Block 14 GI Pathology Hepatitis Radiology

A 60 year old male who has a long history of esophageal reflux disease presents with the complaint of gradually worsening dysphagia to solid foods and not liquids.  He denies anorexia or weight loss.  Which of the following (may be more than one) would one expect to find on his barium esophagogram (barium swallow)?

• A

• B

• C

• D

• E

A two-and-a-half-week-old male infant presents with persistent projectile vomiting and regurgitation.  What is the most likely cause of this clinical presentation?

• Diaphragmatic hernia

• Pyloric stenosis

• Esophageal atresia

• Esophageal rings

• Gastric heterotopia in the duodenum

A 28 year old Caucasian woman complains of abdominal pain, weight loss, and diarrhea.  Physical examination reveals a pale thin woman  with orthostatic hypotension.  Laboratory data is significant for an elevated erythrocyte sedimentation rate.  A colonoscopy and biopsy are done.  A biopsy from the ileum shows segmental transmural  granulomatous inflammation with mucosal ulcerations, fissures and fistulas.  Which of the following is the most likely diagnosis?

• Ulcerative Colitis

• Diverticulitis

• Crohn Disease

• Diverticulosis

• Famililial polyposis

A 50 year old man complains of diarrhea, weight loss, anorexia, and abdominal pain. His stool is extremely malodorous and greasy.  Physical exam reveals a pale thin man with petechiae. His red blood cell count hemoglobin and hematocrit are decreased.  Which of the following is the most likely cause of his condition?

• Pancreatic insufficiency

• Iatrogenic

• Infectious

• Lymphatic obstruction

A 66-year-old female presents to the clinic with watery, non-bloody diarrhea.  History revealed that she had recently been discharged from hospital following a respiratory tract infection.  On physical examination she was found to have mild abdominal tenderness.  Investigations indicated no pathogens in the stool but colonoscopy indicated  pseudomembranous colitis. Which of the following is most likely to be the cause of her diarrhea?

• Irritable bowel syndrome

• Clostridium difficile

• Celiac disease

• Colorectal carcinoma

• Clostridium botulinum

A 25-year-old male complains of recurrent bouts of diarrhoea with crampy abdominal pain, irregular fever, and loss of weight. On examination you found the patient is underweight, anemic and has a tender mass with an ill-defined margin at the lower right abdomen. A small bowel enema showed a narrow irregular lumen of the small bowel.  What is the provisional diagnosis?

• Mesenteric embolism

• Ulcerative colitis

• Crohn’s disease

• Carcinoid syndrome

• Peutz Jeghers syndrome

A 28 year old white male presents to his primary care doctor with complaints of fever, headache, abdominal pain, and intermittent loose stools after traveling to Guatemala.  On physical exam he is noted to have hepatomegaly, splenomegaly, and flat “rose spots” on his chest and abdomen.  The most likely agent causing his symptoms and physical findings would be

• Entamoeba hystolitica

• Vibrio cholera

• Shigella

• Salmonella typhi

• Entero-hemorrhagic E coli (EHEC) O157:H7

This liver biopsy was most likely taken from a patient with:

• Hemachromatosis

• Wilson’s disease

• Alpha-1 anti-trypsin disease

• Cirrhosis

• Amebiasis

Which of the following is the most likely cause of the pathology shown in the gross and microscopic images?

• Viral or bacterial infections

• Furosemide or estrogens

• Hyperlipidemia or hypercalcemia

• Thrombosis and ischemia

• Alcohol or biliary tract disease

An autopsy is performed on a 75 chronic alcoholic year old man with jaundice, icteric sclera, ascites, peri-umbilical caput medusa, and spider angiomas.   Which of the following circulatory disorders is the most likely involved in this diagnosis? (See Attached colored images)

• Impaired hepatic blood inflow

• Impaired intrahepatic blood flow

• Impaired hepatic blood outflow

• Portal vein obstruction

Postmortem examination of a 56-year-old female reveals liver changes shown for you evaluation (Trichrom stain). Investigation of the laboratory data from patient’s case reveals markedly elevated serum levels of total and direct bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase and antimitochondrial antibodies.  Which of the following is the most likely diagnosis?

• Primary biliary cirrhosis

• Secondary biliary cirrhosis

• Primary sclerosing cholangitis

• Wilson disease

A 31-year-old primigravida gives birth at term following an uncomplicated pregnancy to a male infant with no apparent congenital anomalies. At 4 weeks of age the infant begins to exhibit forceful vomiting after each meal. The infant had been fine previously and gaining weight normally. Which of the following conditions is the probable cause for his vomiting?

