Vascular Disorders of Intestine — MCQs
Which of the following is not a branch of the inferior mesenteric artery?
What is the primary vascular abnormality associated with intestinal angiodysplasia?
Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:
Gangrene of the intestine is seen in all the following conditions, except:
A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is:
All of the following are true about Crohn's disease except.
String sign is a radiological feature of:
A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. The most probable diagnosis is?
What condition is associated with a greater risk of gastric carcinoma?
Which of the following conditions is least likely to be associated with Helicobacter pylori infection?
Vascular Disorders of Intestine Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is not a branch of the inferior mesenteric artery?
- A. Left colic
- B. Middle rectal (Correct Answer)
- C. Superior rectal
- D. Sigmoidal artery
Explanation: ***Middle rectal artery*** - The **middle rectal artery** [2] is typically a branch of the **internal iliac artery** [2], supplying the middle part of the rectum. - It is not a direct branch of the inferior mesenteric artery. *Left colic artery* - The left colic artery is a direct branch of the **inferior mesenteric artery** [1], supplying the distal transverse colon and descending colon. - It forms an important anastomosis with the middle colic artery [1]. *Superior rectal artery* - The **superior rectal artery** is the terminal branch of the **inferior mesenteric artery**, supplying the upper rectum. - This artery provides the primary arterial supply to the proximal large intestine structures. *Sigmoidal artery* - The **sigmoidal arteries** are typically 2-4 branches arising from the **inferior mesenteric artery**, supplying the sigmoid colon. - These arteries anastomose with branches of the superior rectal and left colic arteries.
Question 2: What is the primary vascular abnormality associated with intestinal angiodysplasia?
- A. Arteriovenous malformation (Correct Answer)
- B. Capillary hemangioma (usually superficial)
- C. Malignant tumor
- D. Cavernous hemangioma
Explanation: ***AV malformation*** - **Intestinal angiodysplasia** is characterized by abnormal **arteriovenous (AV) connections**, leading to vascular lesions in the gut [1]. - These malformations can cause **chronic gastrointestinal bleeding** due to fragility of the blood vessels [1]. *Capillary hemangioma* - This is a **benign vascular tumor** often found in the skin or subcutaneous tissue, not specifically associated with intestinal vascular changes. - **Capillary hemangiomas** typically do not cause significant gastrointestinal bleeding as seen in angiodysplasia. *Malignant tumor* - Intestinal angiodysplasia is a **benign condition** and not a malignant tumor, therefore it does not fit the characteristics of malignancy. - **Malignant tumors** usually present with different symptoms and underlying pathophysiology than angiodysplasia. *Cavernous hemangioma* - This type of hemangioma involves larger vascular channels and is typically more associated with the liver than the intestines. - **Cavernous hemangiomas** do not relate to the intestinal bleeding patterns seen in angiodysplasia.
Question 3: Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:
- A. Carcinoma cervix
- B. Carcinoma small bowel (Correct Answer)
- C. Carcinoma prostate
- D. Carcinoma testes
Explanation: Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT: ***Carcinoma small bowel*** - **Radiation therapy** is rarely used as a primary treatment for **small bowel carcinoma**, as surgical resection is the main modality. - Therefore, the small bowel is typically not exposed to direct radiation in a manner that would cause proctitis. *Carcinoma cervix* - **Pelvic radiation** is a common treatment for **cervical carcinoma**, which often involves the rectum within the radiation field. - This proximity makes chronic radiation proctitis a known and relatively frequent complication. *Carcinoma prostate* - **External beam radiation therapy** is a standard treatment option for **prostate cancer**, directly targeting the prostate gland which is anatomically close to the rectum. - This close proximity frequently leads to chronic radiation-induced damage to the rectal tissue, resulting in proctitis. *Carcinoma testes* - While **testicular cancer** itself is not directly adjacent to the rectum, certain stages of testicular cancer are treated with **retroperitoneal lymph node irradiation** or whole-pelvis radiation. - This can expose portions of the rectum to radiation, leading to chronic radiation proctitis as a potential side effect.
