Difference between revisions of "Portal hypertensive gastropathy"
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'''Portal hypertensive gastropathy''', abbreviated '''PHG''', is a benign pathology of the [[stomach]] caused by [[hypertension|high blood pressure]] in the portal system. | |||
==General== | |||
*Due to [[portal hypertension]]. | |||
**Usually secondary to [[liver cirrhosis]] which is typically due to [[alcoholism]]. | |||
***Reported in approximately 65% of cirrhotics with portal hypertension in one paper.<ref name=pmid15648238>{{Cite journal | last1 = Mesihovic | first1 = R. | last2 = Prohic | first2 = D. | last3 = Gribajcevic | first3 = M. | last4 = Vanis | first4 = N. | last5 = Gornjakovic | first5 = S. | last6 = Sarac | first6 = A. | title = Portal hypertensive gastropathy (PHG). | journal = Med Arh | volume = 58 | issue = 6 | pages = 377-9 | month = | year = 2004 | doi = | PMID = 15648238 }} | |||
</ref> | |||
==Gross== | |||
Features:<ref name=pmid12492178>{{Cite journal | last1 = Thuluvath | first1 = PJ. | last2 = Yoo | first2 = HY. | title = Portal Hypertensive gastropathy. | journal = Am J Gastroenterol | volume = 97 | issue = 12 | pages = 2973-8 | month = Dec | year = 2002 | doi = 10.1111/j.1572-0241.2002.07094.x | PMID = 12492178 }}</ref> | |||
*Mosaic-like pattern. | |||
**May be referred to as [[Gastric snakeskin appearance|snakeskin-like pattern]].<ref name=pmid22211417/> | |||
**Usu. body of stomach. | |||
*+/-Red spots. | |||
Note: | |||
*May mimic [[eosinophilic gastritis]].<ref name=pmid22211417>{{Cite journal | last1 = Sikanderkhel | first1 = S. | last2 = Luthra | first2 = M. | last3 = Chavalitdhamrong | first3 = D. | title = Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis. | journal = Dig Endosc | volume = 24 | issue = 1 | pages = 53 | month = Jan | year = 2012 | doi = 10.1111/j.1443-1661.2011.01155.x | PMID = 22211417 }}</ref> | |||
===Images=== | |||
<gallery> | |||
Image:PHGastro.jpg | PHG. (WC/Samir) | |||
</gallery> | |||
==Microscopic== | |||
Features:<ref name=Ref_GLP120-1>{{Ref GLP|120-1}}</ref> | |||
*Dilated capillaries in the submucosa (prominent) and to a lesser extent in the lamina propria - '''key feature'''. | |||
Notes: | |||
*May be associated with [[hyperplastic polyp of the stomach|hyperplastic]]-like polyps.<ref name=pmid22002002>{{Cite journal | last1 = Lam | first1 = MC. | last2 = Tha | first2 = S. | last3 = Owen | first3 = D. | last4 = Haque | first4 = M. | last5 = Chatur | first5 = N. | last6 = Gray | first6 = JR. | last7 = Yoshida | first7 = EM. | title = Gastric polyps in patients with portal hypertension. | journal = Eur J Gastroenterol Hepatol | volume = 23 | issue = 12 | pages = 1245-9 | month = Nov | year = 2011 | doi = 10.1097/MEG.0b013e32834c15cf | PMID = 22002002 }}</ref> | |||
**Subepithelial [[granulation tissue]] and vascular proliferation. | |||
*Findings in mucosal biopsies are often [[specificity|nonspecific]], i.e. not diagnostic.<ref name=Ref_GLP120-1>{{Ref GLP|120-1}}</ref> | |||
DDx: | |||
*[[Gastric antral vascular ectasia]] - have thrombi in the dilated blood vessels. | |||
==Sign out== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- ANTRAL-TYPE AND BODY-TYPE GASTRIC MUCOSA WITH PROMINENT CAPILLARIES | |||
AND MODERATE CHRONIC INACTIVE INFLAMMATION. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
No fibrin thrombi are seen. The findings are compatible with portal hypertension. | |||
Clinical correlation is required. | |||
</pre> | |||
===Hyperplastic-like polyp=== | |||
<pre> | |||
POLYP, STOMACH, BIOPSY: | |||
- HYPERPLASTIC-LIKE POLYP WITH PROMINENT VESSELS, EDEMA AND AN ERODED SURFACE WITH | |||
GRANULATION TISSUE FORMATION, SEE COMMENT. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
The polyp is consistent with the type described by Lam et al. in a set of individuals | |||
with portal hypertension. (Eur J Gastroenterol Hepatol 23 (12): 1245-9.) | |||
</pre> | |||
==See also== | |||
*[[Stomach]]. | |||
*[[Hypertension]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] | |||
Latest revision as of 22:51, 7 February 2018
Portal hypertensive gastropathy, abbreviated PHG, is a benign pathology of the stomach caused by high blood pressure in the portal system.
