Chronic Gastritis
Upper Abdominal Pain & Disease
FeaturesPain severityCharacterTimingLocationAdditional symptoms.SymptomsBack pain Chest painConstipationVomitingDiarrheaFever
4Etiology Abdominal PainInfectionFood related PoisoningMedical causes
OnsetAcute upper abdominal pain Abrupt onset potential to be medical emergency.Chronic upper abdominal pain Long lasting intermittent or constantOrganic disorderFunctional disorderAcute abdominal painDue to inflammation, perforation, obstruction, infarction, or rupture of abdominal organs
Characterized by sudden onset, pain, tenderness, and muscular rigidity, and usually requiring emergency surgery
Dorland's Medical Dictionary for Health Consumers. 2007 by SaundersThe American Heritage Medical Dictionary Copyright 2007EtiologyInfection : Amebiasis, hepatitis, falciparum malaria, pneumococcal pneumonia, rheumatic fever, salmonella gastroenteritis, staphylococcal toxemia, syphilis, trichinosis, TB, typhoid fever, viral enteritides, herpes zoster, infectious mononucleosis, Whipple's disease
Inflammation : Appendicitis, cholangitis, cholecystitis, Crohn's disease, diverticulitis, gastroenteritis, hepatitis, SLE, mesenteric lymphadenitis, pancreatitis, peritonitis due to organ perforation, perinephric abscesses, pyelonephritis, ulcerative colitis, intestinal obstruction, rheumatoid arthritis, polyarteritis nodosa, Henoch-Schnlein disease
McGraw-Hill Concise Dictionary of Modern Medicine. 2002 EtiologyIschemia : Renal infarction, mesenteric arterial thrombosisMalignancy :Pain due to organ infarction, Hodgkin's disease ('classically' associated with alcohol ingestion), leukemia, lymphoproliferative disordersMetabolic disease : Adrenal insufficiency (Addisonian crisis), DKA, familial hyperlipoproteinemia, familial Mediterranean fever, hemochromatosis, hereditary angioneurotic edema, hyperparathyroidism, hyperthyroidism, acute intermittent porphyria, uremia, substance abuse withdrawalEtiologyOb/Gyn : Twisted ovarian cyst, Pelvic DiseasesReferred pain :Pneumonia, MI, pleuritis, pericarditis, myocarditis, hematomata of the rectal muscle, renal colic, peptic ulcer, nerve root compressionTrauma : Perforation/ruptureaortic aneurysm, spleen, bladderIntoxication : Black widow spider bite, heavy metals, mushrooms
Chronic Abdominal Pain (CAP)First introduced by Apley and Naish in 1958 CAP previously called recurrent abdominal pain or RAP, To describe : children who experienced at least three bouts of pain severe enough to affect daily activities over a period of at least 3 months In last 5 decades, CAP has changed definitions several times, to describe all children who have abdominal pain for which a specific cause cannot be identified
Collins,et al, 2009CAP :Organic disorders related to abnormalities in an organ system (gastrointestinal, urinary, gynecologic systems. )
Functional disorders cause isnt identifiable or confirmed by laboratory tests. However, not finding the cause does not mean that the child is not in pain.
Congenital Pyloric StenosisAcute gastritisAcute ulcerative gastritisChronic gastritisAutoimmune gastritisPeptice ulcerGastric polyp and tumorSTOMACH
Transient mucosal inflammatory process
Asymptomatic or cause variable degrees of epigastric pain, nausea, vomitus
Severe cases: mucosal erosion, ulceration, hemorrhage, hematemesis, rarely masive blood lossAcute gastritisa. CausesNonsteroidal anti-inflammatory drugs (NSAIDs)Cigarette smokingheavy alcohol intakeBurn injury (severe) Curling ulcerBrain injury Cushing ulcer ingestion of strong acid or alkaline
b. Characteristicfocal damage of mucosa with acute inflammation, necrosis and hemorrhagemay be manifest as gastric ulcer often multiple
Range in depth: Erosion to ulceration 1 cm, circularEtiologyShock, burning ulcer, sepsis, severe trauma High intracranial pressure Cushing ulcerProximal the duodenum + severe burning ulcer/trauma Curling ulcerNSAIDPredominantly affects the anthrum
most common form of gastritis
often has increased gastric acid
young adulthood and early middle age
associated with gastric cancer chronic atrophic gastritis 12-16 fold increase risk of developing gastric carcinoma
2020EtiologyInfectiousH. pylori infectionH. heilmannii infectionGranulomatous gastritis associated with gastric infections in mycobacteriosis, syphilis, histoplasmosis, mucormycosisAssociated with parasitic infections strongyloides species, schistosomiasis, D. latumCaused by viral CMV or herpesvirus infectionNon-infectiousAutoimmune gastritisChemical gastropathy related to chronic bile reflux or NSAID intakeUremic gastropathyChronic noninfectious granulomatous gastritis associated with Crohn disease, sarcoidosis, Wegener granulomatosis, etcLymphocytic gastritisEosinophilic gastritisRadiation injury to the stomachGraft-versus-host diseaseIschemic gastritisGastritis secondary to drug therapyHelicobacter pylori associated gastritisH. pylori virulences
H. pylori and chronic gastritis
HISTOLOGIC PICTURE OF CHRONIC GASTRITISEarly stageinflammation affects the superficial parts of the mucosal layers superficial chronic gastritis
Next stagethe inflammation affects all mucosal and submucosal layers with germinal center1. Inflammatory cells: mononuclear cells; active netrophil (+) 2. Metaplasia: intestinal metaplasia pre-malignant condition3. Glandular atrophy : glandular tissue is reduced in amount and undergoes to intestinal metaplasia4. H. pylori5. Dysplasia: carcinoma2626Clinical of Chronic Gastritis caused by H.pylori infectionClinical:Epigastric painNauseaVomitingMalaiseSometimes feverAnorexia
DiagnosisDiagnosis of chronic gastritis can only be established on histologic grounds endoscopic biopsy (upper GI endoscopy)Labatrophic gastritis may be assessed by measuring ratio of pepsinogen I to pepsinogen II in the serum. Level of PGI in the serum decreases as gastric chief cells are lost during gastric atrophy, resulting in a decreased PGI/PGII ratioRapid urease test on gastric biospy tissueBacterial culture of gastric biopsy tissueTreatmentTx can be aimed at a specific etiologic agentPharmacotherapy for H. pylori requires multidrug therapy 10-14 daysAntibiotics clarithromycin, amoxicillin, metronidazole, tetracycline, furazolidone5 regimens approved by US FDA eg bismuth-metronidazole-tetracycline triple therapy (most effective), 500mg clarithromycin 3x daily plus either omeprazole 20mg or ranitidine bismuth citrate 400mg, PPI lansoprazole 30mg+ clarithromycin 500mg + amoxicillin 1000mgLess than 10% of cases of chronic gastritis
Characterized by:
antibodies to parietal cells and intrinsic factor
reduced serum pepsinogen I concentration
antral endocrine hyperplasia
vit B12 deficiency
achlorhydria
Morphology of autoimmune gastritis Diffuse mucosal damaged and diffuse athrophy of the oxyntic mucosa within the body and fundus
Mild/ absent damaged in the antrum and cardia
Severe vit B12 deficiency: nuclear enlargement of epithelial cells
Lymphocytes, macrophges, plasma cells dominant
Loss of parietal and chief cells can be extensive
Peptic Ulcer of The StomachPeptic Ulcer of The Stomach
H. pylori : 90-100% duodenal ulcer, 70% gastric ulcer
bacterial urease & protease break down glycoprotein in gastric mucus interfering with epithelial protection
NSAID,alcohol, smoke, blood-group, HLA-B5
Increased permeability of the gastric mucosa to hydrogen ion back diffusion of H2 ion injury to gastric mucosa
Bile-induced gastritis leading to gastric ulcerationEtiopathogenic mechanism:Complications :Possible relationship between tobacco and peptic ulcerGastric Polyppolypadenoma>90% non neoplasm (inflammatory/ hyperplasia)Sessile / pedunculated20-25% multipleMostly occur in chronic gastritisNo malignant potentialPolypoid mass
neoplasm 5-10% of gastric polypSessile / pedunculateddistal anthrum predominant Six decade, Male: female = 2:1Some cases origin from chronic gastritis with intestinal metaplasia
Malignant Tumors of The StomachAdenocarcinoma is about 90-95% of gastric malignancyHigh incidence: japan, Chili, Costa Rica, China Location: 40-50% pylorus/anthrum; 25% cardia40% minor curvature; 12% c. majorEtiology:DietChronic atrophic gastritisH. pylori infectionpartial gastrectomyGastric Adenoma Genetic : A blood group, family factor
Gastric CancerOther Gastric Tumors MALIGNANT LYMPHOMA40% malignant lymphoma of GIT5% of gastric malignancyB cell type predominant, MALT origin CARCINOID TUMOR Carcinoid syndromeLow grade malignancyMetastasis to the liverMultiple lesions LEIOMYOMA SECONDARY TUMORS (METASTASIS)rareMostly from leukemia or general lymphoma From breast / lung cancer diffuse linitis plastica
