questionnaire solutions

1. Gastrointestinal
System
Pathanatomy
Submitted By
Anubhuti Dave
Group 21
Semester 5th

2. 276. A 49-year-old female taking ibuprofen for increasing joint pain in her hands
presents with increasing pain in her midsternal area. Gastroscopy reveals multiple,
scattered, punctate hemorrhagic areas in her gastric mucosa. Biopsies from one of these
hemorrhagic lesions reveal mucosal erosions with oedema and haemorrhage. No
mucosal ulceration is seen. What is the best diagnosis?
a. Active chronic gastritis
b. Acute gastritis
c. Autoimmune gastritis
d. Chronic gastritis
e. Peptic ulcer disease

3. 276. The answer is B. Gastritis is a nonspecific
term that describes any inflammation of the gastric mucosa. Acute
gastritis refers to the clinical situation of gastric mucosal erosions (not
mucosal ulcers). Acute gastritis is also known as hemorrhagic gastritis or
acute erosive gastritis. Acute gastritis is associated with the use of non-
steroidal
anti-inflammatory drugs, such as aspirin, ibuprofen, and corticosteroids,
and also with alcohol, chemotherapy, ischemia, shock, and even severe
stress.
Microscopically the gastric mucosa from a patient with acute gastritis is
likely to reveal mucosal erosions, scattered neutrophils, edema, and
possibly haemorrhage.

6. A - Active chronic gastritis
Helicobacter pylori is the most important etiological agent of chronic
active gastritis. The pathogenic mechanisms leading from chronic
active inflammation of the gastric mucosa to the development of the
epithelial and lymphoid alterations that may result in ulceration,
metaplasia, cancer, and lymphoma remain poorly understood.The
basic features of human H. pylori infection (an intense, mostly antral
or diffuse chronic active gastritis), its later complications (mucosal
atrophy and intestinal metaplasia), or its associated diseases (peptic
ulcer, gastric carcinoma, and lymphoma).

8. C. Autoimmune gastritis
Autoimmune gastritis (AG) is an inflammatory condition of the
stomach that is associated with auto-antibodies to parietal cells
and intrinsic factor and can lead in a small percentage of patients
to destruction of the oxyntic mucosa, pernicious anemia, and the
development of carcinoid tumors that are typically indolent.
Autoimmune gastritis. Diffuse mononuclear infiltrates within the
lamina propria that are heavier in the deeper, glandular portions
(A). Patchy lymphocytic infiltrates and damage to oxyntic glands
(B). Parietal cell pseudohypertrophy with "snouting" resulting
from luminal cytoplasmic projections (C). Metaplastic epithelium
of the intestinal (D), pyloric (E), and pancreatic acinar types (F).
Linear enterochromaffin cell-like cell hyperplasia on hematoxylin
and eosin stain (G) and with chromogranin stain (H).

10. D. Chronic gastritis
Chronic gastritis involves swelling or inflammation of the stomach
lining. If you have this condition, you might feel full after eating just a
few bites.
Causes of chroinc gastritis - long-term use of certain medications (aspirin
and ibuprofen)
excessive alcohol consumption
bacteria that cause stomach ulcers (H. pylori)
certain illnesses (kidney failure)
a viral infection in a weakened immune system
persistent, intense stress
bile flowing into the stomach (called bile reflux)
Symptoms-upper abdominal pain indigestion or bloating nausea and
vomiting Belching loss of appetite or weight loss

13. E. Peptic ulcer disease
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first
part of the small intestine, called the duodenum. Causes of ulcer-Use of painkillers
called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen
(Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of
Midol, and others), and many others available by prescription; even safety-coated
aspirin and aspirin in powered form can frequently cause ulcers.
Excessive drinking of alcohol ,Smoking or chewing tobacco, Serious illness ,Radiation
treatment to the area
Symptoms-Dark or black stool (due to bleeding)
Vomiting blood (that can look like "coffee-grounds")
Weight loss
Severe pain in the mid to upper abdomen
Bleeding
Perforation (a hole through the wall of the stomach)
Gastric outlet obstruction from swelling or scarring that blocks the passageway leading
from the stomach to the small intestine

15. 277. A biopsy of the antrum of the stomach of an adult who presents
with epigastric pain reveals numerous lymphocytes and plasma cells
within the lamina propria, which is of normal thickness. There are also
scattered neutrophils within the glandular epithelial cells. A Steiner silver
stain from this specimen is positive for a small, curved organism, which
is consistent with
a. Enteroinvasive Escherichia coli
b. Enterotoxigenic E. coli
c. Helicobacter pylori
d. Salmonella typhi
e. Shigella species

16. Answer C.Chronic gastritis
is histologically characterized by the presence of lymphocytes and
plasma cells. It is important to realize that the presence of neutrophils
within the glandular epithelium indicates active inflammation and may
be the main type of inflammation present (acute gastritis), or may be
combined with more numerous chronic inflammations (active chronic
gastritis). Chronic gastritis is divided into subgroups based either on
etiology (immunologic or infectious), location (antrum or body),
histopathology, or clinical features. H. pylori gastritis is associated with
infection by H. pylori, a small, curved, gram-negative rod that is found in
approximately 20% of the general population. The organisms are found
in the mucus overlying the surface/foveola epithelium. These changes
tend to affect primarily the antral or antral-body-fundic mucosa.

