Exam 13: Gastrointestinal System

A 24 year old nursing student was having difficulty keeping up in class because of extreme fatigue.She sought help from the Students' Health Service.A full blood count (FBC)showed anaemia with increased RBC (red blood cell)size (macrocytic anaemia).An upper GI endoscopy was performed,and biopsies taken.A representative section of the biopsy is shown in the accompanying photomicrograph,with normal small bowel shown on the left for comparison (villi are identified as "V").Which one of the following is the best diagnosis?

A 38 year old male consulted his local physician because he was experiencing strange episodes of skin flushing and sweating.The physician suspected a GI tumour,and ordered a CT scan,which disclosed a mass in the duodenum,and possible metastatic disease in the liver.The duodenal mass was biopsied,and is shown in the accompanying high power photomicrograph.An immunohistochemistry stain for chromogranin is shown on the right.Which one of the following is the best diagnosis?

A 48 year old man became alarmed when he noted some bright red blood in his stool.He consulted a local physician,who palpated an indurated area (firm to touch)in the patient's rectum.Surgery was performed,and a representative section of the surgical specimen is show on low power in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A 48 year old Japanese man who had recently immigrated to the United States was seen by his local physician for fatigue,weight loss,and "feeling full all the time".Endoscopy revealed an absence of rugal folds,and the stomach was difficult to distend with air,so-called "leather bottle stomach".A biopsy was performed,and a representative section is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A 25 year old woman woke one morning feeling something wet and warm on her abdomen.When she pulled back the covers,she discovered it was liquid faeces,leaking from a fistulous opening on her abdominal wall,which was soon discovered to have originated in her ileum.She recounted that she had been experiencing diarrhoea for several weeks prior to this event,but had not sought medical attention.At the hospital,a section of small bowel was resected,and the fistula repaired.A representative section of the surgical specimen is shown in the accompanying photomicrograph,with a high power view on the right.Which one of the following is the best diagnosis?

A 35 year old mechanic was experiencing excruciating bouts of bloody diarrhoea.He consulted his local physician,who recommended partial colectomy in order to control the bleeding.A representative section of the specimen is shown in the accompanying low power photomicrograph.Which one of the following is the most likely diagnosis?

A 26 year old medical student reported epigastric pain and discomfort,often around exam time.Upper GI endoscopy was performed,which reveal oedematous,reddish gastric mucosa.A biopsy was done,a representative section of which is shown in the accompanying photomicrograph.The right panel shows a Cresyl violet special stain.Which one of the following is the best diagnosis?

A 48 year old Japanese man who had recently immigrated to the United States was seen by his local physician for fatigue,weight loss,and "feeling full all the time".Endoscopy revealed a polypoid tumour mass with "heaped up" edges.A biopsy was performed,and a representative section is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?