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Stomach Dr. Girish Kamat
University Questions Peptic Ulcer <ul><li>Long Essay- 10M </li></ul><ul><li>Describe the etiology, gross, and microscopy o...
University Questions Tumors <ul><li>Short Answers- 5M </li></ul><ul><li>Morphologic types of carcinoma of stomach </li></u...
Peptic Ulcer <ul><li>Definition </li></ul><ul><li>Etiopathogenesis </li></ul><ul><li>H.Pylori </li></ul><ul><li>Sites </li...
Gastric Tumors <ul><li>Classification </li></ul><ul><li>Carcinoma </li></ul><ul><ul><li>Etiology </li></ul></ul><ul><ul><l...
Peptic Ulcer
Definition <ul><li>“ It is acid peptic digestion of alimentary mucosa, resulting in an ulcer, that extends through the mus...
Epidemiology <ul><li>Men affected  more than Females </li></ul><ul><li>M: F ratio  in  Duodenal ulcer is  3:1 </li></ul><u...
 
Etiology <ul><li>H.Pylori Infection </li></ul><ul><ul><li>100%- Duodenal, 70%- Gastric </li></ul></ul><ul><ul><li>10-20% i...
Etiology- H. Pylori <ul><li>Mechanism of production of gastritis </li></ul><ul><ul><li>Inflammatory cytokines- IL- 1,6,8, ...
Etiology- H. Pylori <ul><li>Tests </li></ul><ul><ul><li>Biopsy- H&E, Geimsa, Warthin Starry, Steiner silver, Aclian yellow...
 
Etiology- NSAIDS & Steroids <ul><li>Inhibit cyclo-oxygenase   Reduced PG    Reduced cytoprotection   Mucosal injury </l...
Etiology <ul><li>Emotions </li></ul><ul><li>Diet </li></ul><ul><li>Pylorodudenal reflux </li></ul><ul><li>Endocrine- Zolli...
Etiology <ul><li>Curling ulcer- Stress produced by hypotension, endotoxic shock, MI, Burns </li></ul><ul><li>Cushing ulcer...
 
Sites <ul><li>Duodenum- 4X- First Part </li></ul><ul><li>Stomach- 1X- Antrum </li></ul><ul><li>Barrette’s esophagus </li><...
Morphology- Acute Gross <ul><li>Multiple </li></ul><ul><li>1-2mm </li></ul><ul><li>Shallow and do not invade muscular coat...
Morphology- Acute Micro <ul><li>Neutrophils above basement membrane </li></ul><ul><li>Erosion not crossing muscular mucosa...
 
Morphology-Gross <ul><li>Single, round to oval </li></ul><ul><li><2cm </li></ul><ul><li>Lesser curvature </li></ul><ul><li...
Morphology-Gross <ul><li>Single, round to oval </li></ul><ul><li><2cm </li></ul><ul><li>Lesser curvature </li></ul><ul><li...
Morphology- Chronic Micr0- 4 Layers <ul><li>Surface debris </li></ul><ul><li>Neutrophils </li></ul><ul><li>Granulation tis...
 
Clinical Features <ul><li>Abdominal pain- Epigastric, burning type, vomiting (Relieves), episodic </li></ul><ul><ul><li>Fo...
Investigations <ul><li>Blood- Anemia </li></ul><ul><li>Stool-Occult blood </li></ul><ul><li>Barium meal </li></ul><ul><li>...
Complications <ul><li>Bleeding- 15-20% </li></ul><ul><li>Perforation- 5% </li></ul><ul><li>Obstruction due to edema and sc...
Other  gastritis <ul><li>Eosinophilic </li></ul><ul><li>Lymphocytic </li></ul><ul><li>Granulomatous </li></ul><ul><li>Hemo...
Gastric Tumors
Classification <ul><li>Epithelial </li></ul><ul><ul><li>Adenoma </li></ul></ul><ul><ul><li>Adenocarcinoma- Papillary, tubu...
Carcinoma of Stomach
Epidemiology <ul><li>Higher in Japan, China compared to US, UK </li></ul><ul><li>More common in lower socio-economic group...
Etiology <ul><li>H.Pylori </li></ul><ul><li>Diet- Salted/smoked food, nitrates </li></ul><ul><li>Smoking and alcohol </li>...
Morphology Gross <ul><li>Sites-  </li></ul><ul><ul><li>Antrum- 50% </li></ul></ul><ul><ul><li>Body- 30% </li></ul></ul><ul...
Morphology Gross <ul><li>Cauliflower like </li></ul><ul><li>Infiltrating with dense fibrosis- Linitis plastica </li></ul><...
 
