Faculty of Allied Medical Faculty of Allied Medical SciencesSciences

Histopathology and CytologyHistopathology and Cytology

((MLHC-201MLHC-201))

STOMACHSTOMACHPATHOLOGYPATHOLOGY

Prof. Dr. Noha RagabProf. Dr. Noha Ragab

Intended Learning OutcomesIntended Learning Outcomes

By the end of this lecture the student should By the end of this lecture the student should knowknow: :

11 - -The congenital disorders of the stomachThe congenital disorders of the stomach

22 - -Acute stomach inflammation and stress ulcersAcute stomach inflammation and stress ulcers

33 - -Chronic Gastritis and its typesChronic Gastritis and its types

44 - -Chronic peptic ulcers and associated typesChronic peptic ulcers and associated types

55 - -Gastric CarcinomaGastric Carcinoma

ANATOMY OF STOMACHANATOMY OF STOMACH

CONGENITAL CONGENITAL DISORDERS OF DISORDERS OF

STOMACHSTOMACH

1. 1. Pyloric stenosis:Pyloric stenosis:

Congenital stenosis of pylorus due to marked Congenital stenosis of pylorus due to marked muscular hypertrophy of the pyloric sphincter, muscular hypertrophy of the pyloric sphincter, resulting in gastric outlet obstructionresulting in gastric outlet obstruction

22 . .Congenital Diaphragmatic herniaCongenital Diaphragmatic hernia::

Congenital defect in the diaphragm, resulting Congenital defect in the diaphragm, resulting in herniation of the abdominal organs into the in herniation of the abdominal organs into the thoracic cavitythoracic cavity

The stomach is the most commonly herniated The stomach is the most commonly herniated organorgan

ACUTE INFLAMMATION ACUTE INFLAMMATION & &

STRESS ULCERSSTRESS ULCERS

11 . .Acute hemorrhagic gastritisAcute hemorrhagic gastritis::

Definition:Definition: Acute inflammation, erosion, and hemorrhage Acute inflammation, erosion, and hemorrhage

of the gastric mucosa due to breakdown of the of the gastric mucosa due to breakdown of the mucosal barrier and acid-induced injurymucosal barrier and acid-induced injury

Etiology:Etiology: Chronic aspirin or NSAID useChronic aspirin or NSAID use Alcohol useAlcohol use SmokingSmoking

Acute hemorrhagic gastritisAcute hemorrhagic gastritis

Clinical picture: Clinical picture: Epigastric abdominal painEpigastric abdominal pain Gastric hemorrhage, hematemesis and melenaGastric hemorrhage, hematemesis and melena

22 . .Gastric stress ulcerGastric stress ulcer::

Etiology: Etiology: 1.1. NSAID useNSAID use2.2. Severe stressSevere stress3.3. SepsisSepsis4.4. Shock and severe burnsShock and severe burns5.5. SpiritsSpirits6.6. SmokingSmoking

Grossly:Grossly: there is multiple, small round superficial there is multiple, small round superficial ulcers of the stomach and duodenumulcers of the stomach and duodenum

Complications:Complications: bleeding, haematamesis & melena bleeding, haematamesis & melena

CHRONIC GASTRITISCHRONIC GASTRITIS

Definition:Definition:

ChronicChronic inflammation of the gastric mucosa inflammation of the gastric mucosa eventually leading to atrophy (chronic atrophic eventually leading to atrophy (chronic atrophic gastritis)gastritis)

A- Fundic type (Type A)A- Fundic type (Type A)::

This is an autoimmune disease This is an autoimmune disease There is decreased acidic secretion. There is decreased acidic secretion. It usually involves the body and the fundus of It usually involves the body and the fundus of

stomachstomach

Gross picture:Gross picture:

Loss of rugal folds in the body and fundusLoss of rugal folds in the body and fundus

Microscopic picture:Microscopic picture: Mucosal atrophyMucosal atrophy Chronic lympho-plasmacytic inflammationChronic lympho-plasmacytic inflammation Intestinal metaplasiaIntestinal metaplasia

B- Antral type (type B)B- Antral type (type B):: This type is commonly related to Helicobacter pyloriThis type is commonly related to Helicobacter pylori

Microscopic picture:Microscopic picture: H- pylori organisms are visible in the mucous layer of the H- pylori organisms are visible in the mucous layer of the

surface epitheliumsurface epithelium Foci of acute inflammationFoci of acute inflammation Chronic inflammation with lymphoid folliclesChronic inflammation with lymphoid follicles Intestinal metaplasiaIntestinal metaplasia

Complication:Complication: Increased risk of gastric carcinomaIncreased risk of gastric carcinoma

CHRONIC PEPTIC CHRONIC PEPTIC ULCER ULCER

(BENIGN ULCER)(BENIGN ULCER)

