Gastrointestinal Pathology I: Congenital Anomalies/Gastritis/Peptic Ulcer PDF

Gastrointestinal Pathology I: congenital anomalies/gastritis/PEPTIC ULCER DX Dr Kabiru Abdullahi MBBS, FMCPath Associate Professor MORBID ANATOMY DEPARTMENT CHS, BAZE UNIVERSITY, ABUJA 5/11/2...

Gastrointestinal Pathology I: congenital anomalies/gastritis/PEPTIC ULCER DX Dr Kabiru Abdullahi MBBS, FMCPath Associate Professor MORBID ANATOMY DEPARTMENT CHS, BAZE UNIVERSITY, ABUJA 5/11/2024 1  Introduction ❑An ulcer is a local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue ❑A peptic ulcer is usually a solitary lesion due to acid-peptic juices. 2  Introduction: Peptic Ulcer Disease most often associated with H. pylori–induced hyperchlorhydric chronic gastritis may occur in any portion of the GI tract exposed to acidic gastric juices is most common in the: ✓first portion of the duodenum ✓Gastric antrum ✓Duodenum: stomach 4:1 may also occur in the: – esophagus as a result of GERD – ectopic gastric mucosa 3  Epidemiology of PUD ❑the lifetime risk of developing an ulcer is approximately 10% for males and 4% for females (US) In women, it is more common after menopause ❑The average age at the time of diagnosis is 50 years the disease can occur in any age group, including children 20% of patients with gastric peptic ulcer have coexisting duodenal ulcer 4  Pathogenesis of PUD ❑ generally develops on a background of chronic gastritis ❑The imbalances of mucosal defenses and damaging forces that cause chronic gastritis are also responsible for PUD. ❑primary underlying causes of PUD 1. H. pylori infection 2. NSAID ❑more than 70% of individuals with PUD are infected by H. pylori fewer than 20% of H. pylori–infected individuals develop peptic ulcer 5 6 7  Pathogenesis of PUD More common cofactors in ulcerogenesis: i. chronic NSAID use ii. high-dose corticosteroids iii. alcoholic cirrhosis iv. chronic obstructive pulmonary disease v. chronic renal failure vi. Hyperparathyroidism vii. self-imposed or exogenous psychologic stress 8  Morphology: Gross 1 ❑Peptic ulcers are four times more common in the proximal duodenum than in the stomach. Duodenal ulcers usually occur within a few centimeters of the pyloric valve ✓involve the anterior duodenal wall ✓Size does not predict malignancy. 9  Morphology: Gross 2 ❑Gastric peptic ulcers are predominantly located along the lesser curvature near the interface of the body and antrum ❑Peptic ulcers are solitary in more than 80% of patients Lesions less than 0.3 cm in diameter tend to be shallow while those over 0.6 cm are likely to be deeper ulcers 10  Morphology: Gross 3 ❑The classic peptic ulcer is: ✓round to oval ✓sharply punched-out defect ✓The mucosal margin may overhang the base slightly/level with the surrounding mucosa 11  Morphology: Gross 4 The depth of ulcers may be limited by: ✓gastric muscularis propria ✓adherent pancreas ✓omental fat ✓Liver Hemorrhage and fibrin deposition are often present on the gastric serosa 12 13  Morphology: Histology an active, well-developed, chronic peptic ulcer will show: i. a surface coat of purulent exudate, bacteria, and necrotic debris ii. fibrinoid necrosis iii. granulation tissue iv. fibrosis replacing the muscle wall and extending into the subserosa 14  Morphology: Histology Other common features in the ulcer bed include: ✓thickening of vessels at the ulcer bed ✓hypertrophy of nerve bundles 15 16  Clinical Features. ❑notoriously chronic, recurring lesions with much greater morbidity than mortality epigastric burning or aching pain: ✓1 to 3 hours after meals during the day ✓worse at night ✓relieved by alkali or food additional manifestations: Nausea/ vomiting/bloating/belching/significant weight loss 17  Clinical Features. complications i. iron deficiency anemia ii. frank hemorrhage iii. perforation 18  Acute gastric ulcer is a common finding at autopsy and is usually a terminal event It may also be seen during life in: i. any debilitating illness ii. Sepsis iii. After surgery or trauma/burns (stress ulcer: “Curling’s Ulcer”) iv. patients with CNS injury or disease (“Cushing’s ulcer”) v. complication of long-term steroid therapy (“steroid ulcer”) vi. association with aspirin ingestion vii. complication of radiation therapy or hepatic arterial chemotherapy viii. following the introduction of tubes into the stomach 19