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GI Path Online

Pathology of Acute Gastritis

 Dr  Sampurna Roy  MD

 

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Acute gastritis is an acute mucosal inflammatory process usually of a transient nature.

Causes:

Drugs: Nonsteroidal anti- inflammatory drugs (Example: Aspirin).

Alcohol consumption.

Smoking.

Systemic infection.

Gastric irradiation.

Ischaemia.

Shock.

Stress (burn, trauma).

Uraemia.

Following surgery (distal gastrectomy)

Proposed mechanism of action:

- Increased acid production with back diffusion.           

- Decreased production of surface bicarbonate buffer.

- Reduced mucosal blood flow causing disruption of mucous layer.

- Damage to mucosal epithelium.

Gross:

Stress Ulcer:  Less than 1cm in diameter. Multiple lesions. Located anywhere in the stomach.
Intervening mucosa diffusely congested and numerous small petechial haemorrhages.

Acute erosive gastritis:
Mucosa is diffusely haemorrhagic without ulceration.

 

Histopathological features in acute gastritis:

Mild form:

Edema in lamina propria; Slight hyperemia in the interfoveolar area ;

Surface epithelium is intact ; Scattered neutrophils within mucosal epithelial cells - this signifies active inflammation.

Acute erosive/hemorrhagic gastritis:

-With more severe mucosal damage, erosion and hemorrhage develops.

[Erosion is defined as loss of superficial epithelium causing a defect in the mucosa that does not cross the muscularis mucosa.]

-Lesion is acccompanied  by a dense acute inflammatory infiltrate and extrusion of fibrin, containing purulent exudate into the lumen.

-Deep mucosa (glandular zone) is usually unaffected unless stress ulcer results due to local necrosis.

-Crypts may be dilated & filled with acute inflammatory cells in erosive gastritis.

Healing phase:

Epithelial regeneration ; Elongation of pit ; Pseudostratified appearance of superficial epithelium; Residual cluster of neurtrophils in the pit ; Residual cluster of neutrophils in the pit.

Note:  Pathologists should be careful not to diagnose regenerative changes as malignancy.

Regenerative changes include:

Regular glands arranged parallel to one another ;

Lamina propria separating the glands ;

Basally located nucleii ; Basophilic cytoplasm ;

Increased nuclear cytoplasmic ratio ;

Increased mitotic activity.

Summary of histological features:

-Hyperemia

-Surface erosion

-Acute inflammation

-Massive mucosal necrosis

-Sloughing

-Eventual scarring

 

 Rare types of acute gastritis: