Acute duodenitis

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

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

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

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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.