Licensed books on medicine
<< Previous || Next >> |
Among gastric diseases, chronic gastritis, peptic ulcer and cancer are of the greatest importance.
Gastritis is an inflammation of the gastric mucosa.
With the passage of gastritis can be acute and chronic.
• It develops due to irritation of the mucous membrane by alimentary, toxic, microbial factors.
• Depending on the characteristics of morphological changes, the following forms of acute gastritis are distinguished:
a. Catarrhal (simple).
in. Purulent (phlegmonous).
• The most common form is catarrhal gastritis (see “General course”, topic 6 “Inflammation”).
• In the morphogenesis of chronic gastritis, an important role is played by a violation of regeneration and structural rearrangement of the mucous membrane.
Classification of chronic gastritis.
1- According to the etiology and characteristics of pathogenesis, gastritis A, B and C are distinguished. Gastritis B predominates, gastritis A and C are rare.
1) Gastritis A - autoimmune gastritis.
• Autoimmune disease associated with the appearance of autoantibodies to the lipoprotein of parietal cells and an internal factor blocking its binding to vitamin B12.
• Often combined with other autoimmune diseases (thyroiditis, Addison's disease).
• Manifested mainly in children and the elderly.
• It is localized in the fundal department.
• Characterized by a sharp decrease in the secretion of HCl (achlorhydria), G-cell hyperplasia and gastrinemia.
• Accompanied by the development of pernicious anemia.
2) Gastritis B - non-immune gastritis.
• The most common form of gastritis.
• The etiology is associated with Helicobacter pylori, which is found in 100% of patients.
• Various endogenous and exogenous factors also play a role in development (intoxication, disturbance of the rhythm of nutrition, alcohol abuse).
• It is localized in the antrum, can spread to the entire stomach.
3) Gastritis C - reflux gastritis.
• It is associated with the discharge of the contents of the duodenum into the stomach.
• Often occurs in people who have undergone a resection of the stomach.
• It is localized in the antrum.
• HCl secretion is not impaired and the amount of gastrin is not changed.
2. According to the topography of the process, antral, fundal gastritis and pangastritis are distinguished.
3. Depending on the morphological picture, superficial (atrophic) and atrophic gastritis is distinguished.
• Each of these forms is characterized by lymphoplasmacytic infiltration of the mucous membrane.
• Depending on the intensity of cellular infiltrate, mild, moderate and severe gastritis is distinguished.
• Gastritis can be active and inactive. The active phase is characterized by plethora, stromal edema, the appearance in the infiltrate of PN and leukopadesis (penetration of PN into the epithelial cells).
a. Superficial gastritis.
• Lymphoplasmacytic infiltrate is located in the superficial parts of the gastric mucosa at the level of the ridges.
• The forecast is usually favorable. In some cases, it can turn into atrophic gastritis.
b. Atrophic gastritis.
• The mucous membrane is thinned, the number of glands is reduced.
• In their own plate diffuse lymphoid-plasmacytic infiltrate, severe sclerosis.
• Structural restructuring with the appearance of foci of intestinal and pyloric metaplasia is characteristic. In the first case, instead of gastric ridges, intestinal villi appear lined with intestinal epithelium with numerous goblet cells. In the second case, the glands resemble mucous, or pyloric.
• Often there are tricks of dysplasia. Against the background of severe dysplasia of the epithelium, gastric cancer can develop.
Peptic ulcer is a chronic disease whose morphological substrate is a chronic recurrent ulcer of the stomach or duodenum.
• Peptic ulcer must be differentiated from symptomatic ulcers arising from other diseases and conditions (steroid, aspirin, toxic, hypoxic ulcers, etc.).
• Chronic ulcers with peptic ulcer can be localized in the body of the stomach, pyloric antrum and duodenum.
The pathogenesis of body ulcers of the stomach and pyloroduodenal ulcers is different.
