Paper II — 2023 January (Supplementary) (2019 Scheme)

Paper II

2023 January (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Discuss the types of ulcers in intestine (large and small intestine).

Q78 marksShort Essays

Ulcers of the small intestine

Typhoid ulcers: Longitudinal (oval, oriented along the long axis of the bowel), located over Peyer’s patches in the terminal ileum, due to necrosis of hyperplastic lymphoid tissue infected by Salmonella typhi; can perforate or cause haemorrhage
Tuberculous ulcers: Classically transverse/circumferential (encircling the bowel), located in the ileocaecal region, due to haematogenous or swallowed bacilli seeding Peyer’s patches, causing caseating granulomatous inflammation and ulceration; transverse orientation relates to the predominantly circumferential distribution of intestinal lymphatics
Peptic (duodenal) ulcers: Sharply “punched-out” ulcers, most commonly in the duodenal bulb, associated with H. pylori infection and acid hypersecretion
Crohn disease ulcers: Deep, linear/serpiginous ulcers with intervening oedematous mucosa, producing the characteristic “cobblestone” appearance; transmural inflammation with skip lesions

Ulcers of the large intestine

Ulcerative colitis ulcers: Diffuse, continuous mucosal/submucosal ulceration, starting in the rectum and extending proximally, with pseudopolyp formation from residual islands of regenerating mucosa
Amoebic (Entamoeba histolytica) ulcers: Classic “flask-shaped” ulcers — narrow neck at the mucosal surface with a wide base in the submucosa, due to lateral spread of the organism in the submucosal layer
Bacillary dysentery (Shigella) ulcers: Superficial mucosal ulcers, often with pseudomembrane formation, predominantly affecting the rectosigmoid colon
Ischaemic colitis ulcers: Typically affecting “watershed” areas of colonic blood supply (splenic flexure, rectosigmoid junction), with patchy mucosal necrosis and ulceration
Solitary rectal ulcer syndrome: Related to mucosal prolapse and chronic mechanical trauma