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Faculty of Allied Medical Sciences

Faculty of Allied Medical Sciences. Histopathology and Cytology (MLHC-201). STOMACH PATHOLOGY Prof. Dr. Noha Ragab. Intended Learning Outcomes. By the end of this lecture the student should know : 1- The congenital disorders of the stomach 2- Acute stomach inflammation and stress ulcers

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Faculty of Allied Medical Sciences

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  1. Faculty of Allied Medical Sciences Histopathology and Cytology (MLHC-201)

  2. STOMACHPATHOLOGYProf. Dr. NohaRagab

  3. Intended Learning Outcomes By the end of this lecture the student should know : 1- The congenital disorders of the stomach 2- Acute stomach inflammation and stress ulcers 3- Chronic Gastritis and its types 4- Chronic peptic ulcers and associated types 5- Gastric Carcinoma

  4. ANATOMY OF STOMACH

  5. CONGENITAL DISORDERS OF STOMACH

  6. 1. Pyloric stenosis: • Congenital stenosis of pylorus due to marked muscular hypertrophy of the pyloric sphincter, resulting in gastric outlet obstruction

  7. 2. Congenital Diaphragmatic hernia: • Congenital defect in the diaphragm, resulting in herniation of the abdominal organs into the thoracic cavity • The stomach is the most commonly herniated organ

  8. ACUTE INFLAMMATION & STRESS ULCERS

  9. 1. Acute hemorrhagic gastritis: Definition: • Acute inflammation, erosion, and hemorrhage of the gastric mucosa due to breakdown of the mucosal barrier and acid-induced injury • Etiology: • Chronic aspirin or NSAID use • Alcohol use • Smoking

  10. Acute hemorrhagic gastritis

  11. Clinical picture: • Epigastric abdominal pain • Gastric hemorrhage, hematemesis and melena

  12. 2. Gastric stress ulcer: • Etiology: • NSAID use • Severe stress • Sepsis • Shock and severe burns • Spirits • Smoking • Grossly: there is multiple, small round superficial ulcers of the stomach and duodenum • Complications: bleeding, haematamesis & melena

  13. CHRONIC GASTRITIS • Definition: Chronic inflammation of the gastric mucosa eventually leading to atrophy (chronic atrophic gastritis)

  14. A- Fundic type (Type A): • This is an autoimmune disease • There is decreased acidic secretion. • It usually involves the body and the fundus of stomach

  15. Gross picture: Loss of rugal folds in the body and fundus Microscopic picture: • Mucosal atrophy • Chronic lympho-plasmacytic inflammation • Intestinal metaplasia

  16. B- Antral type (type B): • This type is commonly related to Helicobacter pylori Microscopic picture: • H- pylori organisms are visible in the mucous layer of the surface epithelium • Foci of acute inflammation • Chronic inflammation with lymphoid follicles • Intestinal metaplasia Complication: • Increased risk of gastric carcinoma

  17. CHRONIC PEPTIC ULCER (BENIGN ULCER)

  18. Peptic ulcer Definition: • Ulcers of the distal part of stomach and proximal part of duodenum caused by gastric secretions (hydrochloric acid and pepsin) and impaired mucosal defenses

  19. Etiology: • Chronic NSAID and aspirin use • Steroids • Smoking • H.pylori

  20. Complications: • Haemorrhage ( Haematemesis & melena) • Iron deficiency anaemia • Gastric perforation • Pyloric obstruction

  21. Duodenal peptic ulcer: • It is more common than gastric ulcers • Eitiology: • H.pylori • Increased gastric acid secretion • Increased rate of gastric emptying • Blood group O • Cirrhosis & COPD

  22. Grossly (Location of Duodenal Ulcer: It is located at the anterior wall of the proximal duodenum Clinical presentation: Burning epigastric pain 1-3 hours after eating and usually relieved by food

  23. Duodenal ulcer.There are two sharply demarcated duodenal ulcers surrounded by inflamed duodenal mucosa. The gastroduodenal junction is in the midportion of the photograph

  24. Gastric peptic ulcer: • Associated with H.pylori (75%) • Location: lesser curvature of the antrum • Clinical presentation: Burning epigastric pain, which worsens with eating? • Grossly: • Small (<3cm), solitary ulcer • Round or oval shape • Sharply demarcated " punched out" ulcers • Overhanging margins • Radiating mucosal folds

  25. Gastric ulcer.There is a characteristic sharp demarcation from the surrounding mucosa, with radiating gastric folds.

  26. GASTRIC CARCINOMA(MALIGNANT ULCER)

  27. Gastric carcinoma: • Risk factors: • H.pylori • Chronic atrophic gastritis • Smoking • Blood group A

  28. Clinical presentation: • 90% asymptomatic • Weight loss and anorexia • Epigastric abdominal pain mimicking a peptic ulcer • Occult bleeding and iron deficiency anaemia • Location of Gastric Carcinoma: lesser curvature of the antrum

  29. Pathology • Grossly: • Large >3cm, irregular ulcer • Heaped up margins and necrotic ulcer base • May occur as a flat or polypoid mass

  30. Metastasis: • Virchow node: left supraclavicular lymph node • Spread to the ovaries: Krunkenberg tumor

  31. Questions 1- Pyloric stenosis is characterized by the obstruction of …….. 2- The clinical picture of acute hemorrhagic gastritis is characterized by …….. 3- ……… and ……. are the types of chronic gastritis 4- The etiology of duodenal peptic ulcer involves …………… 5- Risk factors of gastric carcinoma are ………..

  32. AssignmentsBenign Tumors of the Upper Respiratory Tract • نيهال كمال الدين • هايدى أحمد عبدة • هدى عبد الله معتمد • هدير علاء الدين عبد الحكيم • وليد على محمد • يمنى عبد الله محمد • أحمد محمود عبد الغنى منصور

  33. GOOD LUCK DR.NOHA RAGAB

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