Nathu singh rathore

Gastrointestinal System Pathanatomy

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Anubhuti DaveGroup 21Semester 5th

276. A 49-year-old female taking ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctate hemorrhagic areas in her gastric mucosa. Biopsies from one of these hemorrhagic lesions reveal mucosal erosions with oedema and haemorrhage. No mucosal ulceration is seen. What is the best diagnosis?

a. Active chronic gastritisb. Acute gastritisc. Autoimmune gastritisd. Chronic gastritise. Peptic ulcer disease

276. The answer is B. Gastritis is a nonspecificterm that describes any inflammation of the gastric mucosa. Acute gastritis refers to the clinical situation of gastric mucosal erosions (not mucosal ulcers). Acute gastritis is also known as hemorrhagic gastritis or acute erosive gastritis. Acute gastritis is associated with the use of non-steroidalanti-inflammatory drugs, such as aspirin, ibuprofen, and corticosteroids, and also with alcohol, chemotherapy, ischemia, shock, and even severe stress. Microscopically the gastric mucosa from a patient with acute gastritis is likely to reveal mucosal erosions, scattered neutrophils, edema, and possibly haemorrhage.

A - Active chronic gastritisHelicobacter pyloriis the most important etiological agent of chronic active gastritis.The pathogenic mechanisms leading from chronic active inflammation of the gastric mucosa to the development of the epithelial and lymphoid alterations that may result in ulceration, metaplasia, cancer, and lymphoma remain poorly understood.The basic features of humanH. pyloriinfection (an intense, mostly antral or diffuse chronic active gastritis), its later complications (mucosal atrophy and intestinal metaplasia), or its associated diseases (peptic ulcer, gastric carcinoma, and lymphoma).

C. Autoimmune gastritisAutoimmune gastritis (AG) is an inflammatory condition of the stomach that is associated with auto-antibodies to parietal cells and intrinsic factor and can lead in a small percentage of patients to destruction of the oxyntic mucosa, pernicious anemia, and the development of carcinoid tumors that are typically indolent. Autoimmune gastritis. Diffuse mononuclear infiltrates within the lamina propria that are heavier in the deeper, glandular portions

(A). Patchy lymphocytic infiltrates and damage to oxyntic glands (B). Parietal cell pseudohypertrophy with "snouting" resulting from luminal cytoplasmic projections (C). Metaplastic epithelium of the intestinal (D), pyloric (E), and pancreatic acinar types (F). Linear enterochromaffin cell-like cell hyperplasia on hematoxylin and eosin stain (G) and with chromogranin stain (H).

D. Chronic gastritisChronic gastritis involves swelling or inflammation of the stomach lining. If you have this condition, you might feel full after eating just a few bites.Causes of chroinc gastritis - long-term use of certain medications (aspirin and ibuprofen)excessive alcohol consumptionbacteria that cause stomach ulcers (H. pylori)certain illnesses (kidney failure)a viral infection in a weakened immune systempersistent, intense stressbile flowing into the stomach (called bile reflux)Symptoms-upper abdominal pain indigestion or bloating nausea and vomiting Belching loss of appetite or weight loss

E. Peptic ulcer diseasePeptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum. Causes of ulcer-Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of Midol, and others), and many others available by prescription; even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.Excessive drinking of alcohol ,Smoking or chewing tobacco, Serious illness ,Radiation treatment to the areaSymptoms-Dark or black stool (due to bleeding)Vomiting blood (that can look like "coffee-grounds")Weight lossSevere pain in the mid to upper abdomenBleedingPerforation (a hole through the wall of the stomach)Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine

277. A biopsy of the antrum of the stomach of an adult who presents with epigastric pain reveals numerous lymphocytes and plasma cells within the lamina propria, which is of normal thickness. There are also scattered neutrophils within the glandular epithelial cells. A Steiner silver stain from this specimen is positive for a small, curved organism, which is consistent with

a. Enteroinvasive Escherichia colib. Enterotoxigenic E. colic. Helicobacter pylorid. Salmonella typhie. Shigella species

Answer C.Chronic gastritis

is histologically characterized by the presence of lymphocytes and plasma cells. It is important to realize that the presence of neutrophils within the glandular epithelium indicates active inflammation and may be the main type of inflammation present (acute gastritis), or may be combined with more numerous chronic inflammations (active chronic gastritis). Chronic gastritis is divided into subgroups based either on etiology (immunologic or infectious), location (antrum or body), histopathology, or clinical features. H. pylori gastritis is associated with infection by H. pylori, a small, curved, gram-negative rod that is found in approximately 20% of the general population. The organisms are found in the mucus overlying the surface/foveola epithelium. These changes tend to affect primarily the antral or antral-body-fundic mucosa.

A. Enteroinvasive Escherichia coli

EnteroinvasiveEscherichia coli(EIEC) infection causes a syndrome that is identical toShigellosis, with profuse diarrhea and high fever. EIEC are highly invasive, and they utilize adhesin proteins to bind to and enter intestinal cells. They produce no toxins, but severely damage the intestinal wall through mechanical cell destruction. Dysentery caused by EIEC usually occurs within 12 to 72 hours following the ingestion of contaminated food. The illness is characterized by abdominal cramps, diarrhea, vomiting, fever, chills, and a generalized malaise. Dysentery caused by this organism is generally self-limiting with no known complication. EnterohemorrhagicE. coli(EHEC): A type of EHEC, E.coli 0157:H7, can cause bloody diarrhea andhemolytic uremic syndrome (anemia and kidney failure).

