Crohn Disease Pathology

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Q) Which of the following is not characteristic of Crohn Disease  : * (From AIIMS 2020 November GI)  

a) Granular mucosa
b) Transmural involvement
c) Skip lesions
d) Giant cell granuloma

Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20) 

The typical gross appearance of ulcerative colitis is hyperemic mucosa. Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340) 

IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid
aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.

( Bailey 1242) 


Carcinoid Syndrome

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Q) Carcinoid syndrome wrong statement is?
a) 40 % Right  heart dysfunction in carcinoid syndrome


Crohn Disease of Duodenum

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Q) In Crohns  disease of duodenum , patient has a duodenal abscess which is  drained. He develops a fistula with  ileal communication. Surgery with the least chance of success would be

a. Ileal reaction and duodenal bypass

b. Ileal resection an dudodenal HMplasty
c. Ileal freshen and closure
d. Duodenum vertical closure

Lab finding in mesenteric Ischemia

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Q) Which of the following is not a lab finding of acute mesenteric ischemia?

a) Leucocytosis

b) Acidosis

c) HIgh Amylase

d) Transaminitis


Small bowel diverticulum

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Q) False about epidemiology of  Small bowel diverticulum  ( Questions on Jejunum) 

a) Duodenal diverticulum is symptomatic and appear before 40 years

b) Jejuno ileal diverticulae are less than 5%

c) Most common congenital anomaly of SI  is Meckel

d) All correct

Small Intestine diverticulum

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Q) Small intestine diverticula true statement is 
a. Meckel is Most common and jejuno ileal is least common but most symptomatic
b. Meckel is true and congenital and rest are false and acquired
c. 1-5 % Duodenal ones require endoscopic or surgical treatment
d. All Meckel’s resected unless strong Contraindication is there


Intestinal TB

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Q) False about intestinal TB
1. Hyperplastic variety has colonic strictures
2. Raised markers,anaemia,positive sputum culture point towards diagnosis
3. BMFT shows pulled up cecum
4. IFN gamma assay


There are two types Of Intestinal TB

Ulcerative type - Transverse ulcers with undermined edges, Serosa of bowel is studded with tubercles. It is a severe form of disease

Hyperplastic - Hyperplasia and thickening of terminal ileum. Narrowing of lumen., Stricture and fibrosis occues of terminal ileum

There are raised inflamatory markers and anemia

Interferon gamma is for subclinical infection

BMFT shows subhepatic caecum

Bailey page 80

Enteropathy in T cell lymphoma

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Q. Not true about enteropathy in T cell lymphoma
a) It is an  variant of intestinal lymphoma mainly in jejunum and ileum
b) Associated with coeliac disease
c) Perforation is frequently seen with ETL (Enteropathy T cell lymphoma)
d) This type of lymphoma is common
Ans. d
Enteropathy T cell lymphoma is an unusual variant of intestinal lymphoma. It is associated with celiac disease and responds to gluten free diet. It has a higher rate of perforations because of circumferential ulcers. It is commonly seen in jejunum and ileum
Ref- Schakelford Surgery of Alimentary canal  pg 1205

Indications of Small Bowel transplant

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Q ) One of the following is not an indication for small bowel transplant

a)  Impensing liver failure by PNALD

b) Multiple thromboses of central veins 

c)  Single episode of catheter-related infection requiring hospitalization in any year

d) single episode of fungal line infection