14. Disease of Stomach 10.06.21 (Student)_ZS.pdf

Disease of Stomach ZULFAHMI SAID, Ph.D Faculty of Dentistry USIM 10th JUNE 2021  Learning objectives Explain the causes, clinicopathologic features, effects and complications of gastritis. Explain the causes, clinicopathologic features, pathogenesis, ef...

Disease of Stomach ZULFAHMI SAID, Ph.D Faculty of Dentistry USIM 10th JUNE 2021  Learning objectives Explain the causes, clinicopathologic features, effects and complications of gastritis. Explain the causes, clinicopathologic features, pathogenesis, effects and complications of peptic ulcer disease. Explain the predisposing factors, clinicopathologic features, effects and complications of gastric carcinoma.  Disease of Stomach Gastritis Peptic ulcerative disease Gastric cancer  Stomach A distensible organ. Food undergoes mechanical (muscular churning action) & chemical (gastric juice secreted by glands) breakdown to form chyme. Absorption (minimum): water/alcohol/some drugs. Complete chyme formation- pyloric sphincter open and chyme enter the duodenum.  Anatomy of Stomach Anatomic region: – Cardia – Fundus – Body (corpus) – Pylorus (pyloric antrum) In relaxed state, mucosa thrown into longitudinal folds (rugae). Anatomy of Stomach Histology of Stomach Histology of Stomach Histology of Stomach  Histology of Stomach 3 distinct histologic zones: Cardia – Predominant mucus- secreting glands. – Surrounding entrance of oesophagus. Histology of Stomach  Histology of Stomach 3 distinct histologic zones: Fundus and body – Major histological region. – Acid-peptic gastric juice secreting glands. – Secrete protective mucus. Histology of Stomach  Histology of Stomach Pylorus – Deep gastric pits and gastric glands. – These glands secrete mucus as well as the enzyme lysozyme. – Associated endocrine cells secrete hormone gastrin. Histology of Stomach Histology of Stomach  Histology of Stomach Parietal (oxyntic) cells – secrete gastric acid, intrinsic factor for absorption of vitamin B12. Chief/peptic (zymogenic) cells - pepsin-secreting cells. Neuroendocrine cells - secrete serotonin and other hormones. Histology of Stomach Histology of Stomach Gastritis  Gastritis Definition: Gastritis, an inflammation or irritation of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).  Acute Gastritis An acute mucosal inflammatory process with neutrophils infiltration. Usually a transient nature. May be accompanied by hemorrhage or sloughing of the superficial mucosa. Frequently associated with: – NSAID – Alcohol, smoking – Chemotherapy – Autoimmune disorders – Severe stress (trauma, burns) – Surgery – Uremia – Radiation  Acute Gastritis Mild: edema and vascular congestion, scattered neutrophil in mucosa. Severe: erosion of mucosa, hemorrhage, acute inflammatory infiltrate (acute erosive gastritis).  Clinical Features of Acute Gastritis May be asymptomatic. Common symptoms include: – loss of appetite – indigestion (belching, heartburn, bloating) – melena (black stools) – nausea – vomiting – hematemesis (bloody vomit that looks like used coffee grounds) – pain in the upper part of the abdomen – a full feeling in the upper abdomen after eating  Acute Gastritis Gross appearance This is a more typical acute gastritis with a diffusely hyperemic gastric mucosa.  Acute Gastritis Histopathology  Acute Gastritis Histopathology  Acute Gastritis Histopathology On microscopic examination, this gastric mucosa shows infiltration by neutrophils.  Acute Gastric Ulceration Also called stress ulcer. Severe form of acute gastritis in which erosion reaches muscularis mucosa. It occurs due to: – Shock, extensive burns or severe trauma (curling ulcer). – Increase intracranial pressure from trauma/surgery (Cushing’s ulcer). – NSAIDs use.  Acute Gastric Ulceration Morphology – 1/2 occur in stomach).  Gastric Cancer Gastrointestinal stromal tumor (GIST) Morphology: – Up to 30cm in size – Solitary, well circumscribed fleshy mass Gross Histopathology  Gastric Cancer Carcinoid tumor This cancer starts from hormone-producing cells in stomach. Majority are found in the GI tract and more than 40% occur in the small intestine. It generally do not spread to different organs and accounts for only 3% of stomach cancer cases.  Gastric Cancer Histopathology The image shows tumor cells arranged in sheets, nests, cords, and trabecular pattern in the submucosa. They are relatively uniform and have abundant amphophilic cytoplasm.  Gastric Cancer Histopathology Gastric neuroendocrine tumors consist of submucosal cords, nests, and sheets of neuroendocrine cells with typical amphophilic cytoplasm and salt-and-pepper chromatin in the nuclei. The background stroma may appear myxoid. Gastric Cancer Clinical Features of Gastric Cancer Abdominal fullness or pain which may occur after eat a small meal Dark stools Difficulty in swallowing, which become worse over time Excessive belching Loss of appetite Nausea Vomiting, which may contain blood Weakness or fatigue Weight loss  Diagnosis of Gastric Cancer Complete blood count (CBC) to check for anemia Stool test to check for blood in the stools Endoscopy Ultrasonography CT scan Barium studies Staging laparoscopy Thank You…..