pathology 3 - Malabsorption syndromes-Inflammatory bowel diseases

Question 1

A patient has diarrhea, steatorrhea, weight loss, weakness, and vitamin/mineral deficiencies; she likely suffers from what type of illness?

Answer 1

A malabsorption syndrome

Question 2

A child develops greasy stools and failure to thrive after the addition of wheat to her diet. She has autoantibodies to what substance?

Answer 2

Gluten (gliadin), suggesting celiac disease

Question 3

Celiac disease primarily affects what part(s) of the bowel?

Answer 3

Distal duodenum and/or proximal jejunum

Question 4

Unlike a patient with celiac disease, a patient with tropical sprue can be treated with which class of drugs?

Answer 4

Antibiotics

Question 5

A patient with tropical sprue has a colonoscopy with biopsy. Which sections of the GI tract are likely to be affected?

Answer 5

The entire small bowel

Question 6

An 80-year-old man presents with Whipple disease. A Gram stain of the causative organism would show what?

Answer 6

Gram-positive rods (Tropheryma whipplei)

Question 7

A patient with suspected Whipple disease has a biopsy with PAS staining. Where would you look to confirm foamy macrophages?

Answer 7

Intestinal lamina propria, mesenteric lymph nodes

Question 8

A woman is diagnosed with Whipple disease and wants to know about potential complications. What non-GI symptoms might also occur?

Answer 8

Cardiac symptoms, Arthralgias, Neurologic symptoms (these symptoms occur mostly in older men)—think foamy whipped cream in a CAN

Question 9

What is the most common disaccharidase deficiency?

Answer 9

Lactase deficiency

Question 10

A boy gets diarrhea any time he eats dairy products. If he were to have an intestinal biopsy, what is the expected appearance of the villi?

Answer 10

Normal villi in lactase deficiency (as opposed to celiac disease, in which villi are blunted)

Question 11

A child has diarrhea and a rash on the extensor surfaces that resