Difference between revisions of "Duodenum"

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Duodenum (view source)

Revision as of 12:35, 3 May 2016

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→‎Peptic duodenitis: split out
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==Peptic duodenitis==
==Peptic duodenitis==
===General===
{{Main|Peptic duodenitis}}
*A somewhat controversial type of [[chronic duodenitis]].
*Considered to be a consequence of [[peptic ulcer disease]] ([[Helicobacter gastritis]]).
*One of the key components of the diagnosis is foveolar metaplasia and it is disputed that this is really due to Helicobacter.
**Genta ''et al.'' consider gastric foveolar metaplasia a congenital lesion.<ref name=pmid20656325>{{Cite journal  | last1 = Genta | first1 = RM. | last2 = Kinsey | first2 = RS. | last3 = Singhal | first3 = A. | last4 = Suterwala | first4 = S. | title = Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori. | journal = Hum Pathol | volume = 41 | issue = 11 | pages = 1593-600 | month = Nov | year = 2010 | doi = 10.1016/j.humpath.2010.04.010 | PMID = 20656325 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_GLP145>{{Ref GLP|145}}</ref>
*Gastric foveolar metaplasia - '''key feature'''.
*[[Brunner's gland hyperplasia]].
*+/-Inflammation - neutrophils.{{fact}}
*Ulceration.{{fact}}
 
DDx:
*[[Chronic duodenitis]] not otherwise specified - no foveolar metaplasia, abundant plasma cells.
*[[Acute duodenitis]].
*[[Brunner's gland hyperplasia]].
*[[Gastric heterotopia of the duodenum]].
 
====Images====
<gallery>
Image:Duodenum_with_foveolar_metaplasia_-_low_mag.jpg | Duodenum with foveolar metaplasia - low mag. (WC/Nephron)
Image:Duodenum_with_foveolar_metaplasia_-_intermed_mag.jpg | Duodenum with foveolar metaplasia - intermed. mag. (WC/Nephron)
Image:Duodenum_with_foveolar_metaplasia_-_alt_-_very_high_mag.jpg | Duodenum with foveolar metaplasia - very high mag. (WC/Nephron)
</gallery>
===Stains===
Foveolar metaplasia:
*[[PAS stain]] +ve.<ref name=Ref_GLP145>{{Ref GLP|145}}</ref>
*[[Mucicarmine stain]] +ve.
 
===Sign out===
====Foveolar metaplasia only====
<pre>
DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- VILLI AND INTRAEPITHELIAL LYMPHOCYTES WITHIN NORMAL LIMITS (NEGATIVE FOR CELIAC DISEASE).
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
<pre>
DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
====Chronic duodenitis====
<pre>
Duodenum, Biopsy:
- Small bowel mucosa with Brunner’s gland in the lamina propria and gastric foveolar metaplasia, consistent with chronic duodenitis.
- NEGATIVE for acute duodenitis.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
<pre>
DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLAND IN THE LAMINA PROPRIA AND
  GASTRIC FOVEOLAR METAPLASIA -- CONSISTENT WITH CHRONIC DUODENITIS.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH PROMINENT BRUNNER'S GLANDS AND FOCAL GASTRIC
  FOVEOLAR METAPLASIA.
- NEGATIVE FOR ACUTE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
=====Micro=====
The sections show small bowel mucosa and a small amount of submucosa. Brunner's glands are abundant and found focally in the lamina propria. Gastric foveolar-type epithelium is identified. Intraepithelial neutrophils are not identified.
 
The epithelium matures appropriately. There is no increase in intraepithelial lymphocytes.


==Brunner's gland hyperplasia==
==Brunner's gland hyperplasia==
Michael
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