Difference between revisions of "Acute duodenitis"

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#redirect [[Duodenum#Acute_duodenitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Acute duodenitis -- intermed mag.jpg
| Width      =
| Caption    = Acute duodenitis. [[H&E stain]].
| Synonyms  =
| Micro      = [[neutrophil]]s - "found without searching", [[eosinophil]]s - "found without searching", plasma cells (increased), intraepithelial lymphocytes
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[duodenum]]
| Assdx      = [[Helicobacter gastritis]]
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  = erythema
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = dependent on underlying cause
}}
'''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.
*[[Neutrophil]]s - "found without searching" - '''key feature'''.
*[[Eosinophil]]s - "found without searching" - '''key feature'''.
*[[Plasma cell]]s (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>
 
===Images===
<gallery>
Image: Acute duodenitis -- low mag.jpg | AD - low mag.
Image: Acute duodenitis -- intermed mag.jpg | AD - intermed. mag.
Image: Acute duodenitis -- high mag.jpg | AD - high mag.
Image: Acute duodenitis -- very high mag.jpg | AD - very high mag.
</gallery>
 
==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]].
*[[Chronic duodenitis]].
*[[Crohn's disease]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Duodenum]]

Latest revision as of 00:32, 30 April 2014

Acute duodenitis
Diagnosis in short

Acute duodenitis. H&E stain.
LM neutrophils - "found without searching", eosinophils - "found without searching", plasma cells (increased), intraepithelial lymphocytes
Site duodenum
Associated Dx Helicobacter gastritis
Prevalence uncommon
Endoscopy erythema
Prognosis benign
Treatment dependent on underlying cause

Acute duodenitis, abbreviated AD, is an acute inflammatory process of the duodenum. It is relatively uncommon.

General

DDx:

Microscopic

Features:

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:
    • NSAIDs not commonly assoc. with acute inflammation;[3] thus, without chronic inflammation NSAIDs are unlikely.
      • Acute NSAID-related duodenitis reported.[4]

Images

  • AD - low mag.

  • AD - intermed. mag.

  • AD - high mag.

  • AD - very high mag.

Sign out

DUODENUM, BIOPSY:
- ACUTE DUODENITIS.

Acute on chronic duodenitis

DUODENUM, BIOPSY:
- ACUTE ON CHRONIC DUODENITIS.

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

References

  1. ↑ Madsen, JE.; Vetvik, K.; Aase, S. (Nov 1991). "Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients.". APMIS 99 (11): 997-1000. PMID 1683540.
  2. ↑ Shudo, R.; Yazaki, Y.; Sakurai, S.; Uenishi, H.; Yamada, H.; Sugawara, K. (Apr 2002). "Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy.". Am J Gastroenterol 97 (4): 867-73. doi:10.1111/j.1572-0241.2002.05602.x. PMID 12003421.
  3. ↑ Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Russell RI (September 1993). "Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs". Gut 34 (9): 1162–6. PMC 1375446. PMID 8406146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375446/.
  4. ↑ Hashash JG, Atweh LA, Saliba T, et al. (November 2007). "Acute NSAID-related transmural duodenitis and extensive duodenal ulceration". Clin Ther 29 (11): 2448–52. doi:10.1016/j.clinthera.2007.11.012. PMID 18158085.
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