162. Chronic gastritis: definition, classification. Role of Helicobacter pylori in the morphogenesis of chronic gastritis. Complications, clinical significance.

Chronic gastritis is a disease whose morphological substrate is chronic inflammation of the gastric mucosa in combination with impaired cellular renewal and the outcome of glandular atrophy, which is manifested by secretory insufficiency (achilia).

Classification: By localization

1.Antral,

2.Fundal,

3. Pangastritis.

By pathogenesis:

1.Autoimmune chronic gastritis (A),

2.Helicobacter-associated chronic gastritis (B),

3.Chemical (reflux) gastritis (C),

4. Other forms of gastritis (lymphocytic; eosinophilic; granulomatous).

Morphological types

1. Chronic superficial gastritis,

2. Chronic atrophic gastritis,

Z. Gigantic hypertrophic gastritis (Menetrier's disease).

Depending on the activity:

-active gastritis (exacerbation),

-inactive (remission).

The role of H.Pyl.

Helicobacter antrum gastritis with mononuclear infiltration of its own plate of the gastric mucosa is a consequence of the interaction of a gram-negative bacterium with the host organism. At the same time, HP, due to the production of catalase and superoxide dismutase, does not undergo phagocytosis by macrophages. Most HP bacteria lie freely in the supraepithelial mucus, and only 20% of them are associated with epithelial cells. HP has a double effect. It destroys the epithelium of the gastric mucosa and simultaneously produces the enzyme urease, which through a series of reactions promotes the formation of ammonia. As a result, the mucous barrier that protects the gastric mucosa from the digesting action of gastric juice is destroyed. In addition, hydrogen ions diffuse into the gastric wall, which also leads to damage to the mucous barrier.

Complications: Gastric bleeding, gastric ulcer and duodenal ulcer, gastric cancer, B12 deficiency anemia.

Clinic:

in case of secretory insufficiency:

aching pains in the epigastric region,

feeling full or bursting, belching, nausea, vomiting.

unstable stool, diarrhea.

pain syndrome, dyspeptic phenomena, are associated with eating and manifest themselves immediately after eating.

With increased and preserved secretion

"Hungry" pains, which usually appear immediately on an empty stomach or after a long break from eating, sometimes the pain begins after an error in the diet.

Dyspeptic symptoms are poorly expressed.

The importance of chronic gastritis is extremely high. Chronic atrophic gastritis with severe epithelial dysplasia is a precancerous disease of the stomach.

163. Peptic ulcer of the stomach and duodenum: definition, etiology, pathogenesis, localization, macro- and microscopic characteristics of the ulcer, complications.

Peptic ulcer is a chronic cyclic disease, the main clinical and morphological manifestation of which is a recurrent ulcer of the stomach or duodenum.

Etiology -Psychoemotional overstrain, stress -Eating disorders -Smoking -Alcohol -Nonsteroidal anti-inflammatory drugs -Genetic factors -Infectious factor (Helicobacter pylori).

Pathogenesis:

Factors: -General: disorders of the nervous and humoral regulation of the stomach and duodenum -Local: Disorders of the acid-peptic factor. Damage to the mucous barrier. Motor disorders.

Morphogenesis: acute erosion  acute ulcer  chronic ulcer.

Localization of ulcers:

Small curvature of the stomach

Antral Department

The pyloric department.

The bulb of the duodenum.

The macroscope. characteristic:

The ulcer has an oval or rounded shape with a diameter of several millimeters to 5-6 cm. It penetrates into the wall of the stomach to various depths, sometimes reaching the serous layer. The bottom of the ulcer is smooth, sometimes rough, the edges are boldly raised, dense. The edge of the ulcer facing the esophagus is covered, and the mucous membrane hangs over the defect. The edge facing the gatekeeper is flat, sometimes has the appearance of a terrace, the steps of which are formed by layers of the wall — the mucous membrane, submucosal and muscular layers. This type of edges is caused by the displacement of the layers of the stomach wall during its peristalsis. In the cross section, the chronic ulcer has the shape of a truncated pyramid, the narrow end of which is facing the esophagus. The serous membrane in the area of the ulcer is thickened, often soldered to adjacent organs.

The microscope. characteristic:

The microscopic picture of chronic gastric ulcer in different periods of the disease is different. During remission, scar tissue is found at the edges of the ulcer. The mucous membrane is thickened and hyperplasized at the edges. In the bottom area, the destroyed muscle layer and the scar tissue replacing it are visible, and the bottom of the ulcer may be covered with a thin layer of epithelium. Here, in the scar tissue, there are many vessels (arteries, veins) with thickened walls. The lumen of many vessels is narrowed or obliterated due to the proliferation of intimal cells (endovasculitis) or overgrowth of connective tissue. During the period of exacerbation of peptic ulcer disease, a wide zone of fibrinoid necrosis is detected in the area of the bottom and edges of the ulcer, on the surface of which there is a fibrinous purulent or purulent exudate. The necrosis zone is delimited by granulation tissue with a large number of thin-walled vessels and cells, among which there are many eosinophils. Deeper, following the granulation tissue, is the coarse fibrous scar tissue.

Complications:

1. Ulcerative-destructive:

- bleeding,

-perforation,

- penetration.

2. Inflammatory: gastritis, duodenitis, perigastritis, periduodenitis.

3.Ulcerative scarring: narrowing of the inlet and outlet sections of the stomach, deformation of the bulb of the duodenum.

4. Malignancy.

4. Combined complications.