4. Chronic gastritis Flashcards
what is the aetiology of chronic gastritis ?
environmental atrophic gastritis
helicobacter pylori - mainly antrum
alcohol
autoimmune atrophic gastritis
HLADR3 AND B8
associated with other autoimmune disease = type 1 diabetes mellitus
graves disease and hashimoto
what are the markers for autoimmune causes of chronic gastritis ?
antiparietal cell antibody
anti intrinsic factor antibodies
serum gastrin increase
pernicious anemia - microcytic megaloblastic anemia
hypochlorhydia or achlorhydria from parietal loss
pathogenesis
of the different chronic gastritis
based on pathogenesis
chronic gastritis-type a (autoimmune )
Autoimmune destruction of the parietal cells in the gastric corpus and fundus
spares the antrum
=> achlorhydria
=> increased gastrin - g cell in the antrum hyperplasia
hypergastrinemia → hyperplasia of enterochromaffin-like cells → ↑ risk of carcinoid tumors.
Achlorhydria impairs the intestinal absorption of inorganic iron → iron deficiency anemia (early manifestation)
Autoantibodies against intrinsic factor → vitamin B12 deficiency → pernicious anemia
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chronic gastritis - type b
begins in the antrum and progressive’s to fundus
Inflammation of the antrum → destruction of D cells → ↓ somatostatin → ↑ gastrin → ↑ production of gastric acids → duodenal ulcers
Inflammation of the gastric body → local destruction of mucosa →
↓ production of mucins and atrophy of the gastric glands → hypochlorhydria → hypergastrinemia → epithelial metaplasia → ↑ risk of gastric cancers
what are the stages of chronic gastritis
active stage - with PMN infiltration
dormant stage - without PMN
what is the complication of chronic gastritis ?
dysplasia
intestinal metaplasia
gastic cancer - esp atrophic gastritis
what are the signs and symptoms of chronic gastritis ?
most patient asymptomatic Hematemesis possibly melena Epigastric pain is possible. Nausea, vomiting dyspepsia
group A :
, pallor, fatigue (caused by iron deficiency anemia and/or pernicious anemia)
Features of vitamin B12 deficiency: triad of hematologic, neurologic, and gastrointestinal disorders
what is the diagnosis of chronic gastritis ?
endoscopy examination with mucosal biopsy
h pylori testing
what is the treatment for chronic gastritis ?
h - pylori eradication
antacids
histamine receptor blockers
proton pumps inhibitors
pro kinetic agents - promote gastric emptying
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autoimmune - vit b12 and folic acid supplement
steroids
chronic atrophic gastritis can be mild , moderate and severe according to what ?
estimated by the thickness of the gland to the whole mucosa
and the increased distance between the glands
which type of chronic gastritis is more likely to develop into cancer ?
type b
name a few of other types of gastritis ?
lymphocytic gastritis - associated with celiac disease
granulomatous gastritis
tb , sarcoidosis
eosinophilic gastritis
distal part of stomach and proximal duodenum
reactive gastropathy
foveolar hyperplasia , loss of mucin and glandular regenerative changes
common in aspirin , NSAIDS intake
when there is no signifiant inflammation it is called ?
Gastropathy
what is gastritis classified according to ?
SYDENY CLASSIFICATION
for sydney classification how many biopsies are taken ? and where are they taken from ?
5
2 from antrum
2 from corpus
1 from incisor angularis - by the lesser cuvuture end
how does sydney classification work ?
using the biopsies from the antrum and the corpus we see the
activity - the level of mononuclear or neutrophil infiltration (chronic inflammation)
glandular atrophy
intestinal metaplasia
helicobacter pylori density
