Gi system

1. Gastritis
Gastropathies
TODAY’S TOPIC

2. Gastritis & Gastropathies
Definition
Classifications:
Duration
Anatomic location
Histologic
Pathogenic mechanism

3. Classification
1-Acute Gastritis
Acute H-pylori infection
Other types of infection
2-Chronic atrophic Gastritis
Type A:Autoimmune,Body predominant
Type B:H-pylori related,Antral predominant
indeterminate

4. 3-Uncommon forms of gastritis
Lymphocytic
Eosinophilic
Crohn’s disease
Sarcoidosis
Granulomatous Gastritis
Russell body gastritis
Menetrier’s disease

5. Acute Bacterial
Gastritis:H-pylori related
Causes mild symptoms
Histologic view :Neutrophillic
gastritis
Diagnosis of acute infection:positive
Urea Breath test and negative Anti H-
pylori iGg antiobody
Strain that related to acid
secretion:CAG A

6. Phlegmonous
Gastritis
Rare but deadly
I. Acute necrotizing gastritis
II. Emphysematous gastritis
Affects:Submucosa and Muscularis
Propria
Occurs in
Alcoholics,Immunocompromise
patients ,URTIs
Common
organisms:Streptococci,Staphylococci
,Hemophus , E-coli

7. Continue Phlegomonous gastritis
Signs & Symptoms:Epigastric Pain,Perionitis,Fever ,Hypotension
Diagnosis:Radiography,Ultrasound,CT scan,Gastroscopy
Gross view:
Microscopic view:
Mortality rate:60%
Treatment:
Resection or Drainage
Broad-spectrum Antibiotics

11. Mycobacteria
oRare
oMost commonly associated with Lung TB
oSymptoms:Abdominal pain,Nausea,vomiting
oDiagnosis
•Endoscopy :ulcers,Gastric outlet
obstruction,masses
•Biopsy:Necrotizing Granulomas,

12. Syphilis
oRadiography:nonspecific gastritis
with thickened mucus layer
•Endoscopy :Irregular ulcers, White
exudates
•Serologic:Positive VDRL for
treponema pollidum

13. Viral Gastritis
•Common in immunocompromise patients
•Symptoms:Fever,Epigastric pain
•Endoscopy:Mucus layer is oedematous,congestive and ulcerative
•Treatment:Gancyclovie,foscarnet,Acyclovir
Cytomegalovirus Herpes simplex virus Epsteinbarrvirus Varicella zoster virus

14. Fungal gastritis
•Common in: immunocompromised and cancer patients,Antibiotic and coriticosteroid use
•Symptoms:Fever,Epigastric pain
•Endoscopy:Aphtoid erosion and ulcers
•Treatment:Amphotericin B
Candidiasis Histoplasmosis Phycomycosis
Pythiuminsidiosum
Aspergillosis

15. Parasitic infection
•Common in immunocompromise patients
•Diagnosis:Biopsy,serologic tests
•Endoscopy:parasite can be seen in stomach and duodenum
•May causes obstruction and GI bleeding
Cryptosporidiosis Ascariasis Anisakis Strongyloidiasis
Strongyloidesstercorali
s

16. REACTIVE GASTROPATHIES
Acute erosive Gastritis
Definition
Risk factors: NSAIDs,Alcohol,Portal hypertensive
gastropathy
Cocaine ,stress , Radiation,Bile reflex
,Ischemia,Prolapse and hernia,
Medications: Iron
supplements,KCL.Biphosphonates,Mercury
Sulfate,Chemotherapy,Alcohol

17. Portal
hypertensive
gastropathy
o65% of Liver cirrhosis
patients
oCause Erosion and ulcers
in stomach
oTREATMENT:medication
and portosystemic shunt

18. Continue Acute Erosive Gastritis
COCAINE:crack cocaine
STRESS:trauma,schock ,sepsis,
BILE REFLUX:Billroth 1-2
ISCHEMIA:chronic mesenteric insufficiency
PROLAPSE&HIATAL HERNIA: vomiting and retching cause prolapse of
stomach cardia area in esophagus

19. Chronic gastritis
Chronic inflammation of stomach with infiltration of Lymphocytes,plasmacells
and neutrophils
Histologic classification;
1) Superficial atrophic changes -lamina propria
2) Gastric atrophy- gastric glands
Atrophic Gastric glands >goblet cells [increased risk for cancer]
Classification by location:
1. Type A
2. Type B
3. AB gastritis

20. Type A Gastritis
Common in Pernicious Anemia
Body predominant
Autoimmune
ANTi intrinsic factor antibody in 40% OF Pernicious anemia
Anti parietal cell antibody
Achlorhydria
hypergastrinemia
ENDOSCOPY: Thin mucosa,intestinal metaplasia

21. Type B Gastritis
Antral Predominant
Common in older age
H-Pylori Related
ENDOSCOPY: Red streaks
RADIOGRAPHY:thickened gastric mucus
DIAGNOSIS : 2 Biopsy from lesser curvature and greater curvature

22. AB Gastritis(multifocal atrophic
gastritis)
Body and Antrum
Intestinal metaplasia
85% of cases are H-pylori related
TREATMENT:
LOW GRADE B CELL LYPHOMA-H-pylori eradication
HIGH GRADE B CELL LYMPHOMA

23. Miscellaneous types of Gastritis
a. Lymphocytic Gastritis
b. Eosinophilic Gastritis
c. Granulomatous Gastritis
d. Russell body Gastritis
e. Meneterier’s disease

24. Lymphocytic Gastritis
Varioliform gastritis
oMost common with H—pylori and celiac sprue
oGluten free diet improve symptoms
Endoscopy:thickened mucus, nodularitly
,erosion
Biopsy:Infiltration of
lymphocyte,plasmacell,neutrophils
Treatment:glucocorticoid and sodium
cromoglycate

25. Eosnophillic gastritis
Systemic allergy
Radiography::thickened
mucus, nodularitly
,ulceration
Treatment:Steroids
,surgery in obstruction

26. Granulomatous gastritis_Crohn’s Disease
Symptoms:Nausea ,vomiting,,Anorexia
,Weight loss,Epigastric pain
Radiography:ulceration,Stricture
Endoscopy:erosion,cobblestone
Treatment:PPI plus treatment of
crohn’s disease

27. Russel body gastritis
Unknown etiology
benign
Pseudotumour endoscopic
appearance
Histologically defined presence of
plasma cells containing Russell
bodies
Resoulution of lesion s with H-
pylori eradication

28. Meneterier disease
Large mucosal fold
Premalignant
Age 40-60
High TGF_alpha level
Symptoms;nausea
,vomiting,,weight loss ,anorexia
TREATMENTPPI,prostaglandins,
somatostatin analogues,h2
receptor
blockers…:Gastrectomy