消化系统疾病

病因与发病机制 病变部位
A型和B型慢性萎缩性胃炎比较表
A型
B型
自身免疫
HP感染（60%~70%)
胃体或胃底部弥漫性分布 胃窦部多灶性分布
抗内因子抗体抗壁细胞抗体
（胃液和血清）
血清胃泌素水平 胃内分泌细胞G细胞的增生 血清中自身抗体 胃酸分泌
病理类型和病理变化
病理类型和病理变化肉眼和组织 学类型
➢ 慢性萎缩性胃炎 ➢ 消化性溃疡病 ➢ 病毒性肝炎 ➢ 肝硬化 ➢ 消化系统常见肿瘤
（胃癌、肝癌）
胃的疾病
This is the normal appearance of the stomach, which has been opened along the greater curvature. The esophagus is at the left. In the fundus can be seen the lesser curvature. Just beyond the antrum is the pylorus emptying into the first portion of duodenum is at the lower right.
（胃底腺）
The gastric fundal epithelium has long tubular glands that are lined by pink-staining parietal cells as well as mucus cells.
胃底腺 HE染色 高倍
• 1.主细胞 • 2.壁细胞 • 3.颈黏液细
有时可见点状出血和糜烂 表面有灰黄或灰白色粘液性渗出物覆盖 光镜观：浅层粘膜（粘膜层上1/3） 灶性或弥漫分布 胃粘膜充血、水肿、表浅上皮坏死脱落 固有层有淋巴细胞、浆细胞浸润 结局： 大多经治疗或合理饮食而痊愈，少数转为慢 性萎缩性胃炎
Chronic superficial gastritis. Note the inflammatory infiltrates limit the upper one third of the mucosa.
胞
The gastric antral epithelium has long pits with shorter glands than the fundus.
一、慢性胃炎（chronic gastritis）
是胃粘膜的慢性非特异性炎症。
（一）病因（自学）
幽门螺杆菌 长期慢性刺激 十二指肠液反流 自身免疫性损伤
The normal appearance of the gastric fundus on upper GI endoscopy is shown below at the left, with the normal duodenal appearance at the right.
This is the normal appearance of the gastric antrum extending to the pylorus at the right of center. The first portion of the duodenum (duodenal bulb) is at the far right.
消化系统疾病 Alimentary system diseases
李丹 重医大病理教研室
2014-5
1.消化性溃疡
（1)病理变化（2)并发症
2.病毒性肝炎
七、消化系统疾 病
3.门脉性肝硬化
4.胃癌、食管癌和大肠癌
5.原发性肝癌
（1)基本病理变化（2)临床病理类 型和病变特点
（1)病因（2)病理变化（3)临床病 理联系
The normal gastric wall in fundus. There are mucosa, muscularis propria, submucoma, muscularis and sera.
胃上皮和胃底腺立体模式图
胃底部黏膜 HE染色 低倍
• ↓表面黏液细 胞
• 1.胃小凹 • 2.固有层
Βιβλιοθήκη Baidu
（二）类型及病理变化
（慢性浅表性胃炎、慢性萎缩性胃炎、慢性肥厚性胃炎、疣状胃炎及肉芽肿 性胃炎）
1、慢性浅表性胃炎（chronic superficial gastritis）
又称慢性单纯性胃炎
没有胃固有腺体萎缩的慢性胃炎
部位：胃窦部>胃其他部位 病变：
多呈灶性或弥漫状 胃镜观：病变胃粘膜充血、水肿、呈淡红色
gastritis)
特点 ：以胃粘膜萎缩变薄、粘膜腺体减少或消失并伴有 肠上皮化生，固有膜内多量淋巴细胞、浆细胞浸润为特 点 病因复杂 根据发病是否与自身免疫有关及是否伴有恶性贫血分为
A型 ：发病与自身免疫有关 （血中抗壁细胞抗体和内因子抗体检查阳性） 伴有恶性贫血 胃体、胃底部
B型：发病与幽门螺杆菌有关 无恶性贫血 胃窦部
In the endoscopic views above, the normal appearance of the pylorus is seen at the left, with the first portion of the duodenum at the right.
This is the normal appearance of the gastric fundal mucosa, with short pits lined by pale columnar mucus cells leading into long glands which contain bright pink parietal cells that secrete hydrochloric acid.
Superficial chronic gastritis with H.pylori infection shows the inflammation limited in the portion of mucosa occupied by the foveolae.
2、慢性萎缩性胃炎(chronic atrophic