GASTRITE

GASTROPATII

DEFINIIEGastritele : afeciuni gastrice ac/crasociaz leziuni inflamatoriietiologie i patogenez multiplclinic asimptomatice/simptome nespecificeGastropatiile :grup de leziuni mucosale gastricedominant epiteliale/vascularecomponenta inflamatorie minim/absent

Criterii de CLASIFICAREClinico-evolutiveGastrite ACUTE : pot fi afectate straturile profunde gastrice, evoluie spre vindecare (cronicizare rar)Gastritele CRONICE: proces extins la suprafa i n profunzimeevoluie spre vindecare( rar)/g. atrofic/atrofie G

Criterii endoscopice : Formele endoscopice : a)G. eritematoas eroziv :eritem 2-3mmdiseminate pe muc. N+/- acoperite exudat albiciosmuscularis mucosae integr b) G. maculo-eroziv : pete eritematoase 3-15mm ulceraii superficiale detritus alb-cenuiu halou periulceraieleziuni acute

G. papulo-eroziv: leziuni protruzive 3-5mm cu excavaie central-varioliform leziuni croniceG.atrofic : mucoas plat/abs. pliurilor/palid vascularizaie superficial vizibilG. hipertrofic : pliuri nalte 1cm grosime 3-5 mmf) G. hemoragic: puncte/pete hemoragice hemoragie difuz/cheaguri

Topografia leziunilor endoscopice : a) G. antral (tip B) : antru/potenial extindere corp H.p. + b) G. fundic (tip A) : corp + fundus gastric autoimun se asociaz cu an. Biermer c) G. multifocal : atrofie la limita antru-corp cu extindere proximal/distal hipoclorhidrie/UG/NeoG d) Pangastrita : afecteaz ntreg corpul gastric leziuni mai severe n antru

Criterii histologice : (fundamental)G. acut : domin PMN abcese cripticeG. cronic : l, Pl evoluie zeci de ani spre g. atrofic iniial superficial (corion) ,apoiprofund (moderat/sever)2 forme :inactiv (PMN-) activ (PMN+) = n corion/ntre cel. epit./glandeG. atrofic : stadiul final de evoluie g. cr. dispar glandele oxintice +/- metaplazie intestinal

Etiologia:G. infecioase : baterii/vir./fungi/paraziiG. autoimunG. medicamentoas : AINS, CST, FeG. specifice : B. Crohn, g. eozinofilic

.GASTRITA CRONICA PREDOMINENT ANTRALA (B)H.p. + frecvent asimptomaticEDS : necaracteristicN/eritem, maculo-erozivHistologia : gastrit superficial II cr. difuz, PMN n lamina propria i epiteliu foliculi limfoizimetaplazie intestinal

Helicobacter Pylori germene G(-) 0,2-0, 5m spiralat, flagelat colonizeaz antrul/jonciunile intercel. NU PTRUNDE N CELULE

. GASTRITA CRONIC ATROFIC MULTIFOCALEDS : mucoas palid, vase proeminente, platPatogeneza: H.p.+ (85%)factori genetici (scandinavia, Am cent/sud) mediu, dietaHisto -Metaplazia intestinal :semnificaie -marker de atrofie ( HCl, gastrin)risc displazie/Neo G intestinal

GASTRITA CRONIC ATROFIC CORPOREAL DIFUZ(TIP A)EDS :pierderea pliurilor gastricemuc. fundic subiatatrofie glandular + metaplazie intestinal (corp + fund gastric) Patogeneza :distrucie autoimun gl. fundicefrecven (sub 5% din g. Cr. )

Histo : hiperplazie cel. G antraleAc anti F.I/ Ac anticel. parietale gastrice- anemie pernicioas+/- metaplazie int. incomplet (tip colonic) :risc Neo G/ tumor carcinoidaclorhidrie/hipergastrinemie sec.

GASTRITE INFECIOASEVirale : CMV : imunodeprimai (neo, SIDA) Clinic:epigastralgii, T0 ;Pclinic: limfocitozEDS : mucoas edemaiat, congestiv cu ulceraii, mas tumoralDgs. : CMV intracel. la biopsieHerpesvirus : simplex/zoster rarimunodeprimaiEDS: ulceraii mici, multiple

Bacteriene G. acut H.p. +Morfologie : II PMN + n corionClinic : epigastralgii acute/severe,grea, vrsturi aclorhidriela copil/durat zileEvoluie : vindecare spontan/ cronicizare

Gastrita supurativ (flegmonoas)infecie bacterian submuc. + muscrisc gastrit ac. necrotizant (gangren)Etiologia : Alcool/IARCS/SIDAClinic :epigastralgii acuteperitonit ac. purulentT0 , hTA,oc septic

EDS intraoperator : perete ngroat, edemaiatperforaii multiplemucoas granular/exudat negru-verzui/puroiHistologie : infiltrat intens PMN/germenitromboze/necroze extinseDg+ frecvent intraoperatormortalitate 60%Tratament : rezecie gastric + ATB

Gastrita emfizematoasClostridium welchiiapare dup :chirurgie G-Dingestie coroziveinfarct gastrointestinal Dg + Rx = bule de gaz perete gastricGastrita cu micobacterii TBC gastric, actinomices, treponema pallidum - HDS

3. Fungice : Candida albicans : imunodeprimaieroziuni aftoide+ulceraii lineare

4. Parazitare : Strongiloides stercoralis-Ascarizi ghemHDS

GASTRITE GRANULOMATOASEBoala Crohn: rar afectare S + intestingrea, vrsturi, epigastralgii,GRx: ngrori de mucoas stenoz antruulceraii aftoide EDS : ulceraii serpiginoase longitudinalelocalizare antral preponderentHisto : - granuloame, II cr., fibroz submucoasSarcoidoza rarAmiloidozaBoala Wipple

