1. Tutorial: Diseases of GIT

2. Image Challenge Image ChallengeQ:
This 12-year-old boy presented with abdominal pain. What is the diagnosis?
1. Cowden syndrome
2. Cronkhite-Canada syndrome
3. Osler-Weber-Rendu syndrome
4. Peutz-Jeghers syndrome
5. VonWillebrand syndrome

3. 4. Peutz-Jeghers syndrome
Image Challenge Q:
This 12-year-old boy presented with abdominal pain. What is the diagnosis?
Answer:
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.

4. 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?
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 this immunosuppressed patient.
(e) The changes seen are the consequences of
long-standing esophageal achalasia

5. 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.

6. This disease is caused by infection by: HIV HPV EBV HBV HCV
Image Challenge
This lesion is seen in patient with:
Sickle cell anemia
Acquired immunodeficiency syndrome
Gairdia lamblia infection
Leishmaniasis
schistosomiasis
This disease is caused by infection by:
HIV
HPV
EBV
HBV
HCV

7. This lesion is associated with: Sickle cell anemia HIV infection
Image Challenge
What is the diagnosis?
This lesion is associated with:
Sickle cell anemia
HIV infection
Gairdia lamblia infection
Leishmaniasis
Dysplasia and squamous cell carcinoma

8. Image Challenge
What is your Dx?

9. Image Challenge
Which of the following dietary factors is not associated with this lesion?
deficiency of vitamins: A, C, thiamine, pyridoxine
deficiency of trace metals: zinc, molybdenum
Nitrite/nitrosamine
Fungal contamination of food stuffs
High fat diet

10. Image Challenge
What is your Dx?
This lesion occur in patient with:
Smoking
Achalasia
Plummer-Vinson syndrome
Barrett’ s esophagus
Pernicious anemia

11. The most common cause is:
Image Challenge
What is your Dx?
The most common cause is:
NSAID
Corticosteroid
H. pylori
Aspirin
Stress

12. Image Challenge

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18. Image Challenge