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Difference between revisions of "Peptic duodenitis"
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'''Peptic duodenitis''' is controversial type of [[chronic duodenitis]]. This article deals with that controversy and '''foveolar metaplasia of the duodenum'''. | |||
==General== | |||
*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. | |||
==See also== | |||
*[[Chronic duodenitis]]. | |||
*[[Gastric heterotopia of the duodenum]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Duodenum]] | |||
[[Category:Diagnosis]] | |||