GASTRITA LIMFOCITAR (VARIOLIFORM) Infiltrat limfocitar dens n epiteliuasociere frecvent cu H.p. / boala celiacEDS : pliuri mucoase ngroate/nodozitieroziuni aftoide (aspect varioliform)Histo : infiltrat cu Pl, l, rare PMN n antru/corp

GASTRITA EOZINOFILIC(gastroenterita eozinofilic)eozinofilieinfiltrat II cu Eoz n peretele Tr. Dig.

afectare mucoas intestinal dureri abdominalegreuri, vrsturidiareeGpierdere de proteine enteralafectare muscular int: - ocluzii/ascit cu Eozafectare gastric : - stenoz gastricDg + : - biopsii = infiltrat cu Eoz/necoze Tratament : - CST, cromoglicat de Na

GASTROPATII REACTIVE(C)Definiie = G. Acute afectarea muc. gastrice de factori multiplinu apare II semnificativ

AINS cea mai frecvent gastropatieleziuni localizate difuz/fornix+corperoziuni + hemoragii mici submucoase multiplefrecvent asimptomatice (50%)dispesie, pirozisTerapia cu Fe++ p.o. ,KCl, terapia antineo i.a.eritem, hemoragii subepiteliale

Alcoolulhemoragii subepitelialeNU inflamaie intens muc.Frecvent asociaz gastrit cr. antral H.p +accentuare lez. + AINSliposolubil = afecteaz membrana cel. epiteliu Cocaina Eroziuni exudative difuzeHDS, perforaie gastric Stresul : eroziuni/ulcerul de stresIradierea gastric ulcer antral

Refluxul biliar-GASTRITA DE REFLUXgastroduodeno-/jejuno-anastomozcolecistectomizaiEDS : edem/hiperemie,eroziunibil n stomacHisto : hiperplazie foveolarglande chistice/dilatate/atipicecel. inflamatorii raregastrit atrofic n final

Gastrita de reflux

Gastropatia cronic ischemic: ICC;ASS;Maratoniti

Gastropatia portal-hipertensiv60% din HTPEDS : forma uoar : mozaicat (piele arpe)hiperemicrash scarlatinifornforma sever: spoturi hemoragice difuzesngerare difuz gastric Localizare : fornix/orice zon a SHistologic : Ectazii vasculare n mucoasII redus

GASTROPATIA PORTAL HIPERTENSIVA form gravSpoturi hemoragice difuze

GASTROPATIILE HIPERPLASTICE: Boala Menetrier Sindromul Zollinger-EllisonBOALA MENETRIER(gastropatie hipertrofic)frecven redusetiopatogenez necunoscutAnat-pat: pliuri hipertrofice gigante fornix+corp1,5 x 1 cm/meninere la insuflareaspect cerebriform-obstrucie antrumucus n exces pe S2 pliuriloreroziuni superficiale pe creste

Histologic: hiperplazie foveolar masiv tip chisticglande oxintice atrofiate +/- metaplazie pseudopiloricedemTGF alfa:- cel. mucosale - cel. parietale

Clinica : preponderent B peste 50 anidisconfort epigastric G, diaree, edeme20%-100% hipoalbuminemie prin pierdere la nivelul jonciunilor i. Cel.

Rx : -pliuri hipertrofice fornix/corpS.A.G: hiposecreie/hipoclorhidrie minim gastrinemieiDGS+: EDS + biopsie mucoasD.Dif. : limfom gastric (ulcere multiple) MALT cel. B/H.p.S. Zollinger-Ellison

Tratament anticolinergiceIPP/BRH2eradicare H.p.CST/octreotidAc monoclonali anti receptor TNFrezecie gastric : - hipoalbuminemie -HDS -risc malignEvoluie : - risc AK gastric (15%)autolimitat la cei sub 10 aniforma postpartum complet rezolutiv (CMV+ i activare TGF alfa)

GASTRITA ACUTGastrit fundic i gastrit eroziv la o pacient cu grea, vrsturi i sngerare gastrointestinal ocult

GASTRIT CRONIC DIFUZ la o pacient de 86 de ani cu sngerare gastro-intestinal i durere abdominal

Left: 74 year-old man with recent hematemesis (vomiting blood), who had been taking NSAIDS and drinking alcohol. Endoscopy demonstrated antral gastritis with multiple small, superficial ulcers. Center: 75 year-old woman with upper abdominal pain and blood in the stool, who had been taking NSAIDS for arthritis. Endoscopy revealed patchy gastritis in the gastric fundus and in the antrum (shown here). Biopsies were negative for Helicobacter pylori. Right: 35 year-old man with chronic dyspepsia and pyrosis poorly responsive to proton-pump inhibitor and metoclopramide therapy. After endoscopy demonstrated erosive antral gastritis, he admitted to regularly taking 15-20 ibuprofen daily, as well as occasionally taking as many as 20 aspirin tablets daily

LEFT: 72 year-old woman with hematemesis (vomiting blood). In addition to this inflammatory process involving the gastric body and antrum, she also had a small gastric ulcer. Biopsies and Clotest were both positive for Helicobacter pylori. RIGHT: 55 year-old man with dyspepsia. Endoscopy revealed multiple erosions and small ulcers; biopsies were positive for H. pylori.

LEZIUNI MACULARE ANTRALE LA O PACIENTA MALNUTRITA DE 90 DE ANI GASTRITA CU Candida.

LEZIUNI ERITEMATOASE FUNDICE LA PACIENT INFECTAT CU HIV-BIOPTIC INCLUZIUNI DE CITOMEGALVIRUS