18. A. Enteroinvasive Escherichia coli
Enteroinvasive Escherichia coli (EIEC) infection causes a syndrome
that is identical to Shigellosis, with profuse diarrhea and high fever.
EIEC are highly invasive, and they utilize adhesin proteins to bind to and
enter intestinal cells. They produce no toxins, but severely damage the
intestinal wall through mechanical cell destruction. Dysentery caused by
EIEC usually occurs within 12 to 72 hours following the ingestion of
contaminated food. The illness is characterized by abdominal cramps,
diarrhea, vomiting, fever, chills, and a generalized malaise. Dysentery
caused by this organism is generally self-limiting with no known
complication.
Enterohemorrhagic E. coli (EHEC): A type of EHEC, E.coli 0157:H7,
can cause bloody diarrhea and hemolytic uremic syndrome (anemia and
kidney failure).

20. B. Enterotoxigenic E. coli
Enterotoxigenic Escherichia coli (ETEC) is a type of Escherichia
coli and the leading bacterial cause of diarrhea in the developing world,
as well as the most common cause of travelers' diarrhea.
Enterotoxins produced by ETEC include heat-labile enterotoxin (LT)
and heat-stable enterotoxin (ST)
Because enterotoxic E. coli strains are non-invasive, they do not cause
inflammation. Infection with ETEC can cause profuse watery diarrhea
with no blood nor leukocytes and abdominal cramping. Fever, nausea
with or without vomiting, chills, loss of appetite, headache, muscle aches
and bloating can also occur but are less common.

22. D. Salmonella typhi
Typhoid fever is caused by Salmonella serotypes which are strictly adapted to humans
or higher primates—these include Salmonella Typhi, Paratyphi A, Paratyphi B and
Paratyphi C. In the systemic form of the disease, salmonellae pass through the
lymphatic system of the intestine into the blood of the patients (typhoid form) and are
carried to various organs (liver, spleen, kidneys) to form secondary foci (septic form).
Endotoxins first act on the vascular and nervous apparatus, resulting in increased
permeability and decreased tone of the vessels, upset thermal regulation, vomiting and
diarrhea. In severe forms of the disease, enough liquid and electrolytes are lost to upset
the water-salt metabolism, decrease the circulating blood volume and arterial pressure,
and cause hypovolemic shock. Septic shock may also develop. Shock of mixed
character (with signs of both hypovolemic and septic shock) are more common in
severe salmonellosis. Oliguria and azotemia develop in severe cases as a result of renal
involvement due to hypoxia and toxemia.

24. E. Shigella species
Shigellosis is caused by a group of bacteria called Shigella. Symptoms usually develop
about 1 to 7 days (average 3 days) after you come in contact with the bacteria.
Symptoms include:
Acute (sudden) abdominal pain or cramping
Acute (sudden) fever
Blood, mucus, or pus in stool
Crampy rectal pain (tenesmus) ,Nausea and vomiting ,Watery diarrhea. During
infection, it typically causes dysentery. Shigella is one of the leading bacterial causes of
diarrhea worldwide. Insufficient data exist, but conservative estimates
suggest Shigella causes about 90 million cases of severe dysentery, with at least
100,000 of these resulting in death, each year, mostly among children in the developing
world.

26. 278. A 51-year-old male presents with epigastric pain that is lessened
whenever he eats. A gastroscopy is performed to evaluate these gastric
symptoms and a solitary gastric ulcer is seen. This ulcer is round and ha
punched-out straight walls. The margins of the ulcer are slightly
elevated, and gastric rugae radiate outward from the ulcer. Based on
these findings, in order to relieve the epigastric pain this patient should
a. Take indomethacin twice a day
b. Abstain from smoking
c. Eat only two meals per day
d. Drink alcohol with his evening meal
e. Have surgery to resect the ulcer

27. Answer B. Abstain from smoking
abstaining from substances or actions that increase gastric
acid production, such as coffee, alcohol, and prostaglandin production
inhibitors, which include aspirin, indomethacin, ibuprofen, and smoking.
smoking may put you at greater risk of developing an ulcer and slow
down your recovery.

28. A. Take indomethacin twice a day
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that
reduces fever, pain and inflammation. It is similar to ibuprofen (Motrin)
and naproxen (Naprosyn, Aleve). Indomethacin works by reducing the
production of prostaglandins.
Indomethacin is used for the treatment of inflammation caused
by rheumatoid arthritis, ankylosing spondylitis, gouty arthritis,
osteoarthritis, and soft tissue injuries such as tendinitis and bursitis.
NSAID drugs are not usuful during treatment of ulcer.

29. C - Eat only two meals per day.
Because food neutralizes acid within
the stomach and relieves the typical epigastric pain of peptic ulcer
disease,patients are advised to eat frequent small meals.so we order to
patient to take more time small amount of meal frequently not only two
times

30. D. Drink alcohol with his evening meal
Additional therapeutic
measures include abstaining from substances or actions that increase
gastric
acid production, such as coffee, alcohol, and prostaglandin production
inhibitors, which include aspirin, indomethacin, ibuprofen, and smoking

31. E. Have surgery to resect the ulcer
Your doctor will prescribe medicines called proton pump inhibitors (PPIs) to reduce the
amount of acid in stomach produces and help the ulcer to heal. This is the main
medicine prescribed to treat ulcers. Medicines include omeprazole, esomeprazole,
lansoprazole, pantoprazole and rabeprazole.
PPIs reduce acid production in stomach, allowing ulcer to heal. Patient need to take the
medicines for about six to eight weeks. Your doctor may prescribe other medicines such
as H2 blockers if you don’t respond to treatment with PPIs.
If you’re taking NSAIDS for medical reasons (for example, you need to take a daily
aspirin to prevent heart disease), your doctor may prescribe PPIs long-term to control
your symptoms and prevent gastric ulcers. There is no need to surgery