IPLab:Lab 3:Chronic Peptic Ulcer - Revision history

Peter Anderson: /* Images */

2020-06-20T00:09:18Z

‎Images

Peter Anderson: /* Images */

2020-06-20T00:03:03Z

‎Images

Peter Anderson: /* Clinical Summary */

2020-06-19T23:56:53Z

‎Clinical Summary

Peter Anderson: /* Journal Articles */

2016-08-25T14:09:36Z

‎Journal Articles

Seung Park at 16:08, 3 January 2014

2014-01-03T16:08:12Z

Seung Park: /* Images */

2013-08-30T01:27:05Z

‎Images

Seung Park: /* Additional Resources */

2013-08-21T22:22:43Z

‎Additional Resources

Seung Park: /* Images */

2013-08-21T22:22:29Z

‎Images

Seung Park: /* Journal Articles */

2013-08-21T22:20:50Z

‎Journal Articles

Seung Park: /* Reference */

2013-08-21T22:19:23Z

‎Reference

@@ Line 8: / Line 8: @@
 File:IPLab3ChronicPepticUlcer1b.jpg|This is a gross photograph of a stomach containing two ulcers. Note the gastric mucosa that extends up to the edge of the ulcer (arrows).
 File:IPLab3ChronicPepticUlcer2.jpg|This is a gross photograph of the ulcer after it has been transected. The edge of the mucosa (1) is better appreciated in this image. Note the thick, fatty tissue (2) which makes up the base of this ulcer (3).
-File:IPLab3ChronicPepticUlcer3b.jpg|This is a low-power photomicrograph of a section through the transected ulcer. The blue cells on the right hand side of this section are the normal gastric epithelial cells of the mucosa (1). Note the absence of any epithelial cells within the crater of the ulcer (2).
+File:IPLab3ChronicPepticUlcer3b.JPG|This is a low-power photomicrograph of a section through the transected ulcer. The blue cells on the right hand side of this section are the normal gastric epithelial cells of the mucosa (1). Note the absence of any epithelial cells within the crater of the ulcer (2).
-File:IPLab3ChronicPepticUlcer4b.jpg|This is a photomicrograph of the margin of the ulcer. Note the intact epithelium on the right side of the section (1) and the ulcerated region without epithelium on the left (2). There are numerous inflammatory cells within this tissue.
+File:IPLab3ChronicPepticUlcer4b.JPG|This is a photomicrograph of the margin of the ulcer. Note the intact epithelium on the right side of the section (1) and the ulcerated region without epithelium on the left (2). There are numerous inflammatory cells within this tissue.
-File:IPLab3ChronicPepticUlcer5b.jpg|This is a medium-power photomicrograph of the base of the ulcer with the fibrinopurulent membrane (1) overlying the ulcerated surface. The ulcerated surface contains granulation tissue and inflammatory cells (2).
+File:IPLab3ChronicPepticUlcer5b.JPG|This is a medium-power photomicrograph of the base of the ulcer with the fibrinopurulent membrane (1) overlying the ulcerated surface. The ulcerated surface contains granulation tissue and inflammatory cells (2).
-File:IPLab3ChronicPepticUlcer6b.jpg|This high-power photomicrograph of the ulcer base (arrows) demonstrates the lack of epithelium and the exuberant inflammatory response (1) consisting of primarily of fibrin and neutrophils (PMNs). The surface of the ulcer bed is covered with this fibrinopurulent exudate.
+File:IPLab3ChronicPepticUlcer6b.JPG|This high-power photomicrograph of the ulcer base (arrows) demonstrates the lack of epithelium and the exuberant inflammatory response (1) consisting of primarily of fibrin and neutrophils (PMNs). The surface of the ulcer bed is covered with this fibrinopurulent exudate.
-File:IPLab3ChronicPepticUlcer7b.jpg|This high-power photomicrograph of the ulcer base demonstrates plump, activated fibroblasts and endothelial cells (arrows) within the granulation tissue that makes up the base of the ulcer. There are inflammatory cells (primarily lymphocytes) within this region as well.
+File:IPLab3ChronicPepticUlcer7b.JPG|This high-power photomicrograph of the ulcer base demonstrates plump, activated fibroblasts and endothelial cells (arrows) within the granulation tissue that makes up the base of the ulcer. There are inflammatory cells (primarily lymphocytes) within this region as well.
-File:IPLab3ChronicPepticUlcer8b.jpg|This low-power photomicrograph demonstrates the healing reaction in the base of this ulcer. The base of the ulcer is at the top of the image and the serosal surface is at the bottom. Note the granulation tissue and fibrous connective tissue within the wall of the stomach (1) and the layer of inflammatory exudate on the surface of the ulcer (arrow).
+File:IPLab3ChronicPepticUlcer8b.JPG|This low-power photomicrograph demonstrates the healing reaction in the base of this ulcer. The base of the ulcer is at the top of the image and the serosal surface is at the bottom. Note the granulation tissue and fibrous connective tissue within the wall of the stomach (1) and the layer of inflammatory exudate on the surface of the ulcer (arrow).
 </gallery>