• Congenital duodenal atresia

• Pyloric stenosis

• Tracheo-esophageal fistula

• Mallory-Weiss syndrome

A 44 year old obese patient presents with fever, pain in the right hypochondrium and nausea. His stool is normal in color. On examination he looks ill and is jaundiced with right upper quadrant tenderness and no splenomegaly. Lab data: Hb 14 gm, PCV 42, WBC 12,000, platelet count 150,000 red cells are normochromic normoctytic with normal morphorology. There is an increased direct and indirect bilirubin, a marked increase in his transaminases (AST and ALT) and a moderated increase in his alkaline phosphatase. What is the most likely diagnosis?

• Viral hepatitis

• Gallstones

• Hereditary spherocytosis

• Dubin Johnson syndrome

• Gilbert’s syndrome

A 28 year old thin, male accountant presents with jaundice and pale stools dark urine and intermittent right upper quadrant abdominal pain.  On examination his sclera are icteric and he has splenomegaly. Labs Hb 12 gm/dl, film shows spherocytes with increased osmotic fragility. He has a marked increase in his alkaline phosphatase and a moderate increase in his transaminases (ALS and AST). His direct bilirubin is more markedly increased than his indirect. What is the most likely diagnosis:

• Cirrhosis

• Acute hepatitis

• Leptospirosis

• Gallstones

• Hepatocellular carcinoma

In the above patient what is the most likely etiology of this disorder?

• Increased cholesterol secretion in the gall bladder

• Increased pigment deposition in the gall bladder

• Bacterial infection

• Viral infection

A 29 year-old female developed right upper quadrant pain, nausea, and fever. Two days later she noted yellow eyes and brown urine. She was an unemployed single mother who didn’t drink alcohol or use IV drugs but admitted to having a boyfriend who used IV drugs. A blood test was positive for HBsAg. What is true about other blood tests?

• If virus is replicating in severe disease, HBV DNA will be positive and HBeAg will be negative.

• After resolution of illness 2 months later, HBsAg remains positive and IgG antibody to HBsAg rises.

• If she develops chronic hepatitis, HBsAg remains positive and IgG antibody to HBCAg is negative.

• After onset of acute infection, IgM antibody to HBCAg rises before IgM antibody to HBsAg.

Which graph best exemplifies the case of a resolved, acute hepatitis B infection?

Using the graph below depicting the progression of a hepatitis A infection, around which week is the IgM titer most likely to peak?

• 4

• 6

• 8

• 10

• 12

Your patient is a 20-year old man who presents with extreme fatigue and malaise with upper abdominal tenderness. There is no evidence of icterus and there are no other physical signs of disease. The patient feels he might have the flu. Upon questioning, the patient admits to having coffee colored urine and creamy colored stools. The patient has no tattoos and has no evidence of IVDA and in fact he denies being upon any medications whatsoever.  He lives with his parents and shares many of his meals with them (but he does enjoy oysters, which the parents don’t eat) and they are currently healthy. He does have a girlfriend whom he has unprotected sex with, and he has been in this relationship for three years (He is concerned about her fidelity though). What is your most likely prognosis for this patient?

• He stands about an 80% chance of the condition becoming chronic

• He will recover without any treatment

• He stands about a 5% chance of the disease becoming chronic

• You think he may be overdosing on acetaminophen and he is likely to continue this way unless you intervene

A 36-year-old male IV drug user developed fever, right upper quadrant pain, and jaundice. What features of hepatitis B virus (HBV) and hepatitis C virus (HCV) help to distinguish them from each other?

• HCV is more likely than HBV to cause symptomatic hepatitis

• HBV is more readily transmitted by sexual intercourse than is HCV

• HBV is more likely than HCV to cause chronic life-long infection

• HCV is more readily passed from mother to child at birth than is HBV

Histologic examination of the liver biopsy obtained from a 45-year-old man with long history of alcohol abuse reveals preserved tissue architecture, prominent interlobular fibrous septa, moderate mononuclear infiltration of the portal tracts and adjacent lobular parenchyma, and minimal necrotic changes of the hepatocytes. Which of the following is the most likely diagnosis?

• Acute hepatitis

• Chronic hepatitis

• Liver cirrhosis

• Hepatic steatosis