Peptic ulcerPeptic ulcer

Definition:Definition: Ulcers of the distal part of stomach and Ulcers of the distal part of stomach and

proximal part of duodenum caused by gastric proximal part of duodenum caused by gastric secretions (hydrochloric acid and pepsin) and secretions (hydrochloric acid and pepsin) and impaired mucosal defensesimpaired mucosal defenses

Etiology:Etiology: Chronic NSAID and aspirin useChronic NSAID and aspirin use SteroidsSteroids SmokingSmoking H.pyloriH.pylori

Complications:Complications: Haemorrhage ( Haematemesis & melena)Haemorrhage ( Haematemesis & melena) Iron deficiency anaemiaIron deficiency anaemia Gastric perforationGastric perforation Pyloric obstructionPyloric obstruction

Duodenal peptic ulcerDuodenal peptic ulcer::

It is more common than gastric ulcersIt is more common than gastric ulcers

Eitiology:Eitiology: H.pylori H.pylori Increased gastric acid secretionIncreased gastric acid secretion Increased rate of gastric emptyingIncreased rate of gastric emptying Blood group OBlood group O Cirrhosis & COPDCirrhosis & COPD

Grossly (Location of Duodenal Ulcer:Grossly (Location of Duodenal Ulcer:

It is located at the anterior wall of the proximal It is located at the anterior wall of the proximal duodenumduodenum

Clinical presentation:Clinical presentation:

Burning epigastric pain 1-3 hours after eating Burning epigastric pain 1-3 hours after eating and usually relieved by foodand usually relieved by food

Duodenal ulcer. There are two sharply demarcated duodenal ulcers surrounded by inflamed duodenal mucosa. The gastroduodenal junction is in the midportion of the photograph

Gastric peptic ulcerGastric peptic ulcer:: Associated with H.pylori (75%)Associated with H.pylori (75%)

Location: lesser curvature of the antrumLocation: lesser curvature of the antrum

Clinical presentation:Clinical presentation:Burning epigastric pain, which worsens with eating?Burning epigastric pain, which worsens with eating?

Grossly:Grossly: Small (<3cm), solitary ulcerSmall (<3cm), solitary ulcer Round or oval shapeRound or oval shape Sharply demarcated " punched out" ulcersSharply demarcated " punched out" ulcers Overhanging marginsOverhanging margins Radiating mucosal foldsRadiating mucosal folds

Gastric ulcer. There is a characteristic sharp demarcation from the surrounding mucosa ,with radiating gastric folds.

GASTRIC CARCINOMAGASTRIC CARCINOMA(MALIGNANT ULCER)(MALIGNANT ULCER)

Gastric carcinomaGastric carcinoma::

Risk factors:Risk factors: H.pyloriH.pylori Chronic atrophic gastritisChronic atrophic gastritis SmokingSmoking Blood group ABlood group A

Clinical presentation:Clinical presentation: 90% asymptomatic90% asymptomatic Weight loss and anorexiaWeight loss and anorexia Epigastric abdominal pain mimicking a peptic ulcerEpigastric abdominal pain mimicking a peptic ulcer Occult bleeding and iron deficiency anaemiaOccult bleeding and iron deficiency anaemia

Location of Gastric Carcinoma:Location of Gastric Carcinoma: lesser lesser curvature of the antrumcurvature of the antrum

PathologyPathology

Grossly:Grossly: Large >3cm, irregular ulcerLarge >3cm, irregular ulcer Heaped up margins and necrotic ulcer baseHeaped up margins and necrotic ulcer base May occur as a flat or polypoid massMay occur as a flat or polypoid mass

MetastasisMetastasis::

Virchow node: left supraclavicular lymph nodeVirchow node: left supraclavicular lymph node Spread to the ovaries: Krunkenberg tumorSpread to the ovaries: Krunkenberg tumor

QuestionsQuestions

11 - -Pyloric stenosis is characterized by the Pyloric stenosis is characterized by the obstruction ofobstruction of..…… ..……

22 - -The clinical picture of acute hemorrhagic gastritis The clinical picture of acute hemorrhagic gastritis is characterized byis characterized by..…… ..……

33 ……… - ……… -and ……. are the types of chronic and ……. are the types of chronic gastritisgastritis

44 - -The etiology of duodenal peptic ulcer involvesThe etiology of duodenal peptic ulcer involves

…………… ……………

55 - -Risk factors of gastric carcinoma areRisk factors of gastric carcinoma are ..……… ..………

AssignmentsAssignmentsBenign Tumors of the Upper Respiratory TractBenign Tumors of the Upper Respiratory Tract

الدين كمال الدين نيهال كمال نيهال عبدة أحمد عبدة هايدى أحمد هايدى معتمد الله عبد معتمد هدى الله عبد هدى الحكيم عبد الدين عالء الحكيم هدير عبد الدين عالء هدير محمد على محمد وليد على وليد محمد الله عبد محمد يمنى الله عبد يمنى منصور الغنى عبد محمود منصور أحمد الغنى عبد محمود أحمد

GOOD LUCKGOOD LUCK

DR.NOHA RAGABDR.NOHA RAGAB