B. Enterotoxigenic E. coliEnterotoxigenicEscherichia coli(ETEC) is a type ofEscherichia coliand the leading bacterial cause ofdiarrheain the developing world, as well as the most common cause oftravelers' diarrhea.Enterotoxins produced by ETEC includeheat-labile enterotoxin(LT) andheat-stable enterotoxin(ST)Because enterotoxicE. colistrains are non-invasive, they do not cause inflammation. Infection with ETEC can cause profuse watery diarrhea with no blood nor leukocytes and abdominal cramping. Fever, nausea with or without vomiting, chills, loss of appetite, headache, muscle aches and bloating can also occur but are less common.

D. Salmonella typhiTyphoid fever is caused bySalmonellaserotypes which are strictly adapted to humans or higher primatesthese includeSalmonella Typhi, Paratyphi A, Paratyphi B and Paratyphi C. In the systemic form of the disease, salmonellae pass through the lymphatic system of the intestine into the blood of the patients (typhoid form) and are carried to various organs (liver, spleen, kidneys) to form secondary foci (septic form).

Endotoxins first act on the vascular and nervous apparatus, resulting in increased permeability and decreased tone of the vessels, upset thermal regulation, vomiting and diarrhea. In severe forms of the disease, enough liquid and electrolytes are lost to upset the water-salt metabolism, decrease the circulating blood volume and arterial pressure, and causehypovolemic shock.Septic shockmay also develop. Shock of mixed character (with signs of both hypovolemic and septic shock) are more common in severesalmonellosis.Oliguriaandazotemia develop in severe cases as a result of renal involvement due tohypoxia andtoxemia.

E. Shigella species

Shigellosis is caused by a group of bacteria calledShigella. Symptoms usually develop about 1 to 7 days (average 3 days) after you come in contact with the bacteria.Symptoms include:Acute (sudden)abdominal painor crampingAcute (sudden) feverBlood, mucus, or pus in stoolCrampy rectal pain (tenesmus) ,Nausea and vomiting ,Watery diarrhea. During infection, it typically causesdysentery.Shigellais one of the leading bacterial causes of diarrhea worldwide. Insufficient data exist, but conservative estimates suggestShigellacauses about 90 million cases of severe dysentery, with at least 100,000 of these resulting in death, each year, mostly among children in the developing world.

278. A 51-year-old male presents with epigastric pain that is lessened whenever he eats. A gastroscopy is performed to evaluate these gastric symptoms and a solitary gastric ulcer is seen. This ulcer is round and ha punched-out straight walls. The margins of the ulcer are slightly elevated, and gastric rugae radiate outward from the ulcer. Based on these findings, in order to relieve the epigastric pain this patient should

a. Take indomethacin twice a dayb. Abstain from smokingc. Eat only two meals per dayd. Drink alcohol with his evening meale. Have surgery to resect the ulcer

Answer B. Abstain from smoking

abstaining from substances or actions that increase gastricacid production, such as coffee, alcohol, and prostaglandin productioninhibitors, which include aspirin, indomethacin, ibuprofen, and smoking. smoking may put you at greater risk of developing an ulcer and slow down your recovery.

A. Take indomethacin twice a dayIndomethacin is anonsteroidal anti-inflammatory drug(NSAID) that reducesfever, pain and inflammation. It is similar toibuprofen(Motrin) andnaproxen(Naprosyn, Aleve). Indomethacin works by reducing the production of prostaglandins.Indomethacin is used for the treatment of inflammation caused byrheumatoid arthritis,ankylosing spondylitis, gouty arthritis, osteoarthritis, and soft tissue injuries such as tendinitis andbursitis. NSAID drugs are not usuful during treatment of ulcer.

C - Eat only two meals per day.

Because food neutralizes acid withinthe stomach and relieves the typical epigastric pain of peptic ulcer disease,patients are advised to eat frequent small meals.so we order to patient to take more time small amount of meal frequently not only two times

D. Drink alcohol with his evening meal

Additional therapeuticmeasures include abstaining from substances or actions that increase gastricacid production, such as coffee, alcohol, and prostaglandin productioninhibitors, which include aspirin, indomethacin, ibuprofen, and smoking

E. Have surgery to resect the ulcer

Your doctor will prescribe medicines called proton pump inhibitors (PPIs) to reduce the amount of acid in stomach produces and help the ulcer to heal. This is the main medicine prescribed to treat ulcers. Medicines include omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.PPIs reduce acid production in stomach, allowing ulcer to heal. Patient need to take the medicines for about six to eight weeks. Your doctor may prescribe other medicines such as H2 blockers if you dont respond to treatment with PPIs. If youre taking NSAIDS for medical reasons (for example, you need to take a daily aspirin to prevent heart disease), your doctor may prescribe PPIs long-term to control your symptoms and prevent gastric ulcers. There is no need to surgery