Chronic peptic ulcer

1.    What pathological process is illustrated now?

       Ulceration, regeneration of gastric epithelium and repair process

2.    What is the cause of the necrosis?

       Toxic injury to the surface epithelium.  Requisite for peptic ulceration is     mucosal exposure to gastric acid and pepsin, and there is a strong causal     association with H. pylori infection.

3.    How deep has the ulceration gone wrt the layers of the stomach?

        Deep ulcer which penetrates the mucosa, submucosa, muscularis propria.              

4.    Describe the 4 zones characteristic of peptic ulceration.

       The base and margins have a thin layer of necrotic fibrinoid debris underlain by a zone of active non-specific inflammatory infiltration with neutrophils underlain by     granulation tissue deep to which is fibrous collagenous scar.

5.    What untoward outcomes may arise as a result of the a) ulceration process, b) regeneration process, c) repair process?

       a) Bleeding

       b) Edema and obstruction.

       c) scarring

6.    What factors would favour healing of the ulcer?

        Robust blood flow, decrease acid production

7.    What would be the histologic appearance of the healed ulcer?

        Granulation tissue, new capillaries formed in submucosa.  In area of scarring, less nuclei seen homogenous pink area.

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Copyright � Joseph Ong 2003