Name: Layfield, David

Theme: Lower GI Histopathology

OPTION LIST

A	Adenocarcinoma - Dukes stage B	I	Diverticular Disease
B	Adenocarcinoma - Dukes stage C1	J	Diverticulitis
C	Angiodysplasia	K	Haemorrhoids
D	Anorectal Abcess	L	Irritable Bowel Syndrome
E	Anterior Rectocele	M	Ischemic Colitis
F	Appendicitis	N	Perianal Haematoma
G	Benign Adenoma	O	Ulcerative Colitis
H	Crohns Disease	P	Villous adenoma

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 77 year old man was referred by his G.P. after reporting the passing of large volumes of mucus. Endoscopy revealed a 6cm sessile cauliflower-like mass covered by dysplastic columnar epithelium in the rectum. His serum potassium is 3.3 mmol/l.

2. A 62 year old housewife returns to your outpatient clinic following another incidence of the passing of blood. Previous sigmoidoscopy, DRE and barium enema’s have failed to identify any lesion and she denies weight loss and diarrhoea. However, blood tests show a microcytic anaemia.

3. An 84 year old gentleman presents to A&E after suffering acute cramp-like abdominal pain lasting several hours which was followed shortly by rectal bleeding. Colonoscopy showed an oedematous thickening of the bowel wall with areas of necrotic ulceration which was confined to the mucosal layers. On examination, the gentleman was found to have an irregularly irregular heart beat.

4. A 34 year old female presents with diarrhoea, abdominal pain and weight loss. Colonoscopy reveals inflammation of the mucosa which has a cobblestoned appearance. Biopsy showed transmural involvement and the presence of non-caseating granulomas.

5. Your consultant is urgently called away from out-patients and asks you to break bad news to a patient. He is distracted and has little time to inform you about the case but mentions that the original presentation was for rectal bleeding and the patient has a 40% chance of surviving 5 years.

ANSWERS

1. P

2. C

3. M

4. H

5. B