A 69-year-old alcoholic

presents to a GP for a range of complaints including dyspepsia (feeling full

after eating, poor digestion), fatigue, weakness, exhaustion, lack of appetite,

weight loss, abdominal distension, swelling, arthralgia, and spinal pain. Even

a physical examination revealing hepatomegaly (enlarged liver), spider angioma,

and ascites (presence of fluid in the abdominal cavity) suggests that the

patient is suffering from cirrhosis. This is confirmed by laboratory, sonography,

and biopsy. Liver cirrhosis is the remodelling of the lobular structure of the

liver into a nodular structure due to the disappearance of hepatocytes,

replacement by connective tissue and nodule formation as a result of chronic

liver disease. Ito cells play an important role in this remodelling process.

Where would we find most of these cells?

A 46-year-old female patient

is found to be anemic during a preventive taking of blood. Despite a healthy

and varied diet, which the patient claims to follow, other findings in her

blood count, such as the presence of large erythrocytes (megalocytes) and low

levels of vitamin B12, make it look like anemia based on a deficiency of this

very important vitamin. Therefore, if the patient is taking enough of it in her

diet, the problem is likely to be in its absorption in the digestive system. In

order for this vitamin to be absorbed from the digestive tract into the blood,

it must be bound to an intrinsic factor in the stomach. Indeed, antibodies to

intrinsic factor have been demonstrated in this patient. Which cells of the

gastric glands produce this factor?

A 27-year-old female patient presents to her GP

for the second part of a preventive check-up. The patient's blood tests show a

fairly significant anemia. It soon becomes apparent that this is probably due

to a vitamin B12 deficiency, as the patient is a strict vegan and has not

supplemented her diet with this vitamin. During the physical examination, the

doctor notices one more symptom that would confirm this cause. The patient's

tongue has a distinct red colour and is completely smooth. In healthy

individuals, papillae can be observed macroscopically on the surface of the

tongue, which disappear in this condition, known as Hunter's glossitis. The

most common cause is vitamin B12 deficiency. Several types of papillae are

generally found on the tongue. But which of them has keratinized epithelium?

During a preventive dental check-up, 35-year-old

man is found to have tooth decay between his first and second molars. As the

decay has already penetrated the enamel and reached the dentin, new dentin

begins to form in response to this local irritation. What type of dentin is

produced?

A 36-year-old man

presents with abdominal pain and gastroesophageal reflux (connected with

heartburn). An endoscopic exam reveals gastric ulcers. A serum analysis reveals

increased levels of gastrin, a hormone that stimulates the release of gastric

acid from the parietal cells of gastric glands. Which of the following cell

types is the source of the hormone?

During the stay in the maternity hospital, the

newborn has a problem. The meconium does not pass (meconium is the first

content of the intestine to be passed during the first 1-2 days). After

examination, the so-called Hirschsprung disease

A 22-year-old patient

presents for a colonoscopy to confirm a diagnosis of Crohn's disease or

ulcerative colitis. He has been suffering from crampy abdominal pain with

watery diarrhea with admixture of blood and mucus for several weeks. During the

endoscopy, a typical picture of mucosal damage by these autoimmune

inflammations is described and a biopsy is taken for histological examination,

which finally establishes the diagnosis of ulcerative colitis. Ulcerative

colitis is a rare autoimmune type of

A 46-year-old female patient

is found to be anemic during a preventive taking of blood. Despite a healthy

and varied diet, which the patient claims to follow, other findings in her

blood count, such as the presence of large erythrocytes (megalocytes) and low

levels of vitamin B12, make it look like anemia based on a deficiency of this

very important vitamin. Therefore, if the patient is taking enough of it in her

diet, the problem is likely to be in its absorption in the digestive system. In

order for this vitamin to be absorbed from the digestive tract into the blood,

it must be bound to an intrinsic factor in the stomach. Indeed, antibodies to

intrinsic factor have been demonstrated in this patient. Which cells of the

gastric glands produce this factor?

A younger colleague

asks you for advice. He received an insufficiently labeled sample from an

intestinal biopsy. The presence of which cells will best tell him whether it is

a small or large intestine?

A 7-year-old girl complains of abdominal pain in

the evening before going to bed, the pain is localized to the area around the

navel. Her parents send her to bed saying that she will definitely feel better

in the morning. Unfortunately, the condition has not improved till morning. The

girl has a fever, vomits and the pain, which is now more intense, has moved to

the right hypogastrium (right lower abdomen, projection of pain from the right

iliac fossa). Her parents take her to surgery, where she is quickly diagnosed

with appendicitis, an inflammation of the appendix. The girl is operated on the

same day and the inflamed appendix is removed and sent for histological

examination. In which figure can we see the typical structure of the appendix?