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GASTRITE

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 :

pot fi afectate straturile profunde gastrice,

evoluie spre vindecare (cronicizare rar)

2. Gastritele CRONICE:

proces extins la suprafa i n profunzime

evoluie spre vindecare( rar)/g.


atrofic/atrofie G

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

c) G. papulo-eroziv: leziuni protruzive 3-5mm


cu

excavaie central-

varioliform

leziuni cronice

d) G.atrofic : mucoas plat/abs. pliurilor/palid


vascularizaie superficial vizibil
e) G. hipertrofic : pliuri nalte 1cm
grosime 3-5 mm
f)

G. hemoragic: puncte/pete hemoragice


hemoragie difuz/cheaguri

2. Topografia leziunilor endoscopice :


a) G. antral (tip B) : antru/potenial extindere
corp

H.p. +

b) G. fundic (tip A) : corp + fundus gastric


autoimun se asociaz cu an. Biermer
c) G. multifocal : atrofie la limita antru-corp cu
extindere proximal/distal
hipoclorhidrie/UG/NeoG
d) Pangastrita : afecteaz ntreg corpul gastric
leziuni mai severe n antru

C. Criterii histologice : (fundamental)


a. G. acut : domin PMN abcese criptice
b. G. cronic : l, Pl evoluie zeci de ani
spre
g. atrofic iniial superficial

(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

EDS : mucoas palid, vase proeminente, plat


Patogeneza:
H.p.+ (85%)
factori genetici (scandinavia, Am cent/sud)
mediu, dieta
Histo
-Metaplazia intestinal :semnificaie

-marker de atrofie ( HCl, gastrin)


risc displazie/Neo G intestinal

GASTRITA CRONIC
ATROFIC CORPOREAL
DIFUZ(TIP A)

EDS :

pierderea pliurilor gastrice


muc. fundic subiat
atrofie glandular + metaplazie
intestinal (corp + fund gastric)
Patogeneza :
distrucie autoimun gl. fundice
frecven (sub 5% din g. Cr. )

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

b. Gastrita supurativ (flegmonoas)


infecie bacterian submuc. + musc
risc gastrit ac. necrotizant
(gangren)

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

Dg + Rx = bule de gaz perete gastric

d. Gastrita cu micobacterii TBC gastric,


actinomices, treponema pallidum
- HDS

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

asociere frecvent cu H.p. / boala celiac

EDS :

pliuri mucoase ngroate/nodoziti

eroziuni aftoide (aspect varioliform)

Histo :

infiltrat cu Pl, l, rare PMN n antru/corp

GASTRITA EOZINOFILIC
(gastroenterita eozinofilic)
eozinofilie
infiltrat II cu Eoz n peretele Tr.
Dig.

afectare mucoas intestinal


dureri abdominale
greuri, vrsturi
diaree
G
pierdere de proteine enteral
afectare muscular int: - ocluzii/ascit cu
Eoz
afectare gastric : - stenoz gastric
Dg + : - biopsii = infiltrat cu Eoz/necoze
Tratament : - CST, cromoglicat de Na

GASTROPATII REACTIVE(C)
Definiie = G. Acute

afectarea muc. gastrice de factori multipli

nu apare II semnificativ

1. AINS cea mai frecvent gastropatie


leziuni localizate difuz/fornix+corp
eroziuni + hemoragii mici submucoase

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

7. Refluxul biliar-GASTRITA DE REFLUX


gastroduodeno-/jejuno-anastomoz
colecistectomizai
EDS :
edem/hiperemie,eroziuni
bil n stomac
Histo :
hiperplazie foveolar
glande chistice/dilatate/atipice
cel. inflamatorii rare
gastrit atrofic n final

Gastrita
de
reflux

8. Gastropatia cronic ischemic:

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

GASTROPATIA PORTAL HIPERTENSIVA


form grav
Spoturi hemoragice difuze

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.

Rx : -pliuri hipertrofice fornix/corp


S.A.G:
hiposecreie/hipoclorhidrie
minim gastrinemiei
DGS+: EDS + biopsie mucoas
D.Dif. :
limfom gastric (ulcere multiple)
MALT cel. B/H.p.
S. Zollinger-Ellison

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

Gastrit fundic i gastrit eroziv la o pacient cu grea,


vrsturi i sngerare gastrointestinal ocult

GASTRIT CRONIC DIFUZ la o pacient de 86 de ani cu sngerare gastrointestinal i durere abdominal

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.

LEZIUNI MACULARE ANTRALE LA O PACIENTA


MALNUTRITA DE 90 DE ANI

GASTRITA CU Candida.

LEZIUNI ERITEMATOASE FUNDICE LA PACIENT


INFECTAT CU HIV-BIOPTIC INCLUZIUNI DE
CITOMEGALVIRUS