164. Gastric cancer: localization, classification. Features of metastasis, complications and causes of death in patients with gastric cancer.

Localization:

Pyloric

Low curvature

Cardiac

Large curvature

Fundal

Total

Classification according to the nature of growth:

With predominant exophytic growth (tumor growth into the lumen of a hollow organ, the tumor covers part of the lumen of the organ, connecting to its wall with a leg)

With predominant endophytic growth (tumor growth deep into the organ wall)

Mixed haratker (exo- and endophytic growth)

Classification by macroscopic form:

Plaque - like

Polypous

Mushroom - shaped

Saucer - shaped

Diffuse

Classification by histological form:

Adenocarcinoma(differentiated)

Undifferentiated

Squamous cell

Unclassifiable

Features of metastasis:

Cancer, located on the small curvature and pyloric section, metastasizes to the pancreas, liver gate, portal vein, bile ducts and gallbladder, small omentum, mesentery root and inferior vena cava.

Cardiac cancer => esophagus

Fundal => spleen gate, diaphragm

Total and large curvature cancer => transverse colon, large omentum

Ways of metastasis:

1)Lymphoid:

Lymph nodes of large and small curvature (lungs, pleura, peritoneum)

Retrograde metastases (against lymph flow) (metastases to supraclavicular lymph nodes)

2)Hematogenic - according to the portal vein system (liver, lungs, pancreas, kidneys, adrenal glands)

Complications:

1)Secondary necrotic tumor changes: perforation, bleeding, peritumorous inflammation

2) Germination into neighboring organs:

into the gates of the liver and the head of the pancreas => compression and obliteration of the bile ducts and portal vein => jaundice, portal hypertension, ascites

Into the transverse colon or mesentery root of the small intestine => wrinkling => intestinal obstruction

Into the diaphragm => pleural contamination => pleurisy

3) Cancerous cachexia

Causes of death: Anemia, peritonitis, sepsis, death from complications caused by metastases (for example, with metastasis to the brain, there is an increase in intracranial pressure, displacement of the cerebellum into the large occipital foramen, compression of the medulla oblongata, death).

165. Acute appendicitis: definition, etiology, macro- and microscopic signs, complications, outcomes.

Appendicitis is an inflammation of the appendix of the caecum. Appendicitis is an enterogenic autoinfection — the intestinal flora becomes pathogenic (Escherichia coli, enterococcus is of the greatest importance)

Etiology:

1. Stagnation in the lumen of the process of intestinal contents. In this case, there is a violation of the epithelium of the mucous membrane => introduction of the pathogen of infection => purulent inflammation.

2. Neurovascular theory. Vascular disorders => vascular spasm of the process => impaired blood and lymph flow, hemorrhage => dystrophic and necrobiotic changes => purulent inflammation

Morphological forms of acute appendicitis:

1) simple- pronounced fullness of blood vessels, stasis in capillaries and venules, edema and hemorrhages, marginal standing of leukocytes in the vessels.

2) the superficial process macroscopically looks swollen, and its serous membrane is dull, hyperemic, granular in appearance. Foci of purulent cone-shaped inflammation are visible in the mucous membrane of the distal part, sometimes with superficial foci of necrosis.

3) destructive (phlegmonous, gangrenous)

Phlegmonous appendicitis. Macroscopically, the process is enlarged, the serous membrane is dull, covered with fibrinous plaque, and there are spot hemorrhages under it. On the incision, the lumen is filled with pus-like contents, the wall is thickened, diffusely impregnated with pus. Microscopically, diffuse neutrophilic infiltration of all layers of the process wall, fullness of vessels of all calibers, and hemorrhages are noticeable.

Gangrenous appendicitis is the further development of phlegmonous appendicitis in the case of attachment of putrefactive flora. The inflammation passes to the mesentery of the process and its vessels. Macroscopically, the appendix is even more enlarged in size, its serous membrane is dull, with purple and bluish spots, covered with greenish-gray overlays. The lumen is filled with pus or decaying dirty gray masses. Microscopically, diffuse infiltration of the wall by leukocytes, extensive hemorrhages, and almost total necrosis of the mucous membrane are visible.

Complications:

1. Perforation- perforation of the wall of a hollow organ.

2. Self-amputation of a gangrenously altered appendix

3. Empyema of the process is the formation of a closed cavity filled with pus

4. Periappendicitis - inflammation of the tissues around the appendix

5. Purulent thrombophlebitis of mesentery vessels is a microbial inflammation of the vascular wall.

Outcomes: Appendectomy followed by recovery, complications, death associated with complications (sepsis, peritonitis, thrombobacterial embolism).