Diseases of the digestive system. Topic 1 icon

Diseases of the digestive system. Topic 1

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Diseases of the digestive system. Topic 1

(Gastritis, gastric ulcer and duodenal ulcer, appendicitis).

Relevance of the topic. Digestive diseases are very common, they suffer from people of all ages. Delayed diagnosis and inappropriate treatment of herbal tract can lead to serious complications and even death. Digestive diseases are varied his clinical and morphological features that are based may lie different pathological processes - damage, inflammation, hyperplasia, autoimmunity violation, etc.

In recent years there has been significant progress in clarifying the etiology, patho-and morphogenesis of many diseases of the herbal system, due to the possibility of obtaining biopsy specimens and study of almost all departments of herbal tract using the methods of histochemistry, immunohistohemy, fluorescent microscopy. In this regard, morphological examination of widely used to diagnose diseases of the digestive system, select the method of treatment and monitoring of its effectiveness.

Knowledge of the nature and morphological manifestations of diseases of the digestive system necessary for their study in the departments of therapy (Gastroenterology) and Surgery, as well as in the practice of doctors.

^ The purpose of (total): able to determine the macro-and microscopic manifestations of diseases of the digestive system, to be able to explain the causes and mechanisms of their development, to assess the credibility and value to the body of possible complications.


The specific objectives

The purpose of the entry-level

be able to:

1. Identify the macro-and microscopic manifestation of acute and chronic gastritis, explain the mechanism of the development, investigation and assess their value

1. Identify the main portion of the stomach (cardiac, fundic, antral) (Department of Anatomy), and histological structure of the mucosa (Department of Histology)

2. Identify morphological signs of acute and chronic ulcers of the stomach and duodenum, to explain why the mechanism of development, complications, and assess their value

2. Identify the main portion of the stomach (cardiac, fundic, antral) and duodenal (Department of Anatomy), and histological structure of the mucosa (Department of Histology)

3. Identify morphological signs of acute and chronic appendicitis, explain the mechanism of development, and assess the significance of the result of possible complications

3. Recognize the macrostructure appendix (Department of Anatomy), and histological features of its structure (Dept. of Histology)

In order for you to realize as to whether the initial level of your knowledge, skills required, we propose to perform multiple tasks.

The challenge for self-examination, self-knowledge source-level skills

Objective number 1. Histological examination revealed gastrobiopsy close together, long tubular glands with narrow lumen, which contains mucus, which alternate with parietal cells, as well as a large number of chief cells. Which of the stomach meets the cellular composition of this cancer?

A cardiac

B. fundal

C. pyloric

of intermediate

Objective number two. Microscopic examination of histological specimens revealed villi, for almost the entire coated high cylindrical cells with a broad brush border, among which there are single goblet cells. In the crypts Paneth cells are found. For some digestive tract characterized by a structure of the mucous membrane?

  1. Esophagus

  2. Stomach

  3. The small intestine

  4. Rising of the colon

  5. Descending part of the colon

Objective number 3.

The mucous membrane of the body is represented by the villi and crypts, covered with high cylindrical epithelium with goblet cells and a very large number of lymphoid follicles, which are located in the submucosa. For a body characterized by marked characteristics?

Fundic stomach of A.

B. antrum

C. Small Intestine

D. Colon

Appendix E.

The correctness of problem solving test, comparing them with the standards of response.

Standards of responses to meet the challenges for self-starting and self-knowledge, skills: 1 - 2 - C 3 - E;

Information necessary to replenish the necessary knowledge, skills can be found in the following literature:

  1. Prywes M., Lysenko, N., V. Bushkovich Human Anatomy. - _.: Hippocrates, 2001. - S. ___-___.

  2. Afanasyev YM, Yurina IA Histology, cytology and embryology. - G.: Medicine, 1999. - S. ___-___.

The content of education must ensure the achievement of learning objectives, which assists the logical structure of the Count theme "Diseases of the digestive system" (Appendix № 1).

The basic theoretical issues on which you can do the task activities

  1. Gastritis: definition, classification, etiology, pathogenesis, morphology, investigation, and the values ​​of possible complications.

  2. Peptic ulcer and duodenal ulcers: etiology, pathogenesis, morphology, and significance of the investigation of possible complications.