 
Morphology Micro- (DIO/ Lauren) <ul><li>Diffuse- Signet ring cells </li></ul><ul><li>Intestinal- Similar to intestinal ade...
 
 
Early Gastric Ca (Superficial/ microinvasive Ca) <ul><li>Ca confined to mucosa and submucosa regardless of status ofregion...
Clinical Features <ul><li>Ulcer like pain </li></ul><ul><li>Weight loss, anorexia </li></ul><ul><li>Hematemesis </li></ul>...
Clinical Features <ul><li>Meatstasis to </li></ul><ul><li>Left axillary nodes </li></ul><ul><li>Supraclavicular nodes </li...
Clinical Features <ul><li>Paraneoplastic syndromes </li></ul><ul><li>Trousseaus’ sign </li></ul><ul><li>Acanthosis nigrica...
Investigations <ul><li>Endoscopy </li></ul><ul><li>Exfoliative brush cytology </li></ul><ul><li>Barium meal </li></ul><ul>...
Staging <ul><li>T1- Submucosa </li></ul><ul><li>T2- Muscularis Propria </li></ul><ul><li>T3- Penetration of serosa </li></...
Staging <ul><li>I- T1N0M0/T1N1M0/T2NoMo </li></ul><ul><li>II-T1N2M0/T2N1Mo/T3N0M0 </li></ul><ul><li>III- T2N2M0/T3N1M0/T4N...
Prognostic markers <ul><li>Stage </li></ul><ul><li>Grade </li></ul><ul><li>Hsitologic type </li></ul><ul><li>P53, c-ERB-2 ...
<ul><li>5 year survival rate </li></ul><ul><li>90 - 95 %  in surgically treated early  carcinoma </li></ul><ul><li>< 15 % ...
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2 stomach girish_10_11

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Powerpoint on pathology of diseases of stomach

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Transcript of "2 stomach girish_10_11"

  1. 1. Stomach Dr. Girish Kamat
  2. 2. University Questions Peptic Ulcer <ul><li>Long Essay- 10M </li></ul><ul><li>Describe the etiology, gross, and microscopy of gastric ulcer. List complications of gastric ulcer </li></ul><ul><li>Define peptic ulcer. Mention the sites. Describe etiopathogenesis and morphology of chronic gastric ulcer </li></ul><ul><li>Short Answers- 5M </li></ul><ul><li>Helicobacter pylori </li></ul><ul><li>Etiology of duodenal ulcer </li></ul><ul><li>Short Notes- 3M </li></ul><ul><li>Macroscopy of benign and malignant gastric ulcer </li></ul>
  3. 3. University Questions Tumors <ul><li>Short Answers- 5M </li></ul><ul><li>Morphologic types of carcinoma of stomach </li></ul><ul><li>Early gastric carcinoma </li></ul><ul><li>Short Notes- 3M </li></ul><ul><li>Morphology of gastric carcinoma </li></ul><ul><li>Linitis plastica </li></ul><ul><li>Signet ring cell </li></ul><ul><li>Modes of spread of gastric cancer </li></ul>
  4. 4. Peptic Ulcer <ul><li>Definition </li></ul><ul><li>Etiopathogenesis </li></ul><ul><li>H.Pylori </li></ul><ul><li>Sites </li></ul><ul><li>Morphology- Acute, Chronic </li></ul><ul><li>Difference between benign and malignant </li></ul><ul><li>Clinical features </li></ul><ul><li>Investigatuions </li></ul><ul><li>Complications </li></ul>
  5. 5. Gastric Tumors <ul><li>Classification </li></ul><ul><li>Carcinoma </li></ul><ul><ul><li>Etiology </li></ul></ul><ul><ul><li>Morphology </li></ul></ul><ul><ul><li>Clinical features </li></ul></ul><ul><ul><li>Investigations </li></ul></ul><ul><ul><li>Spread </li></ul></ul><ul><ul><li>Staging </li></ul></ul><ul><ul><li>Prognostic markers </li></ul></ul>
  6. 6. Peptic Ulcer
  7. 7. Definition <ul><li>“ It is acid peptic digestion of alimentary mucosa, resulting in an ulcer, that extends through the muscularis mucosa into the submucosa or deeper.” </li></ul>
  8. 8. Epidemiology <ul><li>Men affected more than Females </li></ul><ul><li>M: F ratio in Duodenal ulcer is 3:1 </li></ul><ul><li>M : F ratio in Gastric ulcer is 1.5 : 1 </li></ul><ul><li>Women most affected at or after menopause </li></ul>
  9. 10. Etiology <ul><li>H.Pylori Infection </li></ul><ul><ul><li>100%- Duodenal, 70%- Gastric </li></ul></ul><ul><ul><li>10-20% infected develop gastritis </li></ul></ul><ul><ul><li>Non sporing, curvilinear, flagellated, Gram – neg </li></ul></ul><ul><ul><li>Swims through mucus, urease, bacterialadhesins- Bab A, Produces cytotoxin (CagA gene), Vacuolating cytotoxin (VacA) </li></ul></ul><ul><ul><li>Chronic gastritis  Atrophy  Intestinal metaplasia  Dysplasia  Carcinoma </li></ul></ul><ul><ul><li>Also- MALToma </li></ul></ul>
  10. 11. Etiology- H. Pylori <ul><li>Mechanism of production of gastritis </li></ul><ul><ul><li>Inflammatory cytokines- IL- 1,6,8, TNF </li></ul></ul><ul><ul><li>Epithelial injury- Urease, protetease, Phospholipase </li></ul></ul><ul><ul><li>Impairs duodenal bicarbonate production </li></ul></ul><ul><ul><li>Thrombotic occlusion of surface capillaries- Bacterial PAF </li></ul></ul>
  11. 12. Etiology- H. Pylori <ul><li>Tests </li></ul><ul><ul><li>Biopsy- H&E, Geimsa, Warthin Starry, Steiner silver, Aclian yellow tuleidine blue method, IHC </li></ul></ul><ul><ul><li>Serology- Elisa </li></ul></ul><ul><ul><li>Urea breath test- C13/C14 urea </li></ul></ul><ul><ul><li>Culture and sensitivity </li></ul></ul><ul><ul><li>Bacterial DNA detection by PCR </li></ul></ul>