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 == Images ==
 <gallery heights="250px" widths="250px">
-File:IPLab3ChronicPepticUlcer1.jpg|This is a gross photograph of a stomach containing an ulcer. Note the folded pink gastric mucosa that extends up to the edge of the ulcer (arrows).
+File:IPLab3ChronicPepticUlcer1b.jpg|This is a gross photograph of a stomach containing two ulcers. Note the gastric mucosa that extends up to the edge of the ulcer (arrows).
 File:IPLab3ChronicPepticUlcer2.jpg|This is a gross photograph of the ulcer after it has been transected. The edge of the mucosa (1) is better appreciated in this image. Note the thick, fatty tissue (2) which makes up the base of this ulcer (3).
-File:IPLab3ChronicPepticUlcer3.jpg|This is a low-power photomicrograph of the transected ulcer. The blue cells on the right hand side of this section are the normal gastric epithelial cells of the mucosa (1). Note the absence of any epithelial cells within the crater of the ulcer (2).
+File:IPLab3ChronicPepticUlcer3b.jpg|This is a low-power photomicrograph of a section through the transected ulcer. The blue cells on the right hand side of this section are the normal gastric epithelial cells of the mucosa (1). Note the absence of any epithelial cells within the crater of the ulcer (2).
-File:IPLab3ChronicPepticUlcer4.jpg|This is a photomicrograph of the margin of the ulcer. Note the intact epithelium on the right side of the section (1) and the ulcerated region without epithelium on the left (2). There are numerous inflammatory cells within this tissue.
+File:IPLab3ChronicPepticUlcer4b.jpg|This is a photomicrograph of the margin of the ulcer. Note the intact epithelium on the right side of the section (1) and the ulcerated region without epithelium on the left (2). There are numerous inflammatory cells within this tissue.
-File:IPLab3ChronicPepticUlcer5.jpg|This is a medium-power photomicrograph of the base of the ulcer with the fibrinopurulent membrane (1) overlying the ulcerated surface. The ulcerated surface contains granulation tissue and inflammatory cells (2).
+File:IPLab3ChronicPepticUlcer5b.jpg|This is a medium-power photomicrograph of the base of the ulcer with the fibrinopurulent membrane (1) overlying the ulcerated surface. The ulcerated surface contains granulation tissue and inflammatory cells (2).
-File:IPLab3ChronicPepticUlcer6.jpg|This high-power photomicrograph of the ulcer base (arrows) demonstrates the lack of epithelium and the exuberant inflammatory response (1) consisting of primarily of fibrin (and adherent gastric secretions) and PMNs. The surface of the ulcer bed is covered with this fibrinopurulent exudate.
+File:IPLab3ChronicPepticUlcer6b.jpg|This high-power photomicrograph of the ulcer base (arrows) demonstrates the lack of epithelium and the exuberant inflammatory response (1) consisting of primarily of fibrin and neutrophils (PMNs). The surface of the ulcer bed is covered with this fibrinopurulent exudate.
-File:IPLab3ChronicPepticUlcer7.jpg|This high-power photomicrograph of the ulcer base demonstrates plump, activated fibroblasts and endothelial cells (arrows) within the granulation tissue that makes up the base of the ulcer. There are inflammatory cells (primarily lymphocytes) within this region as well.
+File:IPLab3ChronicPepticUlcer7b.jpg|This high-power photomicrograph of the ulcer base demonstrates plump, activated fibroblasts and endothelial cells (arrows) within the granulation tissue that makes up the base of the ulcer. There are inflammatory cells (primarily lymphocytes) within this region as well.
-File:IPLab3ChronicPepticUlcer8.jpg|This low-power photomicrograph demonstrates the healing reaction in the base of this ulcer. The base of the ulcer is at the left-hand side of the image and the serosal surface is at the right. Note the fibrous connective tissue within the wall of the stomach and the layer of inflammatory exudate on the surface of the ulcer (arrow).
+File:IPLab3ChronicPepticUlcer8b.jpg|This low-power photomicrograph demonstrates the healing reaction in the base of this ulcer. The base of the ulcer is at the top of the image and the serosal surface is at the bottom. Note the granulation tissue and fibrous connective tissue within the wall of the stomach (1) and the layer of inflammatory exudate on the surface of the ulcer (arrow).
 </gallery>