  3. Appendicitis: etiology, pathogenesis, classification, morphology and significance of potential complications.

  4. Cholecystitis: etiology, pathogenesis, classification, morphology, the value of possible complications.

Literature to develop the necessary knowledge, skills for this topic:

  1. Strukov AI, Serov VV Pathologic anatomy. - Kharkov: Fact, 1999. - S. ___-___.

  2. Lectures for the Department of the theme of "Diseases of the digestive system."

  3. Count the logical structure of the theme "Diseases of the digestive system" (Appendix № 1).

Further reading:

  1. Shlopov VG Fundamentals of pathological anatomy. - Kiev, 1999. - S. 305-322.

  2. Serov VV, Yarygin NE, Spider VS Pathological Anatomy: An Atlas. - G.: Medicine, 1986. - S. ___ ____.

Perform the following targets

Objective number one. Male 43 years old for a long time complained of pain and discomfort in the epigastric region. Histological examination of biopsy in the pyloric mucosa of the stomach revealed degeneration of the epithelium cover-hole, atrophy of the epithelium of the glands, intense neutrophilic infiltration and lymphoplasmacytic lamina propria, foci of intestinal metaplasia. On Kotok of diseases listed below suggest the following changes:

  1. Autoimmune chronic gastritis;

  2. Helicobacter pylori chronic active gastritis;

  3. Acute gastritis;

  4. Chronic pangastrit;

  5. Chronic inactive antral gastritis.

Objective number two. Male 40 years old for a long time complained of discomfort in the gastro-duodenal region, bouts of heartburn. Histological examination of biopsies of the gastric mucosa revealed a defect in the mucosa, and bottom edges of which are an accumulation of white blood cells, fibrin, fibrinoid necrosis, granulation and fibrous connective tissue. About the cook of the below listed diseases suggest the following changes:

  1. Chronic gastritis;

  2. Erosion of the stomach;

  3. Acute gastric ulcer;

  4. Chronic gastric ulcer;

  5. Acute gastritis.

Objective number three. Histological examination of the appendix women 27 years found that the structure of it is preserved, in all the layers is determined by a significant number of neutrophils, their concentrations do not have clear boundaries. Which version of appendicitis occurs in this case:

  1. simple;

  2. superficial;

  3. abscess;

  4. phlegmonous-ulcerative;

  5. gangrenous.

Standards of responses to address the tasks for self and self-control targets on the topic:

Methodical instructions to work on a practical lesson, students "Diseases of the digestive system"

In early studies on the standards of answers check homework solutions. Then by the test control will be tested to prepare your lesson.

You should independently examine the macro-and micropreparations, solve situational problems. Macro-and microscopic manifestation of gastric ulcer, and phlegmonous appendicitis studied at the macro and micropreparations "Peptic ulcer", "phlegmonous appendicitis." In this instruction is used to study makropreparatov (application number 2) and micropreparations (Annex № 3).

Classes are completed analysis of the results of independent work of each student by checking the description of the test control micropreparations and learning.


Appendix № 2

Instructions for the Study of macropreparations

  1. Identify the authority

  2. Dimensions

  3. Form

  4. Surface

  5. Consistency

  6. Color

  7. Drawing on the cut

  8. The nature of focal changes

  9. Call the disease process
Appendix № 3
Instructions for the Study of micropreparations

At low magnification to inspect the product, install the organ. Find the field of view with pathological changes, to determine their nature. special features. Formulate a conclusion about the nature of the pathological process.

Appendix № 4

Morphological changes, which are defined in the study of macro-and micropreparations

The Authority



The macroscopic picture

On the lesser curvature the presence of deep defect, round shape, which captures the mucosa, submucosa, muscle, and perhaps a shell with a flat bottom and straight, sometimes arched raised edges.

The wall of the appendix is ​​thickened and the lumen is narrowed, serosa full-blooded, with areas of hemorrhage and yellowish-grayish filmy overlay


In the bottom of the defect (in sequence starting from the surface) fibrinopurulent exudate, fibrinoid necrosis, granulation tissue, fibrous tissue

All layers of the appendix difuzno infiltrated with neutrophilic polymorphonuclear leukocytes in the surface layers of the serous membrane of fibrin fibers with an admixture of neutrophilic PMYAL


Chronic gastric ulcer

^ Phlegmonous appendicitis

Count the logical structure of the theme, "Diseases of the digestive system"







On the clinical course:

- Acute

Uremia, infections (cholera, salmonella, H. Pylori), the action of physical and chemical factors

Damage to the gastric mucosa

Alterative or exudative inflammation (catarrhal, serous, fibrinous, purulent)

No, as a rule, the recovery

- Chronic:


Helicobacter pylori

Antibodies to parietal cells

Damage to the parietal cells, atrophy of the glands, focal pyloric and intestinal metaplasia in the stomach fundal, infiltration of the mucous membrane of immunocompetent cells

Atrophy, reduction of acidity, indigestion

Development of gastric cancer


- Fundic

- Antral

- Pangastrit

Damage to the gastric mucosa

Lymphoid infiltration plasmotic mucosal atrophy in the antral glands, intestinal metaplasia

On the severity of histological changes (inflammatory infiltration, activity, atrophy and metaplasia):

  • weak

  • moderate

  • strong degree of severity

reflux gastritis

Chemical damage to the gastric mucosa

Hyperplasia of the epithelium patching, swelling, and vasodilatation lamina propria, intestinal metaplasia

^ Peptic ulcer and duodenal ulcer

Helicobacter pylori, a hereditary tendency to giperatsidnyh states, stress, smoking

