"Each time you are honest and "Each time you are honest and conduct yourself with honesty, a conduct yourself with honesty, a success force will drive you success force will drive you toward greater success. Each toward greater success. Each time you lie, even with a little time you lie, even with a little white lie, there are strong white lie, there are strong forces pushing you toward forces pushing you toward failure." failure." alee alee
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"Each time you are honest and "Each time you are honest and conduct yourself with honesty, a conduct yourself with honesty, a success force will drive you toward success force will drive you toward greater success. Each time you lie, greater success. Each time you lie, even with a little white lie, there are even with a little white lie, there are strong forces pushing you toward strong forces pushing you toward failure."failure."
aleealee
Pathology of Peptic Ulcer
By ali azizBy ali aziz
Normal Stomach
Esophagus & Stomach Normal
Definition:
Ulceration (breach in mucosa) due to acid & pepsin attack – peptic ulcer.
Deeper than just mucosa
Single, punched out, clean base – why?
Etiology: (study of causes)
Helicobacter pylori infection.(bacteria)
Hyperacidity –
Drugs - anti-inflammatory (NSAIDs) & Corticostroids.
Cigarette smoking, Alcohol,
Rapid gastric emptying
Personality and stress
H. Pylori organisms- silver st.
Pathogenesis: : (process)
Helicobacter pylori infection
Colonization of gastric mucous
Urease ammonia neutralization of acid Rebound acid production.
Protease – Mucous break down.
Weak mucosal resistance
Acid & Pepsin digestion of mucosa
Chronic Ulceration
Etiology of PUD
Normal
Increased Attack Hyperacidity
Weak defense Helicobacter pylori* Stress, drugs, smoking
Helicobacter pylori:
Most common infection in the world (20%)
10% of men, 4% women develop PUD *
Positive in 70-100% of PUD patients.
H.pylori related disorders:Chronic gastritis – 90%Peptic ulcer disease – 95-100%Gastric carcinoma – 70%Gastric lymphomaReflux Oesophagitis.Non ulcer dyspepsia
Peptic Ulcer Morphology:
90% ulcers in first portion of duodenum or lesser curvature of stomach(4:1).
80 to 90% cases single ulcer. Round Small ulcers with sharply punched out edges*
Small <2cm, clean base*.
Microscopy: 4 zones. Superficial necrotic layer. Inflammatory cells zone. Granulation tissue zone Collagenous scar layer.
Complications:
Bleeding – Chronic-IDA, Acute, Massive
Fibrosis, Stricture obstruction – pyloric stenosis.
Perforation – Peritonitis- emergency.
Gastric carcinoma. (not duodenal ca)
Acute Esophagitis & Gastritis
Gastric peptic ulcer:
Gastric peptic ulcer:
Gastric Ulcer
Duodenal Peptic Ulcer
Gastric Ulcer
Peptic ulcer - Endoscopy
Gastric Ulcer
Gastric Ulcer
Gastric UlcerPunched out ulcer
Clean base
Small single
Radiating mucosal folds.
Benign ulcer.
No tumor.
Peptic Ulcer
Peptic Ulcer Microscopy:
Perforation:
Acute Esophagitis & Gastritis
Fungating
Linitis Plastica – Schirrhous Carcinoma.
Helecobacter pylori
Gram negative, Spiral bacilli
Spirochetes
Do not invade cells – only mucous
Breakdown urea - ammonia
Break down mucosal defense
Chronic Superficial inflammation
PUD - Diagnosis
Endoscopy
Barium meal – contrast x-ray
Biopsy – bacteria & malignancy
H.Pylori:Endoscopy cytologyBiopsy – Special stainsCulture - difficultUrease Breath test.
Points to Remember:
A peptic ulcer is a sore in the lining of the stomach or duodenum due to attack by acid & Pepsin.
The major cause - H. pylori bacterium. Others are NSAIDs. spicy food, stress are risk factors.
H. pylori can be transmitted from person to person through close contact
A combination of antibiotics and H pump inhibitors is the most effective treatment.
Helecobacter pylori
“You get ulcer, not from what you eat, but from what’s
eating you..!”
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