General
- Due to portal hypertension.
- Usually secondary to liver cirrhosis which is typically due to alcoholism.
- Reported in approximately 65% of cirrhotics with portal hypertension in one paper.[1]
- Usually secondary to liver cirrhosis which is typically due to alcoholism.
Gross
Features:[2]
- Mosaic-like pattern.
- May be referred to as snakeskin-like pattern.[3]
- Usu. body of stomach.
- +/-Red spots.
Note:
- May mimic eosinophilic gastritis.[3]
Images
PHG. (WC/Samir)
Microscopic
Features:[4]
- Dilated capillaries in the submucosa (prominent) and to a lesser extent in the lamina propria - key feature.
Notes:
- May be associated with hyperplastic-like polyps.[5]
- Subepithelial granulation tissue and vascular proliferation.
- Findings in mucosal biopsies are often nonspecific, i.e. not diagnostic.[4]
DDx:
- Gastric antral vascular ectasia - have thrombi in the dilated blood vessels.
Sign out
STOMACH, BIOPSY: - ANTRAL-TYPE AND BODY-TYPE GASTRIC MUCOSA WITH PROMINENT CAPILLARIES AND MODERATE CHRONIC INACTIVE INFLAMMATION. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: No fibrin thrombi are seen. The findings are compatible with portal hypertension. Clinical correlation is required.
Hyperplastic-like polyp
POLYP, STOMACH, BIOPSY: - HYPERPLASTIC-LIKE POLYP WITH PROMINENT VESSELS, EDEMA AND AN ERODED SURFACE WITH GRANULATION TISSUE FORMATION, SEE COMMENT. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: The polyp is consistent with the type described by Lam et al. in a set of individuals with portal hypertension. (Eur J Gastroenterol Hepatol 23 (12): 1245-9.)
See also
References
- ↑ Mesihovic, R.; Prohic, D.; Gribajcevic, M.; Vanis, N.; Gornjakovic, S.; Sarac, A. (2004). "Portal hypertensive gastropathy (PHG).". Med Arh 58 (6): 377-9. PMID 15648238.
- ↑ Thuluvath, PJ.; Yoo, HY. (Dec 2002). "Portal Hypertensive gastropathy.". Am J Gastroenterol 97 (12): 2973-8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.
- ↑ 3.0 3.1 Sikanderkhel, S.; Luthra, M.; Chavalitdhamrong, D. (Jan 2012). "Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis.". Dig Endosc 24 (1): 53. doi:10.1111/j.1443-1661.2011.01155.x. PMID 22211417.
- ↑ 4.0 4.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 120-1. ISBN 978-0443066573.
- ↑ Lam, MC.; Tha, S.; Owen, D.; Haque, M.; Chatur, N.; Gray, JR.; Yoshida, EM. (Nov 2011). "Gastric polyps in patients with portal hypertension.". Eur J Gastroenterol Hepatol 23 (12): 1245-9. doi:10.1097/MEG.0b013e32834c15cf. PMID 22002002.