GASTROINTESTINAL BLOCK 

CASE 1

A 32-year-old woman presents to the clinic complaining of blood tinged diarrhoea.

She reports that she had 4 bowel movements of loose stool per day with

intermittent rectal bleeding for the last 2 weeks. Further questioning reveals that

she frequently sits on the toilet with the urge to daefecate, but does not have

bowel movement. She was diagnosed to have ulcerative colitis

1. What is medical term for “urge to daefecate without any bowel movement”?

(1 mark)

2. State the immunity of GI system briefly (4 marks)

3. Briefly described anatomy of large intestine (3 marks)

4. State 1 pharmacological treatment and 1 surgical treatment in this patient

(2 marks)

CASE 2

A 13 years old girl presents to A&E department with RLQ pain, nausea, vomiting.

 Just 12 hours earlier, she was experiencing vague, colicky periumbilical pain. On

PE, you find that the patient has low grade fever and localized tenderness with

guarding in the RLQ when palpated. Lab investigation reveals mild leukocytosis

1. State your diagnosis (1 mark)

2. List 3 materials that can cause disease you stated above (3 marks)

3. With the aid of diagram, described briefly the quadrants in the abdominal

area. Give 2 organs located at each quadrant (4 marks)

4. Define and draw location of McBurney’s point (2 marks)

CASE 3

An 8 years old boy presents to the clinic because his parents have noticed strange,

 jerky movement and drastic change in his behaviour and personality. On PE, you

see a brownish ring around the superior and inferior poles of cornea. He was

diagnosed to have Wilson’s disease

1. Described briefly the pathogenesis of Wilson’s disease (4 marks)

2. What is the medical term of “brownish ring around the superior and inferior

poles of cornea” (1 mark)

3. List 3 investigations and expected findings (3 marks)

4. State 1 treatment and state how it will help this patient (2 marks)

CASE 4

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A 53 years old Chinese man with known alcoholic cirrhosis presents with increased

abdominal girth and fever. Through PE and investigations, he was diagnosed to

have hepatocellular carcinoma

1. Briefly described the portal circulation of liver (4 marks)

2. State 3 other risk factors for hepatocellular carcinoma (3 marks)

3. Explain 3 gross morphology that can be seen in this patient’s liver (3 marks)

CASE 5

 You are asked to examine a newborn baby boy when his mother when his mother

reports that he instantly regurgitated upon her first attempt to feed the baby. The

mother reports that the baby started choking and coughing up breast milk. He was

diagnosed to have tracheoesophageal fistula

1. With the aid of diagram, list 5 variant of tracheoesophageal fistula with the

frequency of their appearance (8 marks)

2. What is the associated abnormalities with tracheoesophageal fistula, state 2

(2 marks)

CASE 6

A 56-year old woman presents to the emergency department with history of 

vomiting blood. Further history reveals that she has also suffering from some

epigastric pain. Past medical history is significant for long-standing rheumatoid

arthritis. She was diagnosed to have chronic gastritis

1. State 6 risk factors of developing chronic gastritis (3 marks)

2. How do you classify chronic gastritis? Define and state 2 pathological

findings in each type ( 6 marks)

3. How do you relate rheumatoid arthritis with chronic gastritis, explain (1

mark)

CASE 7

A 54 years old Chinese man presents with gnawing epigastric pain. It was also

associated with LOA and has been vomiting after meal. The pain however did not

relieve by the used of over the counter antacids. He was diagnosed to have gastric

carcinoma

1. State 3 cardinal risk factors in this patient (3 marks)

2. Explain briefly the metabolism of Polyaromatic Hydrocarbon (3 marks)

3. What do you mean by carcinogenesis, explain briefly explain the process of 

carcinogenesis (4 marks)

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CASE 8

A 2-year-old boy is examined with history of failed to pass meconium. PE reveals

mthis child has abdominal distension consistent with an obstruction of bowel. He

was diagnosed to have HIrschsprung disease

1. Explain the cause of HIrschsprung disease (2 marks)

2. State 1 genetic disease associated with HIrschsprung disease (1 mark)

3. Give 3 differential diagnosis of abdominal distension (3 marks)

4. You decided to have the patient to undergo surgery, explain how do you

take the informed consent from his parents (4 marks)

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