1. Pathogenesis of pyloroduodenal ulcers:
° vagus nerve hypertonicity with increased activity of acid-peptic factor,
° violation of motility of the stomach and duodenum,
° increase in the level of ACTH and glucocorticoids,
° a significant predominance of the acid-peptic factor of aggression over the protective factors of the mucous membrane.
2. The pathogenesis of stomach ulcers:
° suppression of the functions of the hypothalamic-pituitary system, decreased tone of the vagus nerve and activity of gastric secretion,
° weakening of the protective factors of the mucous membrane.
Morphogenesis of chronic ulcers. During the formation, a chronic ulcer goes through the stages of erosion and acute ulcers.
a. Erosion is a surface defect resulting from necrosis of the mucous membrane.
b. Acute ulcer is a deeper defect that captures not only the mucous membrane, but also other membranes of the wall of the stomach.
It has an irregular rounded oval shape and soft edges.
The bottom of acute erosion and ulcers is painted black due to the accumulation of hydrochloric acid theme.
Morphology of chronic ulcers.
• In the stomach it is often localized on the lesser curvature, in the duodenum - in the bulb on the back wall.
• It has the appearance of a deep defect of oval or round shape, capturing the mucous membrane and muscle.
• The edges of the ulcer are dense, calloused. The proximal edge is undermined and the mucous membrane hangs over it, the distal one is gentle, has the form of a terrace, the steps of which are formed by the mucous membrane, submucosal and muscle layers.
The microscopic picture depends on the stage of peptic ulcer.
a. In the stage of remission, scar tissue is visible at the bottom of the ulcer, displacing the muscle layer, with single sclerosed and obliterated vessels. Often noted ulceration of the ulcer.
b. In the acute stage at the bottom of the ulcer, 4 layers are clearly distinguishable: fibrinous-purulent exudate, fibrinoid necrosis, granulation and fibrous tissue, in which sclerosed vessels are visible. In the walls of some vessels, fibrinoid necrosis is noted.
The presence of a zone of necrosis, delimited by the inflammatory shaft, as well as fibrinoid changes in the walls of blood vessels indicate an exacerbation of the ulcerative process.
Complications of peptic ulcer.
° perforation (perforation) of an ulcer,
° penetration (into the pancreas, colon wall, liver, etc.),
° gastritis, perigastritis,
° duodenitis, periduodenitis.
° stenosis of the inlet and outlet of the stomach,
° stenosis and deformation of the duodenal bulb.
4. Minimization of gastric ulcer (not more than 1%).
5. Combined complications.
• For many years it was the most common malignant tumor, however, over the past two decades, there has been a tendency in the world to a distinct reduction in morbidity and mortality from it.
• Prevails over the age of 50, is more common in men.
• In the occurrence, endogenously formed nitrosoamines and nitrogens exogenously coming from food play a role (used in the manufacture of canned food); The possible role of Helicobacter pylori is discussed.
Diseases with an increased risk of stomach cancer include: stomach adenoma (adenomatous polyp), chronic atrophic gastritis, pernicious anemia, chronic ulcer, gastric stump.
At present, only severe epithelial dysplasia is considered to be a precancerous process in the stomach. Classification of gastric cancer.
1. Depending on the localization, cancer is isolated:
a. Pyloric department.
b. Lesser curvature with the transition to the posterior and anterior walls of the stomach.
in. Cardiac department.
d. Great curvature.
e. The bottom of the stomach.
• In the pyloric department and lesser curvature, 3/4 of all carcinomas of the stomach are localized.
• Cancer of the stomach can be subtotal and total.
2. Clinic-anatomical (macroscopic) forms of stomach cancer.
a. Cancer with predominantly exophytic expansive growth:
° mushroom (fungic)
° ulcerated cancer:
a) primary ulcerative,
b) saucer-like (ulcer cancer),
c) cancer from a chronic ulcer (ulcer-cancer).
b. Cancer with predominantly endophytic infiltrating growth:
in. Cancer with endoexophytic (mixed) growth:
° transitional forms.
