Go to Microscope Slide Lists

OBJECTIVES

1. Distinguish among erosions, acute ulcers and chronic ulcers. (p. 331)

2. Distinguish between acute gastritis and chronic gastritis. (p. 330)

3. Name the two parts of the gastric mucosal barrier (mucus and mucosal cells).

4. Compare and contrast between the two types of peptic ulcers (gastric ulcers and duodenal ulcers) with respect to location, causes, prevalence, signs and symptoms, possible complications and treatment. (pp. 331-334)

5. Give the locations and purpose of Brunner's Glands (pp. 332).

6. Know the following terms : appendicitis, diverticulosis, diverticulitis, regional enteritis, ulcerative colitis, hemorrhoids, peritonitis, adhesion, volvulus, intussusception, hernia.

7. Know all underlined terms and * questions, including * case study questions.

Acute Peptic Ulcer (pp. 331-335) Click here 

Notice that the inner lining of the stomach consists of a very thick mucosal layer consisting of tall rows of glandular cells running parallel to each other. The thick mucosa has a deep narrow gap extending to the bottom of the mucosa. This gap is the ulcer.

           22. Stomach, normal, gross
           23. Stomach, pylorus, normal, gross
           24. Stomach, fundus, normal, medium power microscopic*
           29. Acute gastric ulcer, benign, gross
           30. Gastric ulcer, malignant, gross
           31. Acute gastric ulcer, low power microscopic*  - hemorrhaging
           33. Acute gastric ulcer penetrating to artery, low power microscopic*  - hemorrhaging
           32. Acute gastric ulcer, high power microscopic*  - perforation
           34. Helicobacter pylori in stomach, Methylene blue stain, microscopic*  - H. pylori

* Define the term ulcer. (p. 39)

* What makes this ulcer a peptic ulcer? (p. 331)

* How does this acute ulcer differ from an erosion or a chronic ulcer? (p. 331, Fig. 24-4) 

Chronic Gastritis - ( PH 1410) (p. 330) Click here 

Compare the slide with the diagram of normal stomach mucosa. Notice that on the slide, the mucosa is thinned and flattened and there is exudate (clear spaces with pink structureless material) present within the submucosa. Notice also that the lymph nodes are greatly enlarged and there are large numbers of white blood cells within the submucosa.

        24. Stomach, fundus, normal, medium power microscopic*
        35. Anti-parietal cell autoantibody, immunofluorescence microscopy*  - autoimmune

Notice the marked area on the X-ray indicating where the contrast dye that was swallowed flowed into the pit of the ulcer. (Figs. 4-11, 24-4 and 24-6)

* What chemicals found in the stomach are believed to be most involved in causing peptic ulcers? (p. 331)

* What complication from ulcers would be indicated if the contrast dye had spread over a large area of the X-ray? (p. 335)

Diverticulitis (pp. 359-360)

            77. Normal colonic mucosa, medium power microscopic*
            110. Sigmoid colon, diverticulosis, gross
            111. Colon, diverticulosis, gross
            112. Colon, cut surface, diverticulosis, gross
            113. Colon, cut surface, diverticulosis, gross
            114. Colon,, diverticulosis, low power microscopic*
            115. Colon, diverticulitis, gross
            116. Colon, diverticulitis with perforation, gross
            117. Colon, diverticulitis with perforation, gross

Notice that the inner surface of the mucosa has several regions that appear puckered. The small openings lead into round pockets that are visible on the outer surface of the large intestine. The round pockets are the diverticuli. Compare this specimen with the normal intestine and with Fig. 26-3.

* What causes the formation of diverticuli? (p. 359, Fig. 26-3)

The diverticuli contain trapped fecal material. Some of the diverticuli have been opened. If diverticuli had burst while the intestine was within the body, fecal material would have escaped into the peritoneal cavity.

* What condition would likely result if this occurred? (p. 359)

Regional Enteritis (pp. 348-349)

        Regional enteritis
            48. Normal terminal ileum, gross
            49. Normal small intestinal mucosa, medium power microscopic*
            119. Crohn's disease, terminal ileum, gross
            120. Crohn's disease, terminal ileum, gross
            121. Crohn's disease, colon, low power microscopic*
            123. Crohn's disease, small intestine, medium power microscopic*
        Ulcerative colitis
            77. Normal colonic mucosa, medium power microscopic*
            124. Chronic ulcerative colitis, gross
            125. Chronic ulcerative colitis, gross
            126. Chronic ulcerative colitis, gross
            127. Chronic ulcerative colitis, gross
            128. Chronic ulcerative colitis, low power microscopic*
            130. Chronic ulcerative colitis with crypt abscesses, medium power microscopic*
            132. Chronic ulcerative colitis with dysplasia, medium power microscopic*  - pre-cancerous dysplasia

This is a specimen of human small intestine with regional enteritis (Crohn's Disease). Compare this specimen with the specimens of normal small and large intestine. Note that the mucosa in the normal samples is smooth and thin. The enteritis specimen has undergone years of inflammation and necrosis and as a result, much of the mucosa (the necrotic portion) has peeled away. Notice that there are long areas with mucosa still present and other, deeper areas without mucosa. Although ulcerative colitis is a different disease (and affects the large intestine) it produces changes similar to these. See Table 26-1, p. 361 for a comparison of these two diseases.

* Name 4 complications of regional enteritis (pp. 348-349) and 4 complications of ulcerative colitis. (pp. 360-362)

Case Study 1 : Peptic Ulcer (pp. 331-336)

Joe, a 26 year old graduate student, was brought to the emergency room by a friend. He showed extreme anxiety and complained of excruciating upper abdominal pain shortly after a meal of spicy pizza and wine followed by a cup of coffee. Joe had been experiencing mild abdominal pain irregularly for several years but found that drinking milk or taking antacid tablets usually relieved his distress within a few minutes. He liked to cook and eat well and was slightly overweight.

Though Joe had taken his normal dose of two antacid tablets on the way to the hospital, his pain did not subside until about 30 minutes after his arrival. During this time, he mentioned that he was on academic probation and believed he had to recover quickly so as to prepare for his next major exam at school.

Examination revealed that Joe's stomach and small intestines were active. His blood pressure was slightly elevated and his red blood cell count was low. By one hour after his arrival, he felt no abdominal pain but noticed a general overall weakness. A barium x-ray revealed a small ulcer.

*1. Where do you think Joe's ulcer was located? What factors lead you to this answer? (pp. 331-332).

*2. What factor or factors probably led to Joe's ulcer? (pp. 331-334).

*3. What factor or factors probably caused the extreme pain? (pp. 331-334).

*4. Why did the pain finally subside? What information lead you to this answer? (p. 335).

*5. The doctor recommended that Joe continue to use antacid tablets and also prescribed propantheline, bismuth salts, and antibiotics. What are Joe's chances for a rapid return to normal activities? (p. 334).

8Copyright 2001 - Augustine G. DiGiovanna - All rights reserved.