Question 4: Gangrene of the intestine is seen in all the following conditions, except:
- A. Shock
- B. Mesenteric artery thrombosis
- C. Tricuspid Valve Endocarditis (Correct Answer)
- D. Volvulus
Explanation: ***Tricuspid Valve Endocarditis*** - While vegetations from **tricuspid valve endocarditis** can embolize, they typically affect the **pulmonary circulation** (e.g., pulmonary embolism, septic pulmonary infarcts) due to the venous drainage pattern. - Embolization from the right side of the heart to the systemic circulation (like the mesenteric arteries) is rare unless there's a **patent foramen ovale** or similar intracardiac shunt. - Therefore, tricuspid endocarditis does **NOT** typically cause intestinal gangrene. *Shock* - **Hypoperfusion** during shock leads to a severe reduction in blood flow to the intestines, causing **ischemia**. - Prolonged or severe ischemia can result in **intestinal gangrene** due to tissue death. - This is known as **non-occlusive mesenteric ischemia (NOMI)**. *Mesenteric artery thrombosis* - A **thrombus** in the mesenteric artery directly blocks blood supply to a segment of the intestine. - This abrupt cessation of blood flow leads rapidly to **ischemia and infarction**, resulting in gangrene. - Accounts for approximately 25-30% of acute mesenteric ischemia cases. *Volvulus* - **Volvulus** involves the twisting of a loop of intestine around its mesentery, which constricts and obstructs the mesenteric blood vessels. - This vascular compromise quickly leads to **ischemia and gangrene** of the twisted bowel segment. - Common sites include sigmoid colon and cecum.
Question 5: A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is:
- A. Amebiasis
- B. Irritable bowel syndrome (Correct Answer)
- C. Crohn's disease
- D. Ulcerative Colitis
Explanation: ***Irritable bowel syndrome*** - **Irritable bowel syndrome (IBS)** typically presents with **abdominal pain**, altered bowel habits (constipation, diarrhea, or mixed), and **mucus in stool** without blood [1]. - The symptoms are often exacerbated by **stress** and there is no evidence of structural or biochemical abnormalities [1]. *Amebiasis* - **Amebiasis** is an infection caused by *Entamoeba histolytica*, usually leading to **bloody diarrhea** (dysentery), abdominal pain, and fever. - The absence of blood in the stool and the presence of stress-related symptom exacerbation make amebiasis less likely. *Crohn's disease* - **Crohn's disease** is a type of inflammatory bowel disease characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract. - Symptoms often include **abdominal pain**, diarrhea (which can be bloody), weight loss, and fatigue, and it does not typically show a direct correlation with stress as the primary exacerbating factor. *Ulcerative Colitis* - **Ulcerative colitis (UC)** is an inflammatory bowel disease characterized by **continuous inflammation** of the colon, typically starting in the rectum. - Key symptoms include recurrent **bloody diarrhea**, abdominal pain, and tenesmus, which are not described in this case, particularly the absence of blood.
Question 6: All of the following are true about Crohn's disease except.
- A. Cobble stone appearance
- B. Perianal fistula is seen
- C. Skip lesions seen
- D. It is superficial inflammation involving mucosa (Correct Answer)
Explanation: ***It is superficial inflammation involving mucosa*** - Crohn's disease is characterized by **transmural inflammation**, meaning it affects all layers of the bowel wall, not just the superficial mucosa [1]. - This **full-thickness inflammation** contributes to complications like **fistulas** and **strictures** [2]. *Cobble stone appearance* - The **cobblestone appearance** on endoscopic examination is a classic finding in Crohn's disease, resulting from deep longitudinal ulcers and intervening edematous mucosa. - This is a direct consequence of the **transmural inflammation**. *Perianal fistula is seen* - **Perianal fistulas** are common manifestations of Crohn's disease, occurring due to the transmural inflammation extending into the perianal tissues [2]. - These are formed when an inflamed crypt gland ruptures into the perianal tissue, creating a tract. *Skip lesions seen* - **Skip lesions** refer to discontinuous areas of inflammation, where segments of diseased bowel are separated by healthy, uninvolved segments [1]. - This **patchy pattern** is a hallmark feature distinguishing Crohn's disease from ulcerative colitis [1].
Question 7: String sign is a radiological feature of:
- A. Ileocecal tuberculosis
- B. Ulcerative colitis
- C. Ischemic colitis
- D. Crohn's disease (Correct Answer)
Explanation: ***Crohn's disease*** - The **string sign (Kantor's string sign)** is a classic and pathognomonic radiological finding in **Crohn's disease**, particularly affecting the terminal ileum. - It appears on barium studies as a **thin line of contrast** due to severe luminal narrowing caused by **transmural inflammation, spasm, edema, and fibrosis**. - Other characteristic features of Crohn's include **skip lesions, cobblestoning, fissures, fistulas**, and the ability to affect any part of the GI tract from mouth to anus. *Ileocecal tuberculosis* - While ileocecal TB can cause **strictures and narrowing** of the terminal ileum, the classic "string sign" terminology is specifically associated with Crohn's disease in standard radiology literature. - TB typically shows **circumferential thickening, shortened cecum (pulled-up cecum)**, and associated lymphadenopathy with central necrosis. *Ulcerative colitis* - Primarily affects the **colon and rectum** with continuous inflammation extending proximally, not involving the small bowel. - Radiographic features include **loss of haustra ("lead pipe" appearance)**, mucosal granularity, and pseudopolyps, not a string sign. *Ischemic colitis* - Characterized by acute inflammation due to reduced blood flow, typically affecting the **watershed areas** (splenic flexure, rectosigmoid junction). - Shows **"thumbprinting"** (submucosal edema/hemorrhage) and wall thickening, not the severe stenotic string sign.
