1. Tutorial: Diseases of GIT

2. 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

3. 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.

4. 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.EBV D.HBV E.HCV

5. Image Challenge 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?

6. Image Challenge What is your Dx?

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

8. Image Challenge This lesion occur in patient with: A.Smoking B.Achalasia C.Plummer-Vinson syndrome D.Barrett’ s esophagus E.Pernicious anemia

9. Image Challenge Stomach, What is your Dx? A.chronic atrophic gastritis B.Intestinal metaplasia C.Acute gastritis D.Adenocacinoma

10. Image Challenge Stomach, What is your Dx? A.Lymphoma B.Squamous cell carcinoma C.Early adenocarcinoma D.sarcoma

11. Image Challenge What is your Dx? A.Lymphoma B.Squamous cell carcinoma C.Advanced adenocarcinoma D.sarcoma

12. Malignant neoplasm of stomach

13. Image Challenge What is your Dx? A.Peptic ulcer B.Aphthus ulcer C.Malignant ulcer D.Benign ulcer

14. Image Challenge What is your Dx? A.Acute erosive hemorrahgic gastritis B.Chronic atrophic gastritis C.Autoimmune gastritis D.H. pylori gastritis

15. Image Challenge 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 mural thickening with effacement of the overlying mucosal folds and focal ulceration.

16. Image Challenge This Bx. Is from lower end of esophagus. What is your Dx? A.Intestinal metaplasia B.Atrophy C.Adenocacinoma D.SCC

17. Image Challenge Esophagus, What is your Dx? A.Peptic ulcer B.Aphthus ulcer C.Malignant ulcer D.Benign ulcer

18. Image Challenge Doudenum, What is your Dx? A.H. pylori B.Entamoeba histolytica C.Giardia lamblia D.Clostridium difficile

19. Image Challenge What is your Dx, image b? A. Whipple’s disease B. Celiac sprue C. Hirshsprung’s disease D. Tropical sprue

20. Image Challenge What is your Dx? Normal villous atrophy A.Whipple’s disease B.Celiac sprue C.Hirshsprung’s disease D.Tropical sprue

21. Image Challenge What is your Dx? A.Antibiotic Associated Colitis (Pseudomembranous colitis) B.Tropical sprue C.Celiac disease D.Viral enterocolitis

22. Image Challenge What is your Dx? A.H. pylori B.Entamoeba histolytica C.Giardia lamblia D.Clostridium difficile

23. 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.

24. Image Challenge 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 Q: Image Challenge

25. 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

26. 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).

27. 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.

28. 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 M The 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.

29. 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.

30. 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.

31. Image Challenge