF
rezecie gastric :
hipoalbuminemie
-HDS
-risc malign
Evoluie : - risc AK gastric (15%)
autolimitat la cei sub 10 ani
forma postpartum complet rezolutiv
(CMV+ i activare TGF alfa)
GASTRITA ACUT
Left: 74 year-old man with recent hematemesis (vomiting blood), who had been taking NSAIDS and drinking
alcohol. Endoscopy demonstrated antral gastritis with multiple small, superficial ulcers.
Center: 75 year-old woman with upper abdominal pain and blood in the stool, who had been taking NSAIDS for
arthritis. Endoscopy revealed patchy gastritis in the gastric fundus and in the antrum (shown here). Biopsies were negative
for Helicobacter pylori.
Right: 35 year-old man with chronic dyspepsia and pyrosis poorly responsive to proton-pump inhibitor and
metoclopramide therapy. After endoscopy demonstrated erosive antral gastritis, he admitted to regularly taking 15-20
ibuprofen daily, as well as occasionally taking as many as 20
tablets daily
aspirin
LEFT: 72 year-old woman with hematemesis (vomiting blood). In addition to this inflammatory
process involving the gastric body and antrum, she also had a small gastric ulcer. Biopsies and
Clotest were both positive for Helicobacter pylori.
RIGHT: 55 year-old man with dyspepsia. Endoscopy revealed multiple erosions and small ulcers;
biopsies were positive for H. pylori.
GASTRITA CU Candida.