Clinical Muscle Nerves GI

Question 1

Duchenne Muscular Dystrophy

Answer 1

Dystrophin gene mutation; replacement of muscle by fibrous tissue; wheelchair bound, cardiomyopathy; resp. problems, CHF; X-linked recessive (affecting males)

Question 2

Myasthenia Gravis

Answer 2

Autoimmune disorder (Ab against Ach-R); Loss of AChR on postsynapse membrane; immune complexes along postsynaptic; synapse widening; Ptosis; general muscle weakness; diplopia; improvements with Neostigmine;

Question 3

MI

Answer 3

Ischaemia; coronary artery occlusion; artherosclerosis; Endothelial injury -> Leucocyte & macrophage migration & adhesion to endothelium; macrophage & smooth muscle proliferation & activation (engulf lipid); intense eosinophilia; Acute inflammation: Neutrophils (12-72 h); Macrophage (>72 h; hemosiderin-stianed)

Question 4

Multiple Sclerosis

Answer 4

Ab against Myelin (autoimmune); CNS; Plaque formation in white matter of brain & spinal cord; Neuritis (1st sx); gait problems, nystagmus, extra-ocular muscles palsies; spinal cord dysfx, motor & sensory impairment of trunk & limbs

Question 5

Guillain-Barre Syndrome

Answer 5

Immune-mediated (EBV) disorder of PNS; Inflammation of peripheral nerves; abundance of lymphocytes, macrophages & plasma cells; Ascending paralysis; loss of Deep Tendon Reflex (DTR); sensory fx better preserved; respiratory paralysis may lead to death

Question 6

Hiatal hernia

Answer 6

herniation of stomach into thoracic cavity thru oesophageal opening; associated with GERD; oesohagitis; oesophageal metaplasia

Question 7

Barrett’s Oesophagus

Answer 7

PUD; Strat. Squamous -> Columnar (w/ glands); Very important risk factor for oesophageal cancer; Definitive Dx.: 1. Metaplastic columnar; 2. Presence of intestinal goblet cells in the mucosa

Question 8

Peptic Ulcer

Answer 8

Hyperacidity; H. Pylori; chronic NSAIDs (ibuprofen); Once serosa is eroded, perforation of the stomach occurs

Question 9

Congenital Megacolon (Hirchsprung’s Disease)

Answer 9

Absence of ganglion cells in intestinal tract; faulty migraiton of neural crest cells; Absence of myenteric & submucosal plexus; dilation of gut proximal to aganglionic segment; decreased peristalsis; failure to pass meconium (neonatal period); constipation; ab distension; fluid & electrolyte imbalance; rupture may lead to peritonitis

Question 10

Appendicitis

Answer 10

Acute inflammatory exudate in muscular layer; inflammatory oedema separating muscle fibres; infiltration thru submucosa & muscle layer to serosa by a large number of neutrophils; periumbilical pain moving to right iliac fossa

Question 11

Crohn’s disease

Answer 11

Transmural inflammation (all layers); Granulomas; skip lesions (patches of nl mucosa b/w lesions)

Question 12

Adenomatous polyp

Answer 12

Tumour mass protrudes into lumen of gut; may be neoplastic or non-neoplastic; Varying degrees of dysplasia; carcinomatous invasion into submucosa (adenocarcinoma)

Question 13

Acute pancreatitis

Answer 13

Duct obstruction (cholelithiasis); acinar cell injury (drugs); defective intracell transport (metabolic injury); Acute inflammatory exudate; fatty necrosis (points of hemmorhage); destruction of blood vessels

Question 14

Cholelithiasis

Answer 14

deposition of cholesterol and other lipids in lamina propria of gall bladder (strawberry GB);

Question 15

Alcoholic Cirrhosis

Answer 15

Cirrhosis (shrinkage, Fibrosis); Fibrosis (irreversible); Type 1 & II collage found around

Question 16

Hemorrhoids

Answer 16

swollen blood vessels in lower rectum; portal hypertension, increased venous pressure in S. Rectal v. transmitted to Middle & I. Rectal v. in submucosal layer which starts to bulge