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Powerpoint on pathology of diseases of stomach

Powerpoint on pathology of diseases of stomach

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2 stomach girish_10_11 2 stomach girish_10_11 Presentation Transcript

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