Difference between revisions of "Stomach"

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==Helicobacter gastritis==
==Helicobacter gastritis==
*Often abbreviated ''[[HP]]''.
{{Main|Helicobacter gastritis}}
===General===
*Several Helicobacter species can cause gastritis:
**''[[Helicobacter pylori]]'' - most common.
**''Helicobacter heilmannii''.
 
Epidemiologic associations - ''Helicobacter'' infections are associated with:<ref>{{Ref PBoD|814}}</ref>
*Gastritis.
*Peptic ulcers.
*Cancer.
**Carcinoma.
**[[MALT lymphoma]].
 
===Gross===
*Thickened gastric folds.
*Erythema.
 
===Microscopic===
Features:
*Helicobacter organisms - '''key feature'''.
**''Helicobacter pylori'':
***Usually have v-shape (seagull-like shape). 
****May have a curved shape (comma-like shape) or U-shape.<ref name=pmid21290743>{{Cite journal  | last1 = Mobley | first1 = HLT. | last2 = Mendz | first2 = GL. | last3 = Hazell | first3 = SL. | last4 = Andersen | first4 = LP. | last5 = Wadström | first5 = T. | title = Basic Bacteriology and Culture | journal =  | volume =  | issue =  | pages =  | month =  | year =  | doi =  | PMID = 21290743 | url = http://www.ncbi.nlm.nih.gov/books/NBK2444/}} </ref>
**''Helicobacter heilmannii'':<ref name=pmid16224223 >{{Cite journal  | last1 = Singhal | first1 = AV. | last2 = Sepulveda | first2 = AR. | title = Helicobacter heilmannii gastritis: a case study with review of literature. | journal = Am J Surg Pathol | volume = 29 | issue = 11 | pages = 1537-9 | month = Nov | year = 2005 | doi =  | PMID = 16224223 }}</ref>
***Corkscrew appearance.
*Inflammation - usually ''moderate chronic active''.
**Clusters of (lamina propria) [[plasma cell]]s.
**[[Neutrophil]]s, numerous, classically intraepithelial.
 
Tips:
#One needs to look at 400x magnification. Even at 400x they are possible to miss.
#*Helicobacter are damn small. They are smaller than the nucleus of the gastric foveollar cell.
#Look for mucus - they preferentially reside there.
#*This is usually close to the opening of the gastric pits.
#Helicobacter are found in groups. When you see several that are the same size and shape you can be sure they are real.
 
Notes:
*Helicobacter can be in antrum and/or body.<ref>{{cite journal |author=Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L |title=The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample |journal=Scand. J. Gastroenterol. |volume=25 |issue=10 |pages=1010-7 |year=1990 |month=October |pmid=2263873 |doi= |url=}}</ref>
*Helicobacter don't like the intestinal mucosa ''or'' mucosa that has undergone [[intestinal metaplasia]]; you're less likely to find 'em adjacent to it. In general, Helicobacter is uncommon in the context of a case with IM... but common enough that one still ought to look for it.
*May be associated with G-cell hyperplasia.<ref name=pmid8680911>{{Cite journal  | last1 = Kwan | first1 = CP. | last2 = Tytgat | first2 = GN. | title = Antral G-cell hyperplasia: a vanishing disease? | journal = Eur J Gastroenterol Hepatol | volume = 7 | issue = 11 | pages = 1099-1103 | month = Nov | year = 1995 | doi =  | PMID = 8680911 }}</ref>
 
DDx:
*Dirt - material has a variable size.
*Contamination from oropharynx - bacilli straight, not associated with gastric mucosa.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Immunohistochemical_detection_of_Helicobacter_%281%29_histopatholgy.jpg H. pylori - IHC (WC)].
*Helicobacter gastritis:
**[http://commons.wikimedia.org/wiki/File:Gastritis_helicobacter_-_high_mag.jpg Gastritis due to HP (WC)].
**[http://commons.wikimedia.org/wiki/File:Gastritis_helicobacter_-_very_high_mag_cropped.jpg HP visible (WC)].
*[http://commons.wikimedia.org/wiki/Category:Helicobacter_gastritis Set of images - HP gastritis (WC)].
*[http://gut.bmj.com/content/58/12/1669/F2.large.jpg Helicobacter heilmannii (bmj.com)].<ref>URL: [http://gut.bmj.com/content/58/12/1669.extract http://gut.bmj.com/content/58/12/1669.extract]. Accessed on: 2 March 2012.</ref>
 
===Stains===
*[[Cresyl violet stain]] - background and organisms blue.
*[[Warthin-Starry stain]] - background yellow, organisms black.
 
===IHC===
*Helicobacter pylori IHC stain +ve.
 
Note:
*Reportly also stains ''Helicobacter heilmannii''.<ref name=pmid16224223 >{{Cite journal  | last1 = Singhal | first1 = AV. | last2 = Sepulveda | first2 = AR. | title = Helicobacter heilmannii gastritis: a case study with review of literature. | journal = Am J Surg Pathol | volume = 29 | issue = 11 | pages = 1537-9 | month = Nov | year = 2005 | doi =  | PMID = 16224223 }}</ref>
 
===Sign out===
====Body====
<pre>
STOMACH, BIOPSY:
- BODY-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Body====
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show antral-type gastric mucosa with abundant lamina propria plasma cells and
focal intraepithelial neutrophils. Cocci and bacilli are present.  Some of the bacilli
are Helicobactor-like. The epithelium matures normally to the surface.  No goblet cells
are identified.


==Intestinal metaplasia of the stomach==
==Intestinal metaplasia of the stomach==
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