Tutorial: Diseases of GIT

Tutorial: Diseases of GIT

Image Challenge

This photomicrograph shows the lower end of the

esophagus, with the esophago-gastric junction indicated

by the label. Which of the following is most correct?

(a) The lower esophageal mucosa in this picture is lined by non-keratinizing squamous epithelium.

(b) This is Barrett’s esophagus, with columnar epithelium

(c) The ulcerated areas at the esophago-gastric junction are due to early carcinoma.

(d) The darker red mucosa at is the result of inflammation due to severe Candida infection in immunosuppressed patient.

(e) The changes seen are the consequences of long-standing esophageal achalasia

Image Challenge

Answer (b) is most correct.

(a) The darker red mucosa is lined by gastric-type columnar epithelium.

(b) Barrett’s esophagus is characterized by the replacement of the normal squamous mucosa of the lower esophagus by gastric-type columnar epithelium. The demarcation of the two types of mucosa is indicated by the arrow.

(c) The ulcers are flat, without the hard raised edges which would suggest carcinoma. However, very early malignancy can only be excluded by histological examination of a biopsy from the ulcer edge.

(d) Although Candidal infection causes inflammation of the esophageal mucosa, the surface usually shows white patches due to fungal hyphal colonies.

(e) Achalasia of the esophagus leads to esophageal dilatation, but no mucosal changes or ulceration.

Image Challenge

• This lesion is seen in patient with:

A. Sickle cell anemia

B. Acquired immunodeficiency syndrome

C. Gairdia lamblia infection

D. Leishmaniasis

E. schistosomiasis

This disease is caused by infection by: A.HIV B.HPV C.EBVD.HBVE.HCV

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• This lesion is associated with:

A.Sickle cell anemia

B.HIV infection

C.Gairdia lamblia infection

D.Leishmaniasis

E.Dysplasia and squamous cell carcinoma

What is the diagnosis?

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What is your Dx?

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A. deficiency of vitamins: A, C, thiamine, pyridoxineB. deficiency of trace metals: zinc, molybdenum C. Nitrite/nitrosamine D. Fungal contamination of food stuffsE. High fat diet

Which of the following dietary factors is not associated with this lesion?

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This lesion occur in patient with:A.SmokingB.AchalasiaC.Plummer-Vinson syndromeD.Barrett’ s esophagusE.Pernicious anemia

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Stomach, What is your Dx?

A. chronic atrophic gastritis 

B. Intestinal metaplasia

C. Acute gastritis

D. Adenocacinoma

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Stomach, What is your Dx?

A. Lymphoma

B. Squamous cell carcinoma

C. Early adenocarcinoma

D. sarcoma

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What is your Dx?

A. Lymphoma

B. Squamous cell carcinoma

C. Advanced adenocarcinoma

D. sarcoma

Malignant neoplasm of stomach

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What is your Dx?

A. Peptic ulcer

B. Aphthus ulcer

C. Malignant ulcer

D. Benign ulcer

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What is your Dx?

A. Acute erosive hemorrahgic gastritis

B. Chronic atrophic gastritis

C. Autoimmune gastritis

D. H. pylori gastritis

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What is your Dx?

A. Lymphoma

B. Squamous cell carcinoma

C. Adenocarcinoma

D. sarcoma

In this image, the gastric folds are enlarged and thickened. There is muralthickening with effacement of the overlying mucosal folds and focal ulceration. 

Image Challenge

This Bx. Is from lower end of esophagus. What is your Dx?

A. Intestinal metaplasia

B. Atrophy

C. Adenocacinoma

D. SCC

Image Challenge

Esophagus, What is your Dx?

A. Peptic ulcer

B. Aphthus ulcer

C. Malignant ulcer

D. Benign ulcer

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Doudenum, What is your Dx?

A. H. pylori

B. Entamoeba histolytica

C. Giardia lamblia

D. Clostridium difficile 

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What is your Dx, image b?

A. Whipple’s disease

B. Celiac sprue

C. Hirshsprung’s disease

D. Tropical sprue

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What is your Dx?

Normal villous atrophyA. Whipple’s diseaseB. Celiac sprueC. Hirshsprung’s diseaseD. Tropical sprue

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What is your Dx?

A. Antibiotic Associated Colitis (Pseudomembranous colitis)

B. Tropical sprue

C. Celiac disease

D. Viral enterocolitis

Image Challenge

What is your Dx?

A. H. pylori

B. Entamoeba histolytica

C. Giardia lamblia

D. Clostridium difficile 

Image Challenge

What is your Dx?

The photograph shows a lesion on the lower lip.

Which of the following statements is most correct?

(a) It is a large viral lesion (‘cold sore’).

(b) It is a benign tumor derived from the salivary tissue in the lip.

(c) It is most common in young adult men.

(d) It will resolve with antibiotic therapy.

(e) It is malignant and may metastasize to lymph nodes in the neck.

Image Challenge

This 12-year-old boy presented with abdominal pain. What is the diagnosis?

1. Cowden syndrome 2. Cronkhite-Canada syndrome3. Osler-Weber-Rendu syndrome4. Peutz-Jeghers syndrome5. VonWillebrand syndrome

Q:

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Answer:

This 12-year-old boy presented with abdominal pain. What is the diagnosis? Q:

4. Peutz-Jeghers syndrome

The presence of mucocutaneous pigmented lip lesions suggests the diagnosis of Peutz-Jeghers syndrome, an autosomal dominant disorder characterized by development of multiple hamartomatous gastrointestinal polyps.

Image Challenge

Image Challenge

This photograph shows a distended and discolored

loop of sigmoid colon found at autopsy. Which of the

following statements is most correct?

(a) The discoloration of the colon is due to melanosis coli.

(b) The discoloration of the colon is due to arterial

infarction following a mesenteric thromboembolus.

(c) The discoloration of the colon is due to venous

infarction secondary to torsion.

(d) The discoloration of the colon is due to severe

Crohn’s disease of the colon.

(e) This disease is a well-recognized complication of

diverticular disease of the colon.

The loop of sigmoid colon has twisted on itself leading to occlusion of the venous drainage. This has led to venous infarction of the twisted loop (sigmoid volvulus).

Image Challenge

What is your Dx?

This photomicrograph shows the histology of the

lung in bronchopneumonia. Which of the following

statements is most correct?

(a) Bacteria are inhaled into the alveolar air sacs and

infection then spreads into the bronchioles.

(b) The most common causative organism is Klebsiella

pneumoniae.

(c) Bronchopneumonia is often preceded by an upper

respiratory infection such as acute tracheobronchitis.

(d) It is a disease of sudden onset in young and

middle-aged adults.

(e) It particularly affects the apical segments of the

upper lobes.

Image Challenge

This photograph shows the mucosa of the small

intestine. Which of the following statements is most correct?

(a) The structures labeled (U) are linear deep fissured ulcers.

(b) The raised areas labeled (M) represent malignant infiltration of mucosa and submucosa by small intestinal malignant lymphoma.

(c) The abnormalities are most likely confined to the mucosal and submucosal layers of the small bowel.

(d) The abnormalities are most likely to involve the entire small intestine.

(e) The abnormalities are cured by antibiotic treatment.

U

MThe deep fissured ulcers produce the ‘cobblestone’mucosal pattern characteristic of Crohn’s disease.

The deep fissured ulcers produce the ‘cobblestone’mucosal pattern characteristic of Crohn’s disease.

Image Challenge

This photograph shows a mass protruding into the colon in a patient who passed blood per rectum on a number of occasions. Which of the following statements is most correct?

(a) The lesion is a metaplastic (hyperplastic) polyp.

(b) The lesion is a tubular adenoma.

(c) The lesion is a villous adenoma.

(d) The lesion is a colonic adenocarcinoma Dukes’ Stage B.

(e) The lesion is a post-inflammatory polyp following chronic ulcerative colitis.

Image Challenge

This photograph of a section through the colon wall

shows a diverticulum penetrating through the muscle layer in diverticular disease. Which of the following statements is most correct?

(a) The muscle layer (M) is normal thickness.

(b) The diverticulum (D) is infected.

(c) Diverticular disease occurs in young people.

(d) Diverticular disease can be complicated by

development of a paracolic abscess.

(e) Diverticular disease is most common in cecum and

ascending colon.

M

D

If a diverticulum becomes obstructed, then inflamed, pus accumulates in the obstructed diverticulum. Rupture leads to formation of a paracolic abscess, and often perforation leading tofecal peritonitis.

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