@@ Line 1: / Line 1: @@
 == Clinical Summary ==
-This 56-year-old white female was admitted to the hospital with a six-year history of epigastric pain and burning. This pain was said to be worse at night and on an empty stomach. The patient reported that the pain was relieved by drinking milk. She had also experienced several episodes of hematemesis and melena since the onset of the pain, the last episode occurring 3 weeks prior to admission. The patient described intermittent episodes of colicky pain in the right upper quadrant and right side of the abdomen, frequently radiating to the back and shoulders and often accompanied by "bilious vomiting." Physical examination was noncontributory except for tenderness in the epigastrium and right upper quadrant. An upper GI series showed changes suggestive of a neoplasm. The patient submitted to an abdominal exploration at which time a partial gastrectomy was performed.
+A 56-year-old white female was admitted to the hospital with severe epigastric pain and burning. This pain, which has occurred intermittently for the Last 4 years was said to be worse at night and on an empty stomach. She had also experienced several episodes of hematemesis and melena.   An upper endoscopy was performed which demonstrated an ulcer in the gastric mucosa.  A breath test for Helicobacter pylori was positive so the patient was started on antibiotics and proton pump inhibitors (PPI).
 == Images ==

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 === Journal Articles ===
-* Mackie DB, Gent AE.  [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491545/ Management of upper gastrointestinal haemorrhage].  ''Ann R Coll Surg Engl'' 1977 January; 59(1): 56–60.
+* Laine L.  [http://www.nejm.org/doi/10.1056/NEJMcp1514257 Upper Gastrointestinal Bleeding Due to a Peptic Ulcer.]  ''NEJM'' 2016 June 22; 374: 2367-2376.
 === Images ===

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 File:IPLab3ChronicPepticUlcer11.jpg|This is a trichrome-stained section of tissue demonstrating fibrous connective tissue scar formation (blue color) in this lesion. The surface of the ulcer is at the left-hand side of the image. There is a layer of inflammatory cells and RBCs on the surface of the ulcer.
 </gallery>
 == Study Questions ==

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 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/122-peptic_ulcer PEIR Digital Library: Peptic Ulcer Images]
+* [{{SERVER}}/library/index.php?/tags/122-peptic_ulcer PEIR Digital Library: Peptic Ulcer Images]
 * [http://library.med.utah.edu/WebPath/GIHTML/GIIDX.html#2 WebPath: Stomach Pathology]

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 * [http://peir.path.uab.edu/library/index.php?/tags/122-peptic_ulcer PEIR Digital Library: Peptic Ulcer Images]
 * [http://library.med.utah.edu/WebPath/GIHTML/GIIDX.html#2 WebPath: Stomach Pathology]
 {{IPLab 3}}
 [[Category: IPLab:Lab 3]]

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 == Additional Resources ==
 === Reference ===
+* [http://emedicine.medscape.com/article/181753-overview eMedicine Medical Library: Peptic Ulcer Disease]
 === Journal Articles ===