病理学：8.消化系统-英文.ppt

Diseases of the Digestive System,pathology,Gastritis Peptic ulcers Carcinomas of the alimentary tract （Viral） hepatitis Liver cirrhosis Primary carcinoma of the liver,Main contents in this chapters: Concern the following diseases,Digestive System,Alimentary Tract,Digestive Gland,Brief Review,Anatomic structure and function,Function: ingestion Peristalsis Digestion Absorption Discharge,Relation with diseases of other systems Cirrhosishepatic encephalopathy Hepatic diseasesrenal disease (hepatorenal syndrome) Acute Gastrointestinal inflammation disturbances of water and electrolytes SLEChronic hepatitis Heart failurehepatic congestion,胃炎Gastritis,Non specific inflammation of the gastric mucosa Often overused or missed Exact diagnosis is made only upon gastric endoscope course: acute The lesions occur in any portion of gastrointestinal tract exposed to aggressive acid-peptic juices.,胃和十二指肠的慢性溃疡 酸性胃液的消化有关,At least 98% of peptic ulcers are either in the first portion of the duodenum or in the stomach, with a ratio of about 4:1 M F Most often diagnosed in middle aged to older adults, may first become evidenced in young adult life.,Etiology and Pathogenesis The etiology and pathogenesis are very complicated and have not been defined yet, though some facts are widely accepted -gastric acid and pepsin Why is the gastrointestinal mucosal exposure to gastric acid and pepsin not able to develop the ulcer under physiological condition?,Etiology and pathogenesis,Aggressive forces: Aggressiveness of gastric acid and pepsin Host mechanisms of defensive forces mainly include: Secretion of mucus and bicarbonate, then create mucosal surface barrier Robust mucosal blood flow, sweep away- Acid- and pepsin-containing fluid is secreted into the surface mucus layer, and then enter the lumen directly; Rapid epithelial renewal and regeneration Normal peristalsis and gastric emptying,-mucosa present in the environment with both -,Etiology and pathogenesis,Defensive forces are impaired,aggressive forces are increased,Normal condition,countervail,1. gastric acid and pepsin be required “no acid, no ulcer” Patient with Zollinger-Ellison syndrome（胰腺胃泌素瘤）multiple peptic ulcers in the stomach and duodenum. this tumor - secretes excess gastrin - excess gastric acid is produced. Once this tumor is removed, ulcers will disappear. 2. HP infection-another factor increased aggressive forces in 70%-90% of patients with duodenal ulcers and in about 70% of those with gastric ulcers; antibiotic treatment promotes healing of ulcers.- but only 10-20% of individuals infected with H. P can develop ulcer.,two main factors increased aggressive forces:,Why most H.P are spared and some are susceptible? still not clear.,epth: Penetrated at least into the submucosa, and often into the muscularis propria or deeper. Number : most often solitary (80%) Infrequently 1U multiple U多发性溃疡. duodenum U (2) high content of refined carbohydrates; (3) high fat content; (4) decreased intake of micronutrients (such as vitamins A, C, and E).,Etiology 2. Heredity CE 16/60 abnormal up to 5%,- follow up15-y: 5/16 Precancerous lesion; 7/16 CE, 4/16 death of CE。

CS Twin Second generation in-migrant of Japanese living in USA CRC FAP HNPCC,FAP（家族性腺瘤样息肉病 常染色体显性遗传病 癌变 HNPCC（遗传性非息肉性结肠癌 常染色体显性遗传病）,家族中至少有3人患与HNPCC相关肿瘤，包括结直肠癌，子宫内膜癌，肾癌/肾盂癌，脑肿瘤，胃癌，食管癌和肝癌等一名岁,Etiology 3. Viral and microbial oncogenesis CE Fungal contamination of foodstuffs （白地霉菌、串珠镰刀菌，黄曲霉菌） human papillomavirus HPV CS HP CRC Intestinal bacteria Schistosomiasis（血吸虫）,Etiology 4. Chemical carcinogens CE high content of nitrites within preserved vegetable CS nitrites found in food used as preservative in prepared meats CRC,high fat potential carcinogens intestinal bacteria,bile acids,亚硝酸盐,Barrett esophagus (only recognized precursor of E-adenocarcinoma ),Preneoplastic disorders CE慢性食道炎（烟酒等） 鳞形上皮乳头状瘤 Tylosis (hyperkeratosis), Squamous epithelial dysplasia E-intraepithelial neoplasia so called carcinoma in situ,chronic esophagitis,chronic esophagitis,three histologic features:, eosinophils嗜酸性细胞, with or without neutrophils, in the epithelial layer; basal zone hyperplasia异常增生, elongation of lamina propria papillae.,intraepithelial neutrophils occur in more severe injury.,Barrett esophagus:,Replacement of esophageal squamous-epithelium with gastric epithelium,distal esophagus,stomach,Gastroesophageal junction,Preneoplastic disorders CS 1. Atrophic gastritis with mucosa dysplasia 2. Adenoma,Preneoplastic disorders CRC 1 Adenoma-绒毛乳头状腺瘤 2 Ulcerative colitis,2. Gross pattern three forms CE Exophytic polypoid or fungating mass(息肉型或蕈伞型) Endophytic ulcerative mass (溃疡型) Diffuse infiltration (弥漫浸润型) an encircling lesions that produce so- called napkin-ring constriction of esophagus with narrowing of the lumen.,2. Gross appearance CS (1) Eearly gastric carcinoma is defined as a lesion confined to the mucosa and submucosa regardless of presence or absence of perigstric LN metastasis.（有转移）,Elevated,Depressed,Two gross patterns: elevated form 。