Pathology of Peptic Ulcer

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Pathology of Peptic Ulcer
Dr. Venkatesh M. Shashidhar Associate Professor
of Pathology School of Health Sciences Fiji
School of Medicine
FSM - A Commitment to Excellence
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Normal Stomach
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Esophagus Stomach Normal
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Definition

• Ulceration (breach in mucosa) due to acid
  pepsin attack peptic ulcer.
• Deeper than just mucosa
• Single, punched out, clean base why?

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Etiology

• Helicobacter pylori infection.
• Hyperacidity - eg. zollinger ellison.
• Drugs - anti-inflammatory (NSAIDs)
  Corticostroids.
• Cigarette smoking, Alcohol,
• Rapid gastric emptying
• Personality and stress

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H. Pylori organisms- silver st.
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Pathogenesis

• Helicobacter pylori infection
• Colonization of gastric mucous
• Urease ?ammonia ?neutralization of acid ? Rebound
  acid production.
• Protease Mucous break down.
• Weak mucosal resistance
• Acid Pepsin digestion of mucosa
• Chronic Ulceration

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Etiology of PUDNormalIncreased Attack
HyperacidityWeak defense Helicobacter
pylori Stress, drugs, smoking
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Helicobacter pylori

• Most common infection in the world (20)
• 10 of men, 4 women develop PUD
• Positive in 70-100 of PUD patients.
• H.pylori related disorders
• Chronic gastritis 90
• Peptic ulcer disease 95-100
• Gastric carcinoma 70
• Gastric lymphoma
• Reflux Oesophagitis.
• Non ulcer dyspepsia

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Peptic Ulcer Morphology

• 90 ulcers in first portion of duodenum or lesser
  curvature of stomach(41).
• 80 to 90 cases single ulcer. Round Small ulcers
  with sharply punched out edges
• Small lt2cm, clean base.
• Microscopy 4 zones.
• Superficial necrotic layer.
• Inflammatory cells zone.
• Granulation tissue zone
• Collagenous scar layer.

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Complications

• Bleeding Chronic-IDA, Acute, Massive
• Fibrosis, Stricture obstruction pyloric
  stenosis.
• Perforation Peritonitis- emergency.
• Gastric carcinoma. (not duodenal ca)

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Acute Esophagitis Gastritis
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Gastric peptic ulcer
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Gastric peptic ulcer
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Gastric Ulcer
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Duodenal Peptic Ulcer
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Gastric Ulcer
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Peptic ulcer - Endoscopy
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Gastric Ulcer
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Gastric Ulcer
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Gastric Ulcer

• Punched out ulcer
• Clean base
• Small single
• Radiating mucosal folds.
• Benign ulcer.
• No tumor.

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Peptic Ulcer
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Peptic Ulcer Microscopy
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Perforation
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Acute Esophagitis Gastritis
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Fungating Carconoma
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Linitis Plastica Schirrhous Carcinoma.
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Helecobacter pylori

• Gram negative, Spiral bacilli
• Spirochetes
• Do not invade cells only mucous
• Breakdown urea - ammonia
• Break down mucosal defense
• Chronic Superficial inflammation

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PUD - Diagnosis

• Endoscopy
• Barium meal contrast x-ray
• Biopsy bacteria malignancy
• H.Pylori
• Endoscopy cytology
• Biopsy Special stains
• Culture - difficult
• Urease Breath test.

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Points to Remember

• A peptic ulcer is a sore in the lining of the
  stomach or duodenum due to attack by acid
  Pepsin.
• The major cause - H. pylori bacterium. Others are
  NSAIDs. spicy food, stress are risk factors.
• H. pylori can be transmitted from person to
  person through close contact
• A combination of antibiotics and H pump
  inhibitors is the most effective treatment.

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Helecobacter pylori
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Toludine Blue stain H pylori
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Urease production test
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You get ulcer, not from what you eat, but from
whats eating you..!
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Hmmmm H.pylori
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Physiology class on Monday 1030am OCH?