GIT

Question 1

Enumerate different ulcers of GIT

Answer 1

1. Ulcers of Esophagus & Stomach:

a. Benign:

• Acute gastric ulcers
  • Stress ulcer
  • Curling ulcer
  • Cushing ulcer
• Chronic gastric peptic ulcer

b. Malignant

- Ulcerative / excavated gastric carcinoma

2. Ulcers of Small Intestine:

• Chronic duodenal ulcer
• Typhoid ulcer
• Tuberculous ulcer
• Crohn’s disease ulcers
• Malignant ulcers
• Peptic ulcer in Meckel’s diverticulum

3. Ulcers of Large Intestine

• Ulcerative colitis
• Bacillary dysentery ulcer
• Malignant ulcer

Pg 614

Question 2

Define PUD

Answer 2

Peptic ulcer disease refers to chronic mucosal ulceration affecting the duodenum or stomach due to imbalance between mucosal protective factors and damaging factors and is almost always associated with H. pylori infection, NSAIDs, or cigarette smoking.

Question 3

Define peptic ulcer

Answer 3

Peptic ulcers are the areas of degeneration and necrosis of gastrointestinal mucosa exposed to acid-peptic secretions.

Question 4

Sites of peptic ulcer

Answer 4

1. First part of duodenum
2. Stomach (usually antrum)
3. Gastro-esophageal junction
4. Within margins of jejunostomy
5. Throughout GIT in Zollinger-Ellison syndrome
6. Within or adjacent to an ileal Meckel’s diverticulum that contains ectopic gastric mucosa

Question 5

Causes/predisposing factors for peptic ulcer

Answer 5

1. H. Pylori infection
2. Cigarette smoking
3. NSAIDS
4. Chronic obstructive pulmonary disease
5. Drugs
6. Alcoholic cirrhosis
7. Psychological stress
8. Zollinger-Ellison syndrome
9. Viral infection

Question 6

Morphology of peptic ulcer

Answer 6

Pg 618

Question 7

Differences between benign and malignant ulcer

Answer 7

1. Age: Benign = younger; Malignant = older.
2. Sex: Benign = marked male; Malignant = slight male.
3. Duration: Benign = long (weeks–years); Malignant = short (weeks–months).
4. Location: Benign = lesser curvature/duodenum; Malignant = greater curvature/pylorus.
5. Size & Shape: Benign = small, regular; Malignant = large, irregular.
6. Margins: Benign = sharp, level, punched out; Malignant = thick, irregular, rolled-out.
7. Base: Benign = clean base with necrosis + granulation tissue; Malignant = necrosis + haemorrhage + indurated base.
8. X-ray: Benign = small punched-out defect; Malignant = irregular filling defect with surrounding mucosal involvement.

Pg 619

Question 8

Complications of pud

Answer 8

1. Bleeding 15-20%
2. Perforation 5%
3. Obstruction 2%
4. Malignant transformation <1%

Pg 620

Question 9

What is gastrointestinal stromal tumor

Answer 9

They are mesenchymal tumors derived from the interstitial cells of Cajal, or pacemaker cells of thr gastrointestinal muscularis propria. Most common tumor of abdomen.

Question 10

Malapsorption syndrome

Answer 10

Pg 631

Question 11

Differences between Crohn’s disease and ulcerative colitis

Answer 11

Pg 637