Pathology

Question 1

What are the major diseases causing malnutrition?

Answer 1

Celiac disease
Tropical Sprue
Whippel's disease
Lymphangeactasia
Crohn's enteritis

Question 2

Define malabsorption

Answer 2

A condition characterized by suboptimal absorption of fat, fat- soluble and other vitamins, proteins, carbohydrates, electrolytes and minerals, and water.

Question 3

What functions, when affected, would lead to malabsorption?

Answer 3

Intraluminal digestion
Terminal digestion
Transepithelial transport

Question 4

Describe the clinical presentation of Malabsorption

Answer 4

Abnormal greasy, yellow/gray stools
Weight loss
Anorexia
Abdominal distention

Question 5

Why can a patient with celiac disease be misdiagnosed?

Answer 5

can present with extra GIT symptoms

Question 6

What is another name for celiac disease?

Answer 6

Celiac Sprue

Gluten Sensitive Enteropathy

Question 7

Epidemiology of Celiac disease

Answer 7

Caucasians

Question 8

Pathophysiology of Celiac Disease

Answer 8

Cell mediated immunity against the gluten [alcohol soluble protein component [Gliadin]]

Gluten taken into small intestine → ↑ intraepithelial cytotoxic T cells and ­ ↑ large number of lamina propria T-helper cells that are sensitized to gliadin → cytokine release → damage to the intestinal enterocytes. HLA DQ XIB heterodiamer genetic trend → confer susceptibility through interaction with gliadin.

Question 9

Hypothesis behind the immune reaction in Celiac Disease

Answer 9

Gliadin cross- react with a fragment protein
The E1b protein of type 12 adenovirusàraise possibility that this disease might be resulted from exposure to this virus earlier in life.

Question 10

Gross morphology of Celiac Disease

Answer 10

Flat mucosa [Loss of normal villous architecture → atrophy of mucosa]

Question 11

Microscopic features of Celiac Disease

Answer 11

Surface epithelial layer is packed by T- lymphocytes and lamina propria

Crypts are hyperplastic, ­ ↑ in number, tortuous with ­ ↑ mitotic figures → overall mucosal thickness remains the same

Loss of microvilli + brush borders

Question 12

What are the symptoms of Celiac Disease

Answer 12

Diarrhea
Unexplained weight loss
Abdominal pain 
Failure to thrive 
Skin Rash
Arthritis 
Unexplained malaise and fatigue

Question 13

What does Celiac disease increase the risk of?

Answer 13

T-cell lymphoma
GI carcinoma
Breast carcinoma

Question 14

What genetic factors are associated with Celiac Disease?

Answer 14

HLA B8

HLA DR3-DQw2

Question 15

What is a diagnostic finding of Celiac disease?

Answer 15

Mucosal mosiac changes seen on endoscopy

Question 16

Epidemiology of Tropical Sprue

Answer 16

Tropics [Carribean], Central Africa, India, Southern Asia, South and Central America

Occurs as endemic and epidemics

Question 17

Patholophysiology of Tropical Sprue

Answer 17

Same as celiac deficiency → folate and vitamin B12 deficiency → megaloblastic anemia

Question 18

Symptoms of Whipple’s disease

Answer 18

Steatorrhea 
Lymphadenopathy 
Malabsorption 
Diarrhea
Arthritis [often]
Encephalopathy [occasionally]

Question 19

What stain is used in Whipple’s disease?

Answer 19

PAS stain

Question 20

What is bacterial organisms are implicated in Tropical Sprue?

Answer 20

enterotoxigenic organisms [E. coli and Haemophilus in. ]

Question 21

Microscopic features of Tropical Sprue

Answer 21

Bacteria-laden macrophages and lipid pools in mucosa

Question 22

What would a culture from a patient with Whipple’s disease show?

Answer 22

Tropherhyma whippli bacilli within macrophages

[PAS Stain]

Question 23

What is the treatment for IBD?

Answer 23

Immunosuppressive therapy

Question 24

What is the possible etiology of IBD?

Answer 24

alteration in usual steady state between immune system and host defenses that maintain integrity of mucosa and down-regulate inflammation.

Question 25

Epidemiology of IBD

Answer 25

Increased prevalence Occurs at an early age Low mortality Family history is common

Question 26

Epidemiology of Ulcerative Colitis

Answer 26

Onset: 15-40 yrs, Second peak: 50 - 80 yrs. Men = women Variable course and severity

Question 27

What are the local complications of Ulcerative Colitis?

Answer 27

``` Perforation Toxic Megacolon Hemorrhage Inflammatory polyps [pseudopolyps] Colonic carcinoma ```

Question 28

What are the symptoms of Ulcerative Colitis?

Answer 28

Relapsing blood mucoid diarrhea [stringy mucus] Pain/Cramps [relieved bu defecation] Disease course lasts days/month Remission for months/years

Question 29

What are the systemic complications of Ulcerative colitis?

Answer 29

``` Uveitis Ankylosing Spondylitis Sclerosing cholangitis Erythema nods Malnutrition Arthritis Pyoderma gangrenosum ```

Question 30

What are the gross findings of Ulcerative colitis?

Answer 30

Diffuse mucosal inflammation confined to the colon [mucosa is hemorrhagic, granular, friable] Rectum involvement in 95%; can extend proximally, in a continuous fashion, aCrypt s far as the cecum. Back wash ileitis occur in continuity with active pancolitis Extensive ulceration along bowel axis Pseudopolyps and flat mucosa Normal wall thickness and normal serosa

Question 31

What are the microscopic findings of Chronic Ulcerative colitis?

Answer 31

``` Architectural distortion Basal plasma cells Chronic inflammation in lamina propria Paneth cell metaplasia Pseudopolyps ```

Question 32

What are the microscopic findings of Acute Ulcerative colitis?

Answer 32

Crypt abscesses/Cryptitis | Ulceration