  12. 14. Etiology- NSAIDS & Steroids <ul><li>Inhibit cyclo-oxygenase  Reduced PG  Reduced cytoprotection  Mucosal injury </li></ul>
  13. 15. Etiology <ul><li>Emotions </li></ul><ul><li>Diet </li></ul><ul><li>Pylorodudenal reflux </li></ul><ul><li>Endocrine- Zollinger Ellison, Cushing </li></ul><ul><li>Trauma </li></ul><ul><li>Smoking </li></ul><ul><li>Hereditory- Blood Gr O </li></ul>
  14. 16. Etiology <ul><li>Curling ulcer- Stress produced by hypotension, endotoxic shock, MI, Burns </li></ul><ul><li>Cushing ulcer- Increased intracranial tension </li></ul>
  15. 18. Sites <ul><li>Duodenum- 4X- First Part </li></ul><ul><li>Stomach- 1X- Antrum </li></ul><ul><li>Barrette’s esophagus </li></ul><ul><li>Jejunum in ZE syndrome </li></ul><ul><li>Meckel’s diverticulum with ectopic gastric mucosa </li></ul><ul><li>Margins of gatro-jejunostomy </li></ul>
  16. 19. Morphology- Acute Gross <ul><li>Multiple </li></ul><ul><li>1-2mm </li></ul><ul><li>Shallow and do not invade muscular coat </li></ul>
  17. 20. Morphology- Acute Micro <ul><li>Neutrophils above basement membrane </li></ul><ul><li>Erosion not crossing muscular mucosa </li></ul><ul><li>Fibrinous exudate </li></ul>
  18. 22. Morphology-Gross <ul><li>Single, round to oval </li></ul><ul><li><2cm </li></ul><ul><li>Lesser curvature </li></ul><ul><li>Punched out </li></ul><ul><li>Scarring involving entire thickness  Puckering of surrounding mucosa, borders at the levels of surrounding mucosa </li></ul><ul><li>Base- Smooth, clean </li></ul>
  19. 23. Morphology-Gross <ul><li>Single, round to oval </li></ul><ul><li><2cm </li></ul><ul><li>Lesser curvature </li></ul><ul><li>Punched out </li></ul><ul><li>Scarring involving entire thickness  Puckering of surrounding mucosa, borders at the levels of surrounding mucosa </li></ul><ul><li>Base- Smooth, clean </li></ul><ul><li>Malignancy </li></ul><ul><li>Irregular </li></ul><ul><li>Large </li></ul><ul><li>Lesser curvature </li></ul><ul><li>Heaped up, irregular margin </li></ul><ul><li>Shaggy necrotic base </li></ul><ul><li>Invasion of tumor tissue into surrounding area </li></ul>
  20. 24. Morphology- Chronic Micr0- 4 Layers <ul><li>Surface debris </li></ul><ul><li>Neutrophils </li></ul><ul><li>Granulation tissue </li></ul><ul><li>Collagen </li></ul>
  21. 26. Clinical Features <ul><li>Abdominal pain- Epigastric, burning type, vomiting (Relieves), episodic </li></ul><ul><ul><li>Food aggravates- Gastric </li></ul></ul><ul><ul><li>Food relieves- Duodenal </li></ul></ul><ul><li>Hematemesis, malena </li></ul>
  22. 27. Investigations <ul><li>Blood- Anemia </li></ul><ul><li>Stool-Occult blood </li></ul><ul><li>Barium meal </li></ul><ul><li>Endoscopy- H.Pylori, Malignancy </li></ul><ul><li>H.Pylori </li></ul><ul><li>Gatsric function tests- Obsolete </li></ul>
  23. 28. Complications <ul><li>Bleeding- 15-20% </li></ul><ul><li>Perforation- 5% </li></ul><ul><li>Obstruction due to edema and scarring </li></ul>
  24. 29. Other gastritis <ul><li>Eosinophilic </li></ul><ul><li>Lymphocytic </li></ul><ul><li>Granulomatous </li></ul><ul><li>Hemorrhagic </li></ul><ul><li>CMV </li></ul><ul><li>Radiation/ chemotherapy </li></ul><ul><li>Autoimmune </li></ul><ul><li>Xanthogranulomatous </li></ul>
  25. 30. Gastric Tumors
