Helicobacter Pylori associated chronic gastritis resulting in duodenal ulceration or Peptic ulcer Dsease. Gastric pain at night and when hungry: ulcer Is duodenal as the pyloric sphincter is open. Single punched-out lesion In the duodenum where of peptic ulcers occur. H. PyIori most common cause of peptic ulcers. Erythematous stomach and history of dyspepsia: This indicates inflammation associated with chronic gastritis: result of long term hyperacidity in the stomach and duodenum. Patient was a smoker. Smoking reduces blood flow and Impedes healing of the epithelium and mucosa.
Presence of curved and spiral-shaped bacilli within the superflclal mucosa of the antrum (no mention of the body of stomach) indicates H. Pylori infection. This induces hyperacidity, increasing the risk of duodenal and gastric ulceration (H. PyIori in of people with peptic ulcers). Large numbers of neutrophils in the lamina propria extending into the epithelium forming pit abscesses and large numbers of plasma and lyrnphocytic cells with germinal centres Infiltrating the lamina proprla Is characteristic of chronic gastritis as the body mounts an Immune response.
Gastric epithelium regenerates rapidly, replacing damaged cells. Extensive blood supply to mucosa. Predisposing factors: H. Pylori infection 80% of peptic ulcers Smoking- reduces blood flow, impedes healing. High-dose corticosteroid use (inhibits prostaglandin production) More commonly seen in people with alcohol cirrhosis (alcohol stimulates gastric acid secretion), chronic obstructive pulmonary disease (reduces 02 blood perfusion), chronic renal failure and hyperparathyroidism (promote gastrin secretion). 3) Natural history: o Peptic ulcers usually heal within weeks but reoccur within months(75% after one year) unless treated.
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Longer healing indicates quicker reoccurrence unless stimulus is removed. o A longer period of symptoms before presentation is associated with poorer response to treatment. Complications: o smaller vessels- anaemia o large vessel- malema or haematemesis o major artery: life threatening. o Perforation- spillage of GIT contents into peritoneum: leads to infection (peritonitis) o Obstruction- pyloric stenosis from continuous healing and scarring near pyloric valve. (10% of patients) Leads to hour glass deformity of stomach. o Carcinoma development- (1% of gastric ulcers, never duodenal ulcers)
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