GASTRITIS Year 4 Internal Medicine Notes OmpathStudy

GASTRITIS Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.1 / ALEX -- Slide 1 GASTRITIS Dr Alex Mogere Consultant Physician Slide 2 Sections of the human stomach Slide 3 Gastric gland and gastric wall: histology diagram Slide 4 Approach Defn. Classification Causes Invxs. TX. Prognosis Slide 5 Intro Gastritis refers to inflammation of the gastric mucosa with sparing of the muscularis mucosa. This is a histological diagnosis though it is used loosely on clinical grounds for cases of dyspepsia. The causes can be many but there are some that are more common in clinical practice. Gastritis can be classified based on time course (Acute Vs Chronic), histological features and anatomical distribution. Slide 6 Acute gastritis Note: This is a histological diagnosis. Features include on histology: mucosa infiltration with neutrophils and oedema. often erosive and haemorrhagic Commonly caused by infection especially H. pylori and other non H. pylori infections. Chemical causes- NSAIDS, Alcohol, corrosives. often produces no symptoms but may cause dyspepsia, anorexia, nausea or vomiting, acute onset of epigastric pain and haematemesis or melaena. If not treated, it may evolve into chronic gastritis. Slide 7 Common causes of gastritis Slide 8 Chronic gastritis It is identified by the presence of lymphocytes and plasma cells with scanty neutrophils in the histological biopsy. The inflammation may be mild involving the superficial portions of the mucosa or severe with glandular destruction and atrophy. Slide 9 Ct.chronic gastritis Superficial chronic gastritis- inflammatory changes are limited to the lamina propria with the gastric glands spared. Atrophic gastritis- Inflammation extends deeper into the mucosa with distortion and destruction of the glands. Gastric atrophy- glandular tissue is completely lost, few inflammatory cells are seen. May have achlorhydria, megaloblastic anaemia Slide 10 Causes of chronic gastritis H. Pylori infection ( Antral predominant) Autoimmune diseases ( Pernicious anaemia) Post gastrectomy Other infections- TB, CMV Inflammatory bowel diseases- Crohn’s Idiopathic- granulomatous gastritis Sarcoidosis. Slide 11 Cont. Type A Gastritis- \n Here the inflammatory changes are predominantly involving the fundus and body of the stomach. Its mainly autoimmune mediated. It is less common, associated with pernicious anaemia. Antibodies against the parietal cells may be detected. Slide 12 Ct. chronic gastritis Type B Gastritis-\nAntrum predominant. More common form of chronic gastritis. Commonly related to H. Pylori infection. Infection may progress to the body and fundus of the stomach to give a pan- gastritis. Chronic gastritis can be associated with metaplastic changes which may be pre-cancerous. Slide 13 Cont. H. Pylori is considered an independent risk factor to gastric cancer. Studies have shown a higher prevalence of H. pylori infection in patients with Ca. Stomach than controls. H. pylori infection is also associated with low grade B cell Lymphoma (MALT lymphoma). Treatment of MALT is by eradicating the H. Pylori infection. Slide 14 Cont. Do endoscopy and take histological tissues. Multiple samples are taken from suspicious looking mucosa areas. Preferably from the fundus, body and antrum. Make a histological diagnosis. Staining - done to demonstrate H. Pylori infection. Slide 15 Tx of chronic Gastritis Aims are to eradicate the H. Pylori infection. Address the possible sequeale of the gastritis. If there is perncious naemia- give Vitamin 12 supplementation. MALT Lymphoma, eradicate H. pylori. Hence the triple therapy approach is used Slide 16 Other forms of gastritis Lymphocytic gastritis: Heavy infiltration of the surface epithelium with lymphocytes especially in the body of the stomach. Etiology is not known and H. Pylori plays no significant role. Eosinophilic gastritis : marked eosinophilic infiltration of any of the superficial layers of the stomach. These patients have clinical atopy (allergen-related). Treatment is with glucocortociods. Slide 17 Cont. Ménétrier’s disease - rare entity characterized by large, tortuous gastric mucosal folds (replacement of the parietal and chief cells by mucus-secreting cells) The folds are most prominent in the body and fundus. Symptoms include- epigastric pain, nausea, vomiting, anorexia, wgt loss. May have occult GIT bleeding. Most patients are hypochlorhydric 20-100% will develop a protein losing gastropathy leading to hypoalbuminemia and edema. Slide 18 Ct. Ménétrier’s disease Tx with antisecretory drugs, eg PPIs with or without octreotide, may reduce protein loss and H. pylori eradication may be effective,\nunresponsive pts require partial gastrectomy Slide 19 THANKS!