Question 8: A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. The most probable diagnosis is?
- A. Villous adenoma
- B. Juvenile polyp (Correct Answer)
- C. Vascular malformation
- D. Serrated adenoma
Explanation: ***Juvenile polyp*** - The image shows **dilated, cystically appearing glands** within an inflamed lamina propria, which is characteristic of a juvenile polyp. - Juvenile polyps are the most common cause of **rectal bleeding** in children under 10 years of age and are typically benign. *Villous adenoma* - Villous adenomas are **neoplastic polyps** with a **villous (finger-like) architecture** and are more commonly seen in older adults [1]. - They typically show **dysplastic changes** and are considered premalignant [1]. *Vascular malformation* - Vascular malformations consist of **abnormally formed blood vessels** (e.g., arteriovenous malformations, hemangiomas) and would appear as dilated or aberrant vessels on histology. - While they can cause bleeding, the image does not show a predominance of vascular structures. *Serrated adenoma* - Serrated adenomas are characterized by **sawtooth-like glandular infoldings** and show varying degrees of dysplasia. - They are typically found in adults and are considered premalignant, not benign growths usually found in children. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372.
Question 9: What condition is associated with a greater risk of gastric carcinoma?
- A. Old age
- B. Cardiac end ulcer
- C. Prepyloric ulcer
- D. Intestinal metaplasia (Correct Answer)
Explanation: ***Intestinal metaplasia*** - Intestinal metaplasia is a known **precursor** condition associated with an increased risk of gastric carcinoma due to the transformation of gastric epithelium [1,2]. - This condition often arises from **chronic gastritis**, particularly after **H. pylori** infection, advancing the risk of malignant transformation [1,2]. *Old age* - While old age is a **risk factor** for various cancers, it is not specifically associated with gastric carcinoma without other factors. - The incidence of gastric cancer is more correlated with specific **precursor lesions** rather than just age alone. *Cardiac end ulcer* - Cardiac ulcers are typically **benign lesions** and not directly pre-cancerous. - They are often related to **chronic reflux disease**, which does not significantly increase the risk of gastric carcinoma. *Prepyloric ulcer* - Prepyloric ulcers may arise due to **peptic ulcer disease** but do not significantly predispose to gastric cancer. - The majority of ulcers can be healing or benign, lacking the malignant potential seen in precancerous lesions like intestinal metaplasia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 777-779. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.
Question 10: Which of the following conditions is least likely to be associated with Helicobacter pylori infection?
- A. Atrophic gastritis
- B. Intestinal metaplasia of stomach
- C. Pyloric metaplasia of duodenum
- D. Barrett's esophagus (Correct Answer)
Explanation: ***Barrett's esophagus*** - **Barrett's esophagus** is characterized by the replacement of the normal **squamous epithelium** of the esophagus with **columnar epithelium with intestinal metaplasia** (goblet cells), primarily due to chronic **gastroesophageal reflux disease (GERD)**. - While *H. pylori* can affect the stomach and duodenum, it is **not directly associated** with the pathogenesis of Barrett's esophagus. [1] - Barrett's is a complication of **chronic acid reflux**, not *H. pylori* infection. *Pyloric metaplasia of duodenum* - **Pyloric metaplasia** (gastric metaplasia) in the duodenum is often seen in the presence of an **active duodenal ulcer**, which is strongly associated with *H. pylori* infection. - *H. pylori* can colonize these metaplastic cells, perpetuating inflammation and ulcer formation in the duodenum. *Atrophic gastritis* - **Atrophic gastritis** is a common consequence of chronic *H. pylori* infection, leading to the **loss of gastric glands** and replacement by intestinal-type epithelium. [1] - This condition is a significant risk factor for the development of **gastric cancer**. *Intestinal metaplasia of stomach* - **Intestinal metaplasia** in the stomach is a precursor lesion for gastric cancer and is frequently observed in individuals with **chronic *H. pylori* gastritis**. [1] - *H. pylori* infection drives the inflammatory process that can lead to this metaplastic change in the gastric mucosa. [2] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 770-771. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.
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