Diseases of the stomach – The cytological diagnosis of diseases of the alimentary canal

The most common diseases are stomach gastritis, ulcer, polyps and cancer. For the diagnosis of these diseases are not only methods for the determination of gastric secretory function, and cytological research.

The material for cytology can serve as the stomach contents, obtained during sensing, gastric washings, collected in different ways (And on. I. Altgauzenu, Bottled by, focused on the suction H. N. Schiller Volkova), smears with pieces of gastric mucosa, obtained via biopsy forceps under direct vision by fibergastroscope.

Epithelial desquamation enhanced by the application of mechanical stimulus - probe balloon. In diseases of the stomach mucosa it is often covered with a thick layer of mucus, which hinders the process of shedding cells. By preliminary introduction into the stomach mucolytic enzyme papain or alpha-chymotrypsin can cause dissolution of mucosal barrier and thus create favorable conditions for the maximum shedding of the epithelial cells of the gastric mucosa. The gastric contents under the influence of an acid reaction due to the salt and volatile (Breast, oil, etc.) acids in stagnation and even modified epithelial cells are destroyed. Especially easily destroyed unstable tumor cells. Dilution of a small amount of fasting gastric washings contributes to maintaining cell structure, exfoliated from the surface of the tumor.

The method of gastric lavage for the diagnosis of gastric cancer is not widely used in practice, Although yields positive results 70 % cases.

At A gastric lavage. I. Altgauzenu the patient is administered on an empty stomach in the stomach thick tube with a funnel and extract content into a separate bowl. Not removing probe, is introduced through the funnel 300 ml of warm water and immediately remove it. Then the procedure was repeated, Using another bowl. After standing for 1-2 hours the supernatant, and the residue was placed in a petri dish. Metal spatula and dissecting needle taken mucous, spotting, plotnovata and other particles, used to prepare drugs for microbiological examination.

The washings are no food mass, therefore it is possible the most comprehensive selection of particles for microscopic examination. With stagnation in the stomach, that is frequently observed in tumors, you need to remove the food the night before the study gastric lavage. After that, before the morning washing the patient does not take the food.

Although the process of obtaining the wash water is a time-consuming, it is less dangerous, than taking for research mikrobioptata, and it is important in the diagnosis of malignant tumors of the stomach.

Several difficult balloon method for producing wash water by double gastroduodenal probe. One probe is used to aspirate fluid: in the mouth end of the probe is inserted into the syringe, and the end, located in the stomach, a duodenal olive with larger openings. The second probe has a thin-walled rubber bag cylindrical shape, placed in the mesh of silk, the mouth end of the probe is connected to a blower for inflating the balloon in the air. Pear has a valve for deflation.

Probe, with warm isotonic sodium chloride solution, administered on an empty stomach. First, the entire contents of the stomach is aspirated and washed with isotonic sodium chloride solution. Then, the air bag is inflated and it moves to the peristaltic movements of the gatekeeper. Next, air is discharged, Probe pulled up to the pyloric cave and re-inflated rubber bag. This procedure was repeated five times over 30 m, During this time, several times aspirated stomach contents. After removing the probe wash it 200 ml of isotonic sodium chloride solution. Rinse and liquid is centrifuged for 30 minutes at 1500 / min. From preparing drugs for sediment cytology.

According to the method of H. N. Schiller Volkova, a sample from the stomach is produced by targeted extraction from the place of the alleged destruction, washing necessary part of the stomach in small portions (20 ml) preheated isotonic sodium chloride solution. For this purpose, duodenal tube with a special large olive, having parallel longitudinally extending recesses, at the bottom of which there are holes.

When delayed evacuation leftover food removed the night before by careful gastric lavage. In the morning on an empty stomach under fluoroscopy injected the probe in such a way, his olive tree as much as possible approached to the place of destruction. In this patient, depending on the tumor (on the side, back, stomach) give the most comfortable position for research. After setting the desired level olive suction movements of the syringe is aspirated liquid and collect it in a test tube. Upon termination of fluid intake is administered by gavage 20 ml of warm isotonic sodium chloride solution, who immediately aspirated. Washing is repeated 3 5 time, massaging the abdominal wall at the location of the olive.

Laboratory wash liquid dispensed thin layer in Petri dishes to view with the naked eye or through a special magnifying glass. For microscopic examination select the most dense particles, Lots streaked with blood. Select and explore should be possible all the material (10- 12 percent).

The native and stained preparations, prepared from gastric lavage, found a different number of leukocytes, epithelial cells of the stomach, and malignant tumors - abnormal cells. These microscopic studies in conjunction with the results of functional and clinical studies allow us to establish the nature of the pathological process.

For the diagnosis of diseases of the stomach is also used material, obtained when sighting fibergastroscope. Carried out mainly histological examination, cytological diagnosis used to produce a very small piece of the gastric mucosa, unsuitable for the preparation of histological preparation, and where, if the biopsy is of mucus, fiʙrina, and detritus scattered epithelial cells. Immediately after removal of forceps-cups, used for biopsy, fibergastroscope obtained from the channel material by using a needle is placed on a slide, prepare smears, and then the remaining piece of cloth dipped in formalin and sent for histological examination.

With a significant lesion of the mucosal surface of the stomach it is recommended to take the material for cytology by scraping with a nylon brush, However, the drawback of this method is that, that the majority of cells in the resulting material is destroyed.

Cytograms material, obtained by gastrofibrobiopsii, differ from cytograms gastric lavage. In smears revealed mostly surface epithelial cells, glands of the stomach and the small number of cells from the upper parts of the alimentary canal.

Cells own gastric glands are arranged in the form of tubes or round structures. The main cells of round shape, average value, with a centrally located round the core, in the cytoplasm of basophilic stippling. Parietal cells are found, usually, among the main, larger than last, contain almost centrally located small round nucleus and cytoplasm wide oxyphilic. Mucosal small quantities, morphologically similar to columnar epithelium, therefore it is difficult to differentiate cytologically.

Epithelial cells of cardiac and pyloric glands small quantities, round shape, with a centrally located small hyperchromatic nucleus and vacuolated wide (frothy) cytoplasm.

White blood cells, that create the background smear, made from sediment gastric lavage, and red blood cells in the biopsy diagnosis cytograms not matter. The presence of complexes and clusters of cells may be due to uneven distribution of the material obtained. Of great importance are cellular polymorphism and changes in nuclear structure:

• anisocytosis;
• the presence of polymorphic and hyperchromatic nuclei;
• the appearance of large, painted in blue nucleoli;
• glybchatoe uneven distribution of chromatin.

Gastrobioptatov cytology provides an opportunity to early diagnosis of gastric cancer even in the absence of invasive growth.

When evaluating cytological, according to the classification of a Pap and Cooper, epithelial cells partitioned into five classes.

For Class I include normal epithelial cells; ко II — эпителиоциты (larger amount) degenerative; to the III and IV - epithelial cells with enlarged nuclei, occurring at a stomach ulcer in the case of aggravation; for Class V - malignantly altered cells.