Difference between revisions of "Stomach"

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Revision as of 08:09, 26 July 2013

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→‎Reactive gastropathy: split out
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==Reactive gastropathy==
==Reactive gastropathy==
*Abbreviated ''RG''.
{{Main|Reactive gastropathy}}
*[[AKA]] ''chemical gastropathy'',<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref> incorrectly referred to as ''chemical gastritis'' (see below).
===General===
*May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.
 
====Epidemiology====
General assocations:
*Increases with age.<ref name=pmid22928604>{{Cite journal  | last1 = Maguilnik | first1 = I. | last2 = Neumann | first2 = WL. | last3 = Sonnenberg | first3 = A. | last4 = Genta | first4 = RM. | title = Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract. | journal = Aliment Pharmacol Ther | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.1111/apt.12031 | PMID = 22928604 }}</ref>
 
Etologic factors - associated with:<ref>ALS. 5 February 2009.</ref>
*Excess acid.
*[[EtOH]].
*Bile.
*[[H. pylori]].
*Drugs:<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref>
**Iron (brown pigment on histology).
**[[NSAID]]s - synergistic effect with corticosteroids.
 
Drugs that cause erosions and/or ulcers -- adapted from ''Genta'':<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref>
 
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Drug
! Comment
! Indication for Rx
|-
| NSAIDs
| common cause
| pain, reduce cardiovascular risk
|-
| Corticosteroids
| synergistic effect with NSAIDs
| rheumatologic diseases + others
|-
| Potassium (KCl)
| common cause
| renal failure
|-
| Bisphophonates
| uncommon cause
| [[osteoporosis]]
|-
| Ferrous sulfate
| very common if symptomatic
| iron deficiency anemia
|-
| Chloroquine
| uncommon
| only in the context of [[malaria]]
|-
| Sodium polystyrene sulfonate (Kayexalate)
| rare
| renal failure patients
|}
 
====Relation to gastritis====
*May mimic a (true) gastritis symptomatically and visually in an endoscopic examination.
*"Chemical gastritis" is misnomer. Etymologically, the ''-itis'' in ''gastritis'', implies an inflammatory process.  Chemical gastropathy is not (predominantly) an inflammatory process.
**This type of confusion is not uncommon. [[Steatohepatitis]] is another example of this; it is not a process with significant inflammation yet, confusingly, carries the ''-itis'' ending.
 
===Gross/endoscopic===
Features:<ref>{{Ref GLP|69}}</ref>
*Antral erythema +/- erosions.
*+/-Bile.
 
===Microscopic===
Features - triad:<ref>El-Zimaity. 18 October 2010.</ref><ref name=pmid16939055/>
#Foveolar hyperplasia.
#*Tortuosity of glands in the "neck" region of the gastric glands.
#*Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
#Smooth muscle fibre hyperplasia.
#*Abundant eosinophilic lamina propria.
#Scant acute & chronic inflammatory cells.
Additional features.
*+/-Edema.
*+/-Erosions.
 
Notes:
*Triad rarely present; mild inflammation common.
 
DDx:
*[[Amyloidosis]].
*[[Collagenous gastritis]].
*[[Hyperplastic polyp of the stomach]].<ref name=Ref_GLP69>{{Ref GLP|69}}</ref>
 
====Images====
<gallery>
Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron)
Image: Reactive_gastropathy_-_high_mag.jpg | RG - high mag. (WC/Nephron)
</gallery>
 
===Sign out===
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 
COMMENT:
This nonspecific finding may be due to a number of causes, including
medications (especially NSAIDs), alcohol and bile reflux.
</pre>
 
====Not well-developed====
<pre>
STOMACH, BIOPSY:
- BODY-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA,
  RARE GLAND TORTUOSITY AND NO SIGNFICANT INFLAMMATION, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 
 
COMMENT:
These findings are suggestive of a reactive gastropathy; however, gland
corkscrewing is not evident.
</pre>
 
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL
LIMITS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>


==Autoimmune metaplastic atrophic gastritis==
==Autoimmune metaplastic atrophic gastritis==
Michael
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