Gastritis and Peptic Ulcers Flashcards
what is gastritis?
inflammation of the gastric mucosa
what is chronic gastritis?
the presence of chronic inflammatory changes leading eventually to mucosal atrophy and epithelial metaplasia
3 types of chronic gastritis
- helicobacter associated
- autoimmune
- chemical
causes of chronic gastritis
- chronic infection
- immunologic
- toxic: alcohol and tobacco use
- postsurgical: postantrectomy with bile reflux
- motor/mechanical: obstruction/atony
- others: radiation, Crohn’s disease, GVHD, uraemia, amyloidosis
which are the modifying features of chronic gastritis?
- activity (intraepithelial neutrophils)
- regenerative change
- variable glandular atrophy
- intestinal metaplasia +/- dysplasia
- presence of H.pylori
what happens in helicobacter-associated gastritis?
- colonisation of h.pylori
- epithelial damage and a mixed acute and chronic inflammatory infiltrate
- pyloric antrum most severely affected but also fundus and usually patchy
what is autoimmune chronic gastritis associated with, as in conditions?
pernicious anaemia
which antibodies are associated with autoimmune chronic gastritis?
- gastric parietal cells
- intrinsic factor
what type of damage happens in autoimmune chronic gastritis?
- reduced gastric acid production
- failure to absorb vitamin B12
what can trigger reactive gastropathy?
- bile reflux
- previous surgery to the pylorus
- NSAIDs/alcohol abuse
which part of the stomach is damaged in reactive gastropathy?
toxic damage to mucus layer
what can accompany acute gastritis?
- mucosal haemorrhage
- erosion
what is associated with acute gastritis?
- heavy use of NSAIDs, mainly aspirin
- excessive alcohol consumption
- heavy smoking
- chemotherapy
- uraemia
- systemic infections
- severe physical stress
what are ulcers?
a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosa into the submucosa or deeper
sites of peptic ulcer
- duodenum 1
- gastric antrum
- barrett’s mucosa
- margins of gastroenterostomy
- Zollinger-Elison syndrome: duodenum, stomach, jejunum
- within or next to a Meckel’s diverticulum
clinical presentation of peptic ulcer
- epigastric burning or aching pain
- pain worse at night and 1-3hrs after a meal
- nausea, vomitng, bloating, belching, weight loss
complications of peptic ulcer
- anaemia
- haemorrhage
- perforation
- obstruction
- malignant formation
what imbalance is there to cause peptic ulcers?
gastro-duodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunological agents
what are the associated disease of peptic ulcers?
- cirrhosis
- chronic renal failure
- zollinger elison syndrome
- hyperparathyroidism
- chronic lung disease
- chronic pancreatitis
morphology of peptic ulcers
- single, sharply out defect
- overhanging mucosal borders
- smooth and clear ulcer base
four layers of peptic ulcers
- thin superficial layer of necrotic debris
- zone of inflammation
- layer of granulation tissue
- fibrous tissue or scarring
complications of peptic ulcers
- anaemia
- haemorrhage
- penetration (into adjacent organs)
- perforation (leads to peritonitis)
- pyloric obstruction (oedema and scarring in pyloric channel)
- malignant transformation
