PEPTIC ULCERS

Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine or sometimes the lower esophagus.

MORPHOLOGICAL FEATURES

1) Acute Peptic Ulcer:-

Grossly- Acute ulcers are multiple. They are more common anywhere in the stomach decreasing frequently in the first part of the duodenum. They may be oval or circular in shape.

Microscopically-  They are shallow, do not invade the muscular layer. Margin & base show inflammatory reactions. These commonly heal by re-epithelialization without leaving any scars.

2) Chronic Peptic Ulcer:-

Grossly-  Grossly gastric & duodenal ulcers are similar. Ulcers are commonly solitary, small (1-1.25cm in diameter), round to oval & characteristically ‘punched out’. Ulcers may vary in depth from being superficial to deep ulcers (mucosa to muscular layer).

-Most are benign <1% can turn into a malignant form which is larger, bowl shaped with elevated mucosa at margins. Gastric ulcer is found along the lesser curvature in the region of pyloric antrum & duodenal ulcers are found in the first part of the duodenum (post-pyloric).

Microscopically- Have 4 histological zones, from within outside:-

Necrotic Zone:- Lies in the floor of the ulcer & composed of fibrous exudates containing necrotic debris.

Superficial exudative zone:- lies underneath of necrotic zone. Tissue elements show coagulative necrosis giving eosinophilic, smudgy (dirty mark) appearance.

Granulation tissue Zone:- Merging into a necrotic zone, composed of nonspecific inflammatory infiltrate.

Zone of cicatrization:- It is merging into a thick layer of granulation tissue composed of the dense fibro collagenic scar. Thrombosed arteries may cross the ulcer which on erosion may result in hemorrhage.

Share via
Copy link
Powered by Social Snap