Beruflich Dokumente
Kultur Dokumente
• Prerequisite knowledge
– Anatomy
– Histology
• Congenital disorders
– Gastritis
– Ulcers
• Foveolar region - Surface Epithelium + Gastric pits lined by mucous secreting cells.
• Glandular area - Glands opening into the base of the gastric pits.
• Muscularis mucosa
• Sub mucosa
• Gastric Glands - Mucous secreting cells, Parietal cells (HCL), Chief cells (Pepsin).
• Parietal cells - Eosinophilic cytoplasm, in the upper portion of the tubular gland.
• Chief cells - Basophilic cytoplasm, Pyramid shaped cells. Base of the glands.
Anatomical variations
• CARDIA - 1 cm in length, Small irregular branched glands secreting mucin. Foveolar
region occupies 50% of the mucosa.
• BODY & FUNDUS - Occupies most of the stomach. Foveolar region only 25 % of the
mucosa. Long tubular glands (Parietal & Chief cells).
• ANTRUM - immediately proximal to the pylorus. Foveolar region occupies most of the
mucosa. Less prominent racemose glands (Parietal & Neuroendocrine cells)
Congenital abnormalities
• HETEROTOPIA - Pancreatic tissue as a sub mucosal nodule
• Clinical features –
– Regurgitation/ Vomiting
– Visible peristalsis,
• Pathology –
Gastritis
Acute gastritis
Chronic gastritis - Type A and B or
Type C / Reactive
Acute gastritis
• Nausea Vomiting Epigastric pain and haematemesis.
• Pathology -
• OTHERS –
– Hypertrophic gastritis –
• Menetrier’s, disease
• Hypersecretory gastropathy
Chronic Gastritis
• Chronic superficial - Inflammation. Limited to the foveolar region.
-Inflammation.
-Special type
-HP.
Chronic Gastritis
• Type A Immune/ Fundal • Type B Non immune / Antral
• Circulating AB’s • )
• Hypo/ Achlorhydria • )
• Hypergastrinaemia. • ) (-)VE.
• )
• )
Type B Gastritis
Hyper secretory type
• Maltomas / Lymphomas.
• Microscopy
- Organisms along the luminal surface and does not penetrate the mucosa.‘N’ limited
Glandular atrophy
Intestinal metaplasia
ULCERS
• EROSIONS - Lesion confined to the muscularis mucosa.
• ACUTE ULCER - Penetrate the muscularis mucosae but not the muscularis propria.
• Aetiology - Shock, Burns (Curlings’), Head injury ((Cushings) Asprin Caffein Drugs
Peptic Ulcer
• Definition - Ulceration of the mucosa exposed to the aggressive action of gastric juices.
• Distribution –
1. Duodenum ( 1st Part)
2. Stomach (Antrum)
3. Barrett’s oesophagus
4. Gastroenterostomy stoma.
5. Duodenum , Stomach & Jejunum (Zollinger - Ellison Syndrome
Meckel’s Diverticulum
6. (Ectopic gastric mucosa)
• )
• )
• )
• )
• )
• Complications - 1. Bleeding
2. Perforation - Peritonitis.
• Non epithelial
– Lymphomas
• Pathogenesis -1. Racial & Genetic factors. (Bld gp A, Blacks, American Indians Maoris.)
2. Environmental - increased Salt, Complex CHO, and Nitrites.
Low animal fat DGLV fruits. Helicobacter pylori
• Protruding
• Flat
• Ulcerative
• Ulcerated - infilterative
• Polypoidal
• Depressed
Histology
• Adenocarcinoma
– Well differentiated.
– Moderately “
– Poorly “