AIIMS GI 2020

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 % have Right  heart dysfunction in carcinoid syndrome

b) >1cm in appendix is  indication for Right  hemi colectomy
c) 30 %  jejunoileal carcinoid are metastatic
d) Resection of primary is done in presence of metastatic disease

 

Gastrinoma diagnosis

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Q) Gastrinoma false is (AIIMS GI 2020) 
a) Fasting serum gastrin levels are  1000 g/ml
b) Duodenotomy should be done in all cases
c) Diarrhea most common symptom
d) SRS can localize 80% cases

Ans  )  c -

Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.

Gastrin  levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid  secretion ( gastric secretion ph should be less than 2) 

Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom

 Saby page 954) 

SRS should be performed because almost all gastrinomas express somatostatin receptors.

Caustic Injuries of Esophagus

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Q . Caustic injury of esophagus. Which statement is not true  ( # All Questions of esophagus) 
a) Steroid is used as a treatment 
b) Carcinoma risk  is 30%
c) Contrast study has false negative of 25%
d Esophageal stent reduce leaks by 75%

Ans ) a

Points of esophagus caustic injuries

There is no proven benefit of starting steroids in early or intermediate phase of injury as there is no evidence to support prevention of stricture

  1. Endoscopy should be performed after initial stabilization
  2. Complete esophagus can be examined now with flexible endoscopes
  3. Available studies show no benefit of steroid use ( skf PAGE 521) 
  4. Cancer risk is 30% in injured and non injured portions

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