• From a clinical point of view, it is important to identify early gastric cancer, which grows no deeper than the submucosal layer, ie superficial cancer, in which 5-year postoperative survival is almost 100%.
3. Histological types of stomach cancer (WHO classification).
° in structure: tubular, papillary, mucinous (mucous cancer),
° according to the degree of differentiation: highly differentiated, moderately differentiated and low-differentiated.
b. Undifferentiated cancer.
in. Squamous cell carcinoma.
glandular squamous cell carcinoma.
e. Unclassified cancer.
• Adenocarcinoma as a more differentiated form of cancer is more common with predominantly esophytic tumor growth.
• Undifferentiated forms of cancer (often with a scirrhous growth type) prevail with predominantly endophytic growth, in particular with diffuse cancer.
Metastasis of stomach cancer.
• It is carried out by a lymphogenous, hematogenous and implantation way.
• The first metastases occur in regional lymph nodes along the lesser and greater curvature of the stomach.
• Among distant lymphogenous metastases from a diagnostic point of view, retrograde metastases are important:
a. In both ovaries - Krukenberg metastases.
b. In pararectal fiber - Schnitzler metastases.
in. In the left supraclavicular lymph node - virchovsky gland.
• And implantation metastases lead to carcinomatosis of the peritoneum, pleura, pericardium, diaphragm.
• Hematogenous metastases often occur in the liver, lungs, etc.
| << Previous || Next >> |
| = Skip to textbook content = |
- Stomach disease. Gastritis. Peptic ulcer. Tumors of the stomach.
1. In acute gastritis, gastric mucosa develops 1. enterolization 2. coagulation necrosis 3. productive inflammation 4. exudative inflammation 5. proliferation of integumentary epithelium 2. Intestinal metaplasia of the epithelium can develop in chronic gastritis 1. superficial 3. atrophic 2. productive 4 Catarrhal 3. Macroscopic characteristics of acute gastric ulcer 1. edge
- DISEASES OF THE DIGESTIVE SYSTEM. STOMACH DISEASES
Diseases of the digestive system in the structure of morbidity and mortality are in third place after diseases of the organs of the cardiovascular system and tumors. In the domestic literature, the classification of these diseases is built according to the classical ideas about the division of the digestive system into the anterior, posterior and middle sections. The anterior digestive system includes
- Diseases of the stomach and intestines
1. Definition of gastritis: a) degenerative disease of the mucous membrane of the stomach b) inflammatory disease of the mucous membrane c) dysregenerative disease of the gastric mucosa d) infectious disease with damage to the gastric mucosa e) precancerous disease of the stomach Correct answer: b 2. The essence of morphological changes in acute gastritis : a) exudative inflammation
- DISEASES OF THE STOMACH AND GUT
Diseases of the gastrointestinal tract are very diverse, numerous and include diseases of the pharynx, salivary glands, esophagus, stomach, intestines, pancreas, liver and gall bladder. However, peptic ulcer, stomach cancer, appendicitis and liver diseases are of the greatest importance in human pathology. ULCER DISEASE is a common chronic, cyclically occurring disease with frequent
- Stomach ulcer
Peptic ulcer is a chronic recurrent disease characterized by the development of peptic ulcer of the mucous membrane of the stomach or duodenum. The prevalence of peptic ulcer in the structure of gastroenterological pathology is from 3.6 to 14.8%. Boys and girls get sick equally often, only after 14 years the number of patients among young men is greater.
