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Questions and Answers
Which structures settle in the middle of the tracts in the interlobular ductus system?
Which structures settle in the middle of the tracts in the interlobular ductus system?
Which cells are found in the lumen of hepatic sinusoids?
Which cells are found in the lumen of hepatic sinusoids?
Which markers are commonly used to examine the portal ductal system?
Which markers are commonly used to examine the portal ductal system?
What is the function of Herig ducts and ductules in the liver?
What is the function of Herig ducts and ductules in the liver?
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Which area serves as a connection for the transport of bile between the portal tract and hepatocytes?
Which area serves as a connection for the transport of bile between the portal tract and hepatocytes?
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What is the role of Disse space in liver anatomy?
What is the role of Disse space in liver anatomy?
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Which structures become apparent in pathological conditions concerning the intrahepatic bile ductus system?
Which structures become apparent in pathological conditions concerning the intrahepatic bile ductus system?
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Which cells are generally NOT seen in normal liver, but can be observed in Herig ducts and ductules under certain conditions?
Which cells are generally NOT seen in normal liver, but can be observed in Herig ducts and ductules under certain conditions?
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What stains positively with CD31 and CD34 in the hepatic sinusoids?
What stains positively with CD31 and CD34 in the hepatic sinusoids?
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What type of epithelium typically lines interlobular ducts?
What type of epithelium typically lines interlobular ducts?
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Study Notes
Causes of Chronic Gastritis
- Main causes include chronic H. pylori infection, autoimmune atrophic gastritis, nonsteroidal anti-inflammatory drugs (NSAIDs), and toxic agents such as alcohol and cigarettes.
- Additional causes: bile reflux (post-antrectomy), mechanical obstruction, radiation, and granulomatous infections.
Pathology of Chronic Gastritis
- Dominated by mononuclear inflammation with active inflammation and regenerative changes in the lamina propria.
- Features include intestinal metaplasia, gastric atrophy, and dysplasia.
- Major complications are the development of malignancy and gastric ulcers.
H. pylori
- Most significant cause of chronic gastritis; pathogenic in various gastric and duodenal diseases.
- Found in 90% of peptic ulcer cases; prevalence increases with age (50% in the USA, 80% in Turkey).
- Transmitted via fecal-oral route; water hygiene is critical for prevention.
- Early-life contamination common in low-socioeconomic areas; recontamination and inadequate eradication are issues.
- Infection can lead to either antrum colonization (causing duodenal ulcers) or multifocal atrophic gastritis (increasing gastric cancer risk).
Pathogenic Mechanisms of H. pylori
- Flagella enable movement through mucus.
- Produces ammonia via urease, raising local pH and providing protection from gastric acid.
- Attaches to the epithelial surface through adhesins.
Hypertrophic Gastropathies
- Characterized by extensive cerebriform mucosal growths; includes conditions like Menetrier's disease, hypertrophic secretory gastropathy, and Zollinger-Ellison syndrome.
- May mimic infiltrative carcinoma or lymphoma on endoscopy.
- Increased peptic ulcer risk due to excessive acid secretion in Zollinger-Ellison syndrome and hypertrophic secretory gastropathy.
Neoplastic Diseases of the Stomach
- Gastric polyps are identified in 5% of upper gastrointestinal (GI) endoscopies; often associated with chronic gastritis.
- Main types: inflammatory/hyperplastic polyps, fundic gland polyps, and adenomatous polyps.
- Inflammatory and hyperplastic polyps represent 75% of polyps; larger sizes increase dysplasia risk and are more common in individuals aged 50-60.
Fundic Gland Polyp
- Associated with familial adenomatous polyposis (FAP) and increased use of proton pump inhibitors.
- Important to differentiate from nodal lymphoma and primary gastric lymphoma, with the latter showing no systemic involvement.
Gastric Lymphoma
- Majority are of B-cell origin, with T-cell lymphomas also observed; prognosis correlates with lymphoma grade.
- MALT lymphoma arises from associated mucosal lymphoid tissue and has a generally favorable prognosis.
- H. pylori infection contributes to malignancy via IL-2 secretion; eradicating H. pylori can lead to regression.
Gastric Neuroendocrine Tumors
- Occur across ages with possible carcinoid syndrome (flushing, sweating, bronchospasm, diarrhea, abdominal pain, right heart valve fibrosis).
- Constitute 11-14% of GI neuroendocrine tumors; classified into four types, with Type 1 linked to autoimmune atrophic gastritis.
Microscopy of Gastric Conditions
- Notable findings include neutrophil infiltration, crypt abscesses, and crypt disorders.
- May present with villous blunting, branching, atrophy, and signs of metaplasia; noncaseous granulomas may be present.
Clinical Features of Related Conditions
- Symptoms include diarrhea, abdominal pain, and fever, interspersed with asymptomatic periods.
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Ulcerative Colitis:
- An ulceroinflammatory disease affecting only mucosa and submucosa of the colon; lacks granulomas.
- Commonly arises between ages 20-25 and has higher prevalence in whites and males above age 45.
Macroscopy and Microscopy of Ulcerative Colitis
- Affects rectum extending to the proximal colon, with continuous lesions and erythematous, fragile mucosa prone to bleeding.
- Microscopy reveals neutrophilic infiltration, crypt abscesses, inflammation, and submucosal ulceration.
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Description
Test your knowledge on the causes and pathology of chronic gastritis, including H.pylori infection, autoimmune atrophic gastritis, and NSAIDs. Learn about the complications such as development of malignancy and ulcers. Explore the mononuclear inflammation, intestinal metaplasia, gastric atrophy, and dysplasia associated with chronic gastritis.
