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Difference between revisions of "Acute duodenitis"
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'''Acute duodenitis''', abbreviated '''AD''', is an acute inflammatory process of the [[duodenum]]. It is relatively uncommon. | |||
==General== | |||
DDx: | |||
*Infection. | |||
**Helicobactor organisms in the [[stomach]]. | |||
***Helicobacter ''not'' seen unless gastric metaplasia is present.<ref>{{Cite journal | last1 = Madsen | first1 = JE. | last2 = Vetvik | first2 = K. | last3 = Aase | first3 = S. | title = Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients. | journal = APMIS | volume = 99 | issue = 11 | pages = 997-1000 | month = Nov | year = 1991 | doi = | PMID = 1683540 }}</ref> | |||
*Medications ([[NSAID]]s). | |||
*[[Crohn's disease]] (usually focal/patchy). | |||
*[[Portal hypertension]] (portal hypertensive duodenopathy).<ref name=pmid12003421>{{Cite journal | last1 = Shudo | first1 = R. | last2 = Yazaki | first2 = Y. | last3 = Sakurai | first3 = S. | last4 = Uenishi | first4 = H. | last5 = Yamada | first5 = H. | last6 = Sugawara | first6 = K. | title = Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy. | journal = Am J Gastroenterol | volume = 97 | issue = 4 | pages = 867-73 | month = Apr | year = 2002 | doi = 10.1111/j.1572-0241.2002.05602.x | PMID = 12003421 }}</ref> | |||
*[[Celiac sprue]]. | |||
==Microscopic== | |||
Features: | |||
*Intraepithelial lymphocytes. | |||
*Neutrophils - "found without searching" - '''key feature'''. | |||
*Eosinophils - "found without searching" - '''key feature'''. | |||
*Plasma cells (increased). | |||
Notes: | |||
*One needs stomach concurrent biopsies to r/o Helicobactor. | |||
*Erosions make celiac sprue much less likely. | |||
*Presence of chronic inflammation useful for NSAIDs vs. Helicobacter organisms: | |||
**[[NSAID]]s not commonly assoc. with acute inflammation;<ref name=pmid8406146>{{cite journal |author=Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Russell RI |title=Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs |journal=Gut |volume=34 |issue=9 |pages=1162–6 |year=1993 |month=September |pmid=8406146 |pmc=1375446 |doi= |url=}}</ref> thus, without chronic inflammation NSAIDs are unlikely. | |||
***Acute NSAID-related duodenitis reported.<ref name=pmid18158085>{{cite journal |author=Hashash JG, Atweh LA, Saliba T, ''et al.'' |title=Acute NSAID-related transmural duodenitis and extensive duodenal ulceration |journal=Clin Ther |volume=29 |issue=11 |pages=2448–52 |year=2007 |month=November |pmid=18158085 |doi=10.1016/j.clinthera.2007.11.012 |url=}}</ref> | |||
==Sign out== | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- ACUTE DUODENITIS. | |||
</pre> | |||
===Acute on chronic duodenitis=== | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- ACUTE ON CHRONIC DUODENITIS. | |||
</pre> | |||
====Micro==== | |||
The sections show small bowel mucosa with intraepithelial neutrophils. The epithelium shows nuclear hyperchromasia, pseudostratification and nuclear enlargement; however, it matures toward the surface (reactive changes of the epithelium). | |||
Brunner's glands are found focally in the lamina propria. Gastric foveolar-type epithelium | |||
is identified. Lamina propria plasma cells are abundant. | |||
==See also== | |||
*[[Duodenum]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Duodenum]] | |||