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 3- Chronic Gastritis and its types 4- Chronic peptic ulcers and associated types 5- Gastric Carcinoma

ANATOMY OF STOMACH

CONGENITAL DISORDERS OF STOMACH

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

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

ACUTE INFLAMMATION & STRESS ULCERS

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

Acute hemorrhagic gastritis

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

2. Gastric stress ulcer: Etiology: Etiology: 1. NSAID use 2. Severe stress 3. Sepsis 4. Shock and severe burns 5. Spirits 6. Smoking Grossly: there is multiple, small round superficial ulcers of the stomach and duodenum Grossly: there is multiple, small round superficial ulcers of the stomach and duodenum Complications: bleeding, haematamesis & melena Complications: bleeding, haematamesis & melena

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

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

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

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

CHRONIC PEPTIC ULCER (BENIGN ULCER)

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 Ulcers of the distal part of stomach and proximal part of duodenum caused by gastric secretions (hydrochloric acid and pepsin) and impaired mucosal defenses

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

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

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

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

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

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

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

GASTRIC CARCINOMA (MALIGNANT ULCER)

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

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

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

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

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 ………..

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

GOOD LUCK DR.NOHA RAGAB