Question
A patient presented with epigastric burning , pain worse at night, within 1-3 hours after meals and decreases with food.Upper Gastrointestinal Endoscopic Biopsy picture is shown in the image.Which part of gastrointestinal system can’t be affected by this pathology?
A. First part of Esophagus
B. First part of Duodenum
C. Stomach ,usally antrum
D. Within the margins of a gastrojejunostomy.
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Correct Answer » A Explanation |
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Ans:A. Fisrt part of Esophagus.
The patient in question is suffering from Peptic Ulcer Disease.
Image shows: Chronic peptic ulcer. Histologic zones of the ulcer are illustrated in the diagram. The photomicrograph on right shows necrotic debris, ulceration and inflammation on the mucosal surface,and scarring.
PEPTIC ULCER
- Peptic ulcers are chronic , most often solitary lesions that occur in any protion of the gastrointestinal tract exposed
- to the aggressive action of acid / peptic juice .
- Peptic ulcers located in the following sits, in order of decreasing frequency :
- Duodenum, 1′ portion
- Stomach ,usally antrum
- At the gastro – esophageal junction in the setting of gastroesphageal reflux or Barrett’s esophagus.
- Within the margins of a gastrojejunostomy.
- In the duodenum, stomach or jeunum of patients with Zollinger -Ellison Syndrome. Within or adiacent to Meckels diverticulum that contains ectopic gastric mucosa.
MORPHOLOGIC FEATURES.
- Gross and microscopic changes in gastric and duodenal ulcers are similar and quite characteristic.
- Gastric ulcers are found predominantly along the lesser curvature in the region of pyloric antrum, more commonly on the posterior than the anterior wall.
- Most duodenal ulcers are found in the first part of the duodenum, usually immediate post-pyloric, more commonly on the anterior than the posterior wall.
- Uncommon locations include ulcer in the cardia, marginal ulcer and in the Meckel’s diverticulum .
- Grossly, typical peptic ulcers are commonly solitary (80%), small (1-2.5 cm in diameter), round to oval and characteristically ‘punched out’.
- Benign ulcers usually have flat margins in level with the surrounding mucosa.
- The mucosal folds converge towards the ulcer. The ulcers may vary in depth from being superficial (confined to mucosa) to deep ulcers (penetrating into the muscular layer).
- Chronic duodenal ulcer never turns malignant, while chronic gastric ulcer may develop carcinoma in less than 1% of cases.
- Malignant gastric ulcers are larger, bowl-shaped with elevated and indurated mucosa at the margin .
- Microscopically, chronic peptic ulcers have 4 histological zones. From within outside, these are as under :
- Necrotic zone—lies in the floor of the ulcer and is composed of fibrinous exudate containing necrotic debris and a few leucocytes.
- Superficial exudative zone—lies underneath the necrotic zone. The tissue elements here show coagulative necrosis giving eosinophilic, smudgy appearance with nuclear debris.
- Granulation tissue zone—is seen merging into the necrotic zone. It is composed of nonspecific inflammatory infiltrate and proliferating capillaries.
- Zone of cicatrisation—is seen merging into thick layer of granulation tissue. It is composed of dense fibrocollagenic scar tissue over which granulation tissue rests.
- Thrombosed or sclerotic arteries may cross the ulcer which on erosion may result in haemorrhage