  26. 31. Classification <ul><li>Epithelial </li></ul><ul><ul><li>Adenoma </li></ul></ul><ul><ul><li>Adenocarcinoma- Papillary, tubular, mucinous, signet ring, undifferentiated, adenosquamous </li></ul></ul><ul><ul><li>Small cell carcinoma </li></ul></ul><ul><ul><li>Carcinoid tumor </li></ul></ul><ul><li>Non Epithelial </li></ul><ul><ul><li>Leiomyoma </li></ul></ul><ul><ul><li>Schwannoma </li></ul></ul><ul><ul><li>GIST </li></ul></ul><ul><ul><li>Lymphoma </li></ul></ul>
  27. 32. Carcinoma of Stomach
  28. 33. Epidemiology <ul><li>Higher in Japan, China compared to US, UK </li></ul><ul><li>More common in lower socio-economic groups </li></ul><ul><li>Male to Female ratio is 2: 1 </li></ul><ul><li>Steady decline in incidence & mortality for the past 6 decades </li></ul>
  29. 34. Etiology <ul><li>H.Pylori </li></ul><ul><li>Diet- Salted/smoked food, nitrates </li></ul><ul><li>Smoking and alcohol </li></ul><ul><li>Decreased gastric acid secretion- Proton pump inhibitors, atrophic gastritis </li></ul>
  30. 35. Morphology Gross <ul><li>Sites- </li></ul><ul><ul><li>Antrum- 50% </li></ul></ul><ul><ul><li>Body- 30% </li></ul></ul><ul><ul><li>Cardiac- 20% </li></ul></ul><ul><ul><li>MC site- Lesser curvature </li></ul></ul>
  31. 36. Morphology Gross <ul><li>Cauliflower like </li></ul><ul><li>Infiltrating with dense fibrosis- Linitis plastica </li></ul><ul><li>Ulcerative- Heaped up beeded margins </li></ul>
  32. 39. Morphology Micro- (DIO/ Lauren) <ul><li>Diffuse- Signet ring cells </li></ul><ul><li>Intestinal- Similar to intestinal adenoca </li></ul><ul><li>Others </li></ul>
  33. 42. Early Gastric Ca (Superficial/ microinvasive Ca) <ul><li>Ca confined to mucosa and submucosa regardless of status ofregional lymph nodes </li></ul>
  34. 43. Clinical Features <ul><li>Ulcer like pain </li></ul><ul><li>Weight loss, anorexia </li></ul><ul><li>Hematemesis </li></ul><ul><li>Palpable epigastric mass </li></ul>
  35. 44. Clinical Features <ul><li>Meatstasis to </li></ul><ul><li>Left axillary nodes </li></ul><ul><li>Supraclavicular nodes </li></ul><ul><li>Umbilicus </li></ul><ul><li>Ovaries </li></ul><ul><li>Pouch of Douglas </li></ul><ul><li>Called as </li></ul><ul><li>Irish nodes </li></ul><ul><li>Virchow nodes/ Trousier </li></ul><ul><li>Sistem Mary Joseph Nodule </li></ul><ul><li>Kruckenberg tumor </li></ul><ul><li>Blummer’s shelf </li></ul>
  36. 45. Clinical Features <ul><li>Paraneoplastic syndromes </li></ul><ul><li>Trousseaus’ sign </li></ul><ul><li>Acanthosis nigricans </li></ul><ul><li>Dermatomysitis </li></ul>
  37. 46. Investigations <ul><li>Endoscopy </li></ul><ul><li>Exfoliative brush cytology </li></ul><ul><li>Barium meal </li></ul><ul><li>CT, USG </li></ul>
  38. 47. Staging <ul><li>T1- Submucosa </li></ul><ul><li>T2- Muscularis Propria </li></ul><ul><li>T3- Penetration of serosa </li></ul><ul><li>T4- Adjacent structures </li></ul><ul><li>N1- Regional LN </li></ul><ul><li>N2- Distant LN </li></ul><ul><li>M1- Distant mets </li></ul>
  39. 48. Staging <ul><li>I- T1N0M0/T1N1M0/T2NoMo </li></ul><ul><li>II-T1N2M0/T2N1Mo/T3N0M0 </li></ul><ul><li>III- T2N2M0/T3N1M0/T4NoM0 </li></ul><ul><li>IV- T4N2M0/T any N any M1 </li></ul>
  40. 49. Prognostic markers <ul><li>Stage </li></ul><ul><li>Grade </li></ul><ul><li>Hsitologic type </li></ul><ul><li>P53, c-ERB-2 </li></ul><ul><li>Location </li></ul><ul><li>Inflammatory raection </li></ul><ul><li>Perneural invasion </li></ul>
  41. 50. <ul><li>5 year survival rate </li></ul><ul><li>90 - 95 % in surgically treated early carcinoma </li></ul><ul><li>< 15 % in advanced carcinoma </li></ul>
  42. 51. Thank You…
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