1. strengthening the damaging effect on the gastric mucosa;

2.snizhenie resistance of the mucous membrane

Close-up - deep defects of the mucous membrane, round, with the same edge and bottom, micro - on the surface of the exudate (leucocytes, fibrin), fibrinoid necrosis, granulation tissue, fibrous connective tissue, scar tissue

Bleeding, perforation, penetration, cicatricial stenosis


On the clinical course:

Intestinal microflora

Mechanical damage of the mucosa, neuro-vascular disorders


--- Simple

Catarrh of the mucous membrane, serous - in other layers of the wall of the distal appendix

Perhaps self-healing or transition to destructive forms of

---- Surface

Foci of necrosis and exudative purulent inflammation of the mucous membrane

--- Destructive:

------ Abscess

Diffuse infiltration of the wall of the appendix NPMYAL on serosa fibrinopurulent exudate

Perforation, peritonitis, typhlitis and perityphlitis, pylephlebitis, pileflebiticheskie liver abscesses, intestinal fistulas

------ Gangrenous

Necrosis, hemorrhage, thrombosis


Intestinal microflora

Multiple acute type of simple or superficial

Atrophy of the mucous membrane and other parts of the walls of the appendix, proliferation of connective tissue, thickening of the wall, multiple sclerosis and adiposis submucosa

Exacerbation of the destructive type, edema of the appendix, mukotsele, psevdomiksoma peritoneum


On the clinical course:

Infection, in particular, Helicobacter hepaticus, kkalkulez, dyskinesia

Mucosal damage, neuro-vascular disorders


--- Catarrhal

Catarrhal, serous inflammation

Perhaps self-healing or transition to destructive forms of

--- Abscess

Diffuse infiltration of the gallbladder wall NPMYAL on serosa fibrinopurulent exudate

Perforation, peritonitis, biliary

--- Gangrenous

Necrosis, hemorrhage, thrombosis

- Chronic

Atrophy of the mucosa, proliferation of connective tissue and epiteoiya crypts (glands) with penetration into the muscle layer

^ Inflammatory bowel disease

On the clinical course:

--- Sharp

--- Chronic:

----- Ulcerative colitis (NUC)


Immune disorders, genetic tendency, impaired secretion

In the colon throughout numerous surface defects (ulcers) in combination with the proliferation of the epithelium (polipopodobnye education) micro - mainly lymph plazmotsitarnaya infiltration of the mucous membrane, sometimes mixed with PMYAL, reducing the number of goblet cells and mucus in them, crypt abscesses, sometimes extraintestinal lesions

Severe toxicity, cachexia, bleeding, pre-cancerous changes

----- Crohn's disease


Immune disorders, genetic propensity

Predominantly terminal ileitis, but can be defeated only with the presence of the digestive tract of narrow slit-shaped, deep ulcers, which alternate with patches of cicatricial stenosis of the lumen and the areas of normal organ structure, micro - lobular inflammatory infiltration of the lymph plazmotsitarnaya in all layers, sometimes epithelioid cell granulomas, vasculitis, a characteristic alternation of lesions and normal colon. Sometimes extraintestinal lesions

Perforation, peritonitis, rarely - bleeding


On the clinical course:


Hepatitis B, C, delta, etc., drugs, alcohol, hepatotropic poisons (carbon tetrachloride), autoimmune processes, biliary hepatitis

Acute or chronic inflammation of alterative

- Weak

- Moderate

  • pronounced activity

Macular degeneration, atrophy of hepatocytes necrosis, lymphocytic infiltration of portal tracts and parenchyma, the connective tissue septa presence sclerosis



On morphology:

- Melkouzlovoy (up to 3 mm)

- SKD (> 3 mm)

- Mixed

Viral, alcoholic, toxic, autoimmune, biliary

Postnekrotichesky, portal, mixed

Macro - the surface of small-or, coarsely nodular the liver is reduced in size, thick, tapered edge; micro - a violation of lobed and beam structure, degeneration and necrosis of hepatocytes, the presence of spurious lobes, diffuse fibrosis, regeneration of hepatocytes and bile ducts

hepatic, portal hypertension (ascites, splenomegaly, varicose veins anastomoses porto-caval), bleeding varices mainly the lower third of the esophagus


Of origin:

- Primary

Alcohol, drugs, fatty foods

Violation of cross-duct of the pancreas (Wirsung), bile reflux, poor circulation (shock), the activation of enzymes PZHZ, autolysis

- Secondary

Diseases of the gastrointestinal tract - cholecystitis, cholelithiasis, biliary dyskinesia, gastric ulcer and duodenal ulcer

On the clinical course:

- Acute:



Shock, peritonitis


- Chronic

The replacement of the exocrine parenchyma by fibrous tissue

Sprue, steatorreya, malabsorption of fat-soluble vitamins, cachexia


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