GASTRITIS

ULCER DISEASE

ss. Prof.

Datsko T.V.

rosive gastritis
The typical case of
erosive gastritis is
characterized grossly
by widespread
petechial hemorrhages
in any portion of the
stomach or regions of
confluent mucosal or
submucosal bleeding.

 Erosions vary in size from 1 to 25 mm across and

appear occasionally as sharply punched-out
ulcers. Microscopically, patchy mucosal necrosis
extending to the submucosa is visualized adjacent
to normal mucosa. The necrotic epithelium is
eventually sloughed, and deeper erosions and
hemorrhage may be present. In extreme cases
penetrating ulcers are associated with necrosis
extending through to the serosa. Depending on
the age of the process, there may by mild
inflammation, initially neutrophilic and then
mononuclear. Healing is usually complete within a
few days.

Nonerosive gastritis
(chronic gastritis)
Nonerosive gastritis refers to chronic
inflammatory diseases of the stomach that
range from mild superficial involvement of
the gastric mucosa to severe atrophy.

Autoimmune gastritis (type A)

Autoimmune gastritis refers to a chronic, diffuse
inflammatory disease of the stomach is restricted to
the body and fundus and is associated with
autoimmune phenomena. This disorder typically
exhibits the following:
Diffuse gastritis in the body and fundus of the
stomach
Lack of or minimal involvement of the antrum
Antibodies to parietal cells
Significant reduction in or absence of gastric
secretion

Infectious gastritis

Is a chronic inflammatory disease of

the antrum and body of the
stomach causes by Helicobacter
pylori.
The curved rods of H.pylori are found
in the surface mucus of the
epithelial cells and in the gastric
foveolae. Active gastritis features
polymorphonuclear leucocytes in
the neck glands and inlamina
propria. It has been claimed that
chronic infectious gastritis caused
by H. pylori can lead to gastric
atrophy and intestinal metaplasia.
In addition, infection with H.pylori
has been linked to the development
of gastric adenocarcinoma.

Reflux gastritis
Refers to chronic gastric injury that results from
the reflux of alkaline duodenal contens and bile
into the stomach, usually following partial
gastrectomy. Whereas conspicuous reflux gastritis
is most common after surgery, a milder form is
often identified in intact stomachs from patient with
gastric ulcer, postcholecystectomy syndrome, and
various motor disturbances of the distal stomach.
The term gastritis , as applied to chronic
gastroduodenal reflux , is something of a
misnomer, since it is not primarily an inflammatory
disorders. The gistologic appearance is
dominated by foveolar hyperplasia, edema,
vasodilatation and congestion, and a paucity of
inflammatory cells.

trophic gastritis
This condition may evolve from superficial gastritis, but
there is no sharp distinction between them. Like superficial
gastritis, active atrophic gastritis is characterized by
prominent chronic inflammation in the lamina propria.
However, lymphocytes and plasma cells extend onto the
deepest reaches of the mucosa as far as the muscularis
mucosae. Occasionally, lymphoid cells are arranged as
follicles, an appearance that has led to an erroneous
diagnosis of lymphoma or pseudolymphoma. Involvement
of the gastric glands leads to degenerative changes in their
epithelial cells and ultimately a conspicuous reduction in
the number of glands, hence the name atrophic gastritis.
Eventually the inflammatory process may ablate, leaving
only a thin atrophic mucosa, in which case the term gastric
atrophy is applied.

Menetrier disease (hyperplastic

gastropathy)
Is an uncommon disease of
the stomach characterized by
enlaged rugae. It is often
accompanied by a severe
loss of plasma proteins
(including albumin) from the
altered gastric mucosa.The
cause of this disorder is
unknown.
The folds of the stomach are
increased in height and
thickness, forming a
convoluted surface similar to
that of the brain

Peptic ulcer disease

Refers to breaks in the mucosa of the
stomach and small intestine, principally the
proximal duodenum, that are produced by
the action of gastric secretions.

Pathogenesis

Environmental factor
Genetic factor
Psychological factor
Hydrochloric acid
Physiologic factors in duodenal ulcers
Physiologic factors in gasric ulcers
The role of H. pylori
Associated diseases

 Gastric ulcer. The

stomach has been opened
to reveal a sharply
demarcated, deep peptic
ulcer on the lesser
curvature

Duodenal ulcer
A sharply punched-out
peptic ulcer of the
duodenum situated
immediately below the
pylorus.

Complications

Hemorrhage
Perforation
Pyloric obstruction
Development of combined ulcers
Malignant transformation of a benign gastric
ulcer

Low socioeconomic settings:

These situations pose an increased risk of
gastric cancer, an observation that has been
used to explain the high freguency of the
tumor among American blacks and the fact
that the incidence of the disease in that
population has not declined as rapidly as it
has among whites.
Atrophic gastritis, pernicious anemia, subtotal
gastrectomy, and gastric adenomatous polyps
have been discussed earlier as factors
associated with a high resk of stomach cancer

The major types of gastric cancer

 Infiltrating gastric
carcinoma. The wall of
the stomach is
thickened and
indurated by diffusely
infiltrating cancer

Acute appendicitis

 Mucocele of the
appendix. The
appendix is
conspicuously dilated
by mucinous material
secreted by a
mucinous
cystadenoma