Malabsorption (Gupta/Ray)

Question 1

What do you expect to see on biopsy of someone with Celiac Disease?

Answer 1

• CD8+ Lymphocytes infiltration
• Crypt Hyperplasia
• Loss of Villi

**Shown here is normal tissue on the top and celiac disease tissue below

Question 2

What is most likely the etiology of the malabsoption disorder in this person?
• Key features?

Answer 2

Etiology is most likely Celiac Disease - seen here are many intravillus lymphocytes (seeing one or two is normal, but this may is pathologic)
**This is more important the villus blunting when you’re trying to make a diagnosis of celiac disease

Question 3

What complication associated with Celiac Disease is shown here?
• what causes this?

Answer 3

Dermatitis Herpetiformis is shown here
• Caused by IgA antibodies to proteins at the tip of the Dermal Villus

**Associated Rash is shown below

Question 4

What complication other than dermatitis herpetiformis may be associated with Celiac Disease?

Answer 4

T cell lymphoma - enteropathy associated T cell lymphoma

Question 5

Another picture of enteropathy associated T cell lymphoma

Question 6

What are 2 things that should be in your diffential in this small intestine biopsy showing PAS positivity?

Answer 6

Whipple disease: Tropheryma whippelii
Mycobacterium Avium Complex (MAC): M. avium, M. intracellulare

Question 7

What histologic appearance is seen in this small intestine biopsy?

Answer 7

Foamy macrophages - could be Whipple’s disease or Mycobacteria

Question 8

What is the key to differentiating Whipple’s disease from MAC?

Answer 8

AFB positivity in MAC

Question 9

What is the best test for diagnosing celiac sprue?

Answer 9

tTG IgA antibodies in the serum

Question 10

Where are Ca, B12, Iron, and bile salts reabsorbed?

Answer 10

Ca and Iron - mostly duodenum (calcium may can get absorbed in different areas)
B12 and bile salts - ileum

Question 11

What is seen here?

Answer 11

Dilated pancreatic duct with strictures and abnormal appearance due to CHRONIC PANCREATITIS

Question 12

What is shown on the left and right here?

Answer 12

Left: NL small intestinal tissue

Right: Crohn’s disease (with ulceration)

Question 13

What malabsorptive disorder is likely in a patient whose small intestine has this pathology?

Answer 13

Scalloping shown here is likely due to Celiac Sprue