- Stomach diseases
The main clinical symptoms: belching, vomiting of the stomach contents, anarexia or, conversely, severe hunger, eating grass, licking carpets and other things, gas accumulation. Hypertrophic pyloric stenosis. Pylorospasm. A disease caused by a congenital anomaly in the development of the pyloric sphincter of the stomach in the form of hypertrophy, hyperplasia and disorders of the innervation of the pyloric muscles. Manifested
- 65. DISEASES OF A ULCERAL STOMACH
Classification • Type I. Most type I ulcers occur in the body of the stomach, namely in the area called the place of least resistance, ie. transitional zone located between the body of the stomach and the antrum. • Type II. Gastric ulcers that occur along with a duodenal ulcer. • Type III. Ulcers of the pyloric canal. In their course and clinical manifestations, they are more like ulcers
- GASTRIC AND TWELVE ULCER DISEASES
Since about 200 years ago, Crewellier attracted the attention of doctors to stomach ulcers, interest in this disease has been progressively increasing. Approximately the same applies to duodenal ulcer described in detail much later (Moynihan, 1913). Peptic ulcer is now understood as a common, chronic, recurring, cyclically occurring disease in which
- Diseases of the pharynx, esophagus and stomach
Among the diseases of the pharynx and pharynx, angina, the infectious disease with the pronounced inflammatory changes in the lymphadenoid tissue of the pharynx and palatine tonsils, has the greatest clinical significance. The following forms of acute angina are distinguished: catarrhal, lacunar, follicular, fibrinous, purulent, necrotic and gangrenous. In chronic tonsillitis, hyperplasia and lymphoid sclerosis occur.
- Peptic ulcer of the stomach and duodenum
Questions for repetition: 1. Methods of examination of children with diseases of the stomach and 12 duodenal ulcer. 2. Fractional study of gastric secretion in children. Test questions: 1. Modern views on the etiopathogenesis of peptic ulcer. 2. Classification of peptic ulcer. 3. Clinical manifestations of duodenal ulcer: 3.1. pain syndrome 3.2. dyspeptic syndrome 3.3.
- Gastric and intestinal diseases with colic in horses
Disease of the stomach and intestines, accompanied and manifested by colic, includes a large group of nosological diagnoses. These diseases are diverse in etiology and localization of the pathological process and are characterized by pain sensations manifested by animal anxiety (Colica). Violation of the patency of the contents of the stomach and intestines is determined by the concept of Ileus Acute expansion
- DISEASES OF THE OPERATED STOMACH
include post-gastroresection disorders in the postoperative period. Classification of post gastroresection disorders I. Functional disorders: a) dumping syndrome (I, II, III, IV degrees); b) afferent loop syndrome; c) hypoglycemic syndrome; d) enterogenic syndrome; e) postgastroresection asthenia; e) chronic post-resection pancreatitis. II.
- Question 21: ULCER OF THE STOMACH AND TWELVE
—Chronic recurrent disease in which, as a result of disturbances in the nervous and humoral mechanisms that regulate secretory-trophic processes in the gastroduodenal zone, an ulcer forms in the stomach or duodenum (less often two or more ulcers). Etiology, pathogenesis. Peptic ulcer is associated with a violation of the nervous, and then the humoral mechanisms that regulate the secretory,
- Peptic ulcer of the stomach and duodenum (ciphers K 25; K 26)
Definition Peptic ulcer of the stomach and (or) duodenal ulcer (essential mediogastric and duodenal ulcer) - a heterogeneous disease with a lot? actor etiology, complex pathogenesis, chronic relapsing course, morphological equivalent in the form of a mucosal and submucosal defect with an outcome in the connective tissue scar. Statistics. In different age periods
- Diseases of the stomach and intestines
Gastritis (gastritis) - inflammation of the mucous membrane and wall of the stomach with a violation of its functions. Gastritis by origin are primary and secondary; by the nature of the inflammation - alterative (erosive-ulcerative and necrotic), exudative (serous, catarrhal, purulent, hemorrhagic and fibrinous) and less productive; localization and distribution - focal and diffuse,
- STOMACH DISEASES
- Nutrition for peptic ulcer of the stomach and duodenum
In order to create maximum peace of the stomach and duodenum, you need to eat 5-6 times a day. Take food in small portions, slowly, without rushing. At night, it is best to slowly drink a glass of warm milk. In order to eliminate pain and neutralize the gastric juice, which irritates the gastric mucosa, you must also drink a glass of warm milk and eat