8. Pathology of the GIT small/large intestine

Question 1

A 23 year old Jewish female comes to the doctor with a 5 months history of abdominal pain and bloody diarrhea. A colonoscopy is performed which shows mucosal and submucosal ulcers and crypt abscesses with neutrophils. What is true of this condition?

A.  Results in creeping fat
B. Smokers have increased risk
C. Starts in the rectum 
D. Associated with polyarthritis 
E. Associated with erythema nodosum 

RFA

Answer 1

Ans. C Start in the rectum- the patient has ulcerative colitis the man differential of UC is crohn’s disease which all the other options describe.

The main differences are UC is mucosal and submucosal while Crohn’s is full thickness

A. Results in creeping fat- Crohn’s can also cause cobble stone appearance of the bowel

B. Smokers have increased risk- smoking increases risk of crohn’s but actually decreases risk of UC

D and E are complication of Crohn’s. complications of UC are toxic megacolon and carcinoma

Question 2

23 year old Jewish female comes to the doctor with a 5 months history of abdominal pain and bloody diarrhea.A colonoscopy with a biopsy is done. Necrotizing granulomatous inflammation is noted at the terminal ileum. Labs are doing showing a AFB positive organism. What shaped ulcers would biopsy also likely yield?

A. Flask  shaped ulcers 
B. Longitudinal circular ulcers 
C. Square transverse 
D. Transverse oval ulcer 
E. Pentagonal Longitudinal 

RFA

Answer 2

D. Transerve oval ulcers- the patient has TB which is associated with oval or circular ulcer usually over Terminal Ileum to the jejunum

A. Flash shaped ulcer- Amebic colitis causes by Entamoeba histolytica

B. Longitudinal circular ulcers- is associated with Typhoid, these are usually over Peyer Patches

C and E don’t exist.

Question 3

A 33 year old male presents to the clinic complaining of recent attacks of bloody diarrhea with stringy, mucoid material in it. These attacks are always preceded by abdominal pain and cramping that is relieved temporarily by defecation. Before the attacks started one month ago, he had a bout of infectious enteritis. Which of the following morphological features would be seen on examination of a biopsy from the affected part of the patient’s colon? (MG)

A. Skip lesions
B. Granulomas
C. Backwash ileitis 
D. White plaques
E. Squamous metaplasia

Answer 3

C. Backwash ileitis

Question 4

A section of the large intestine shows destructive colitis with flask shaped ulcers. Laboratory testing shows the presence of a parasite. What is the causative organism? (MG)

A. Salmonella
B. Entamoeba histolytica
C. Yersinia
D. Shigella

Answer 4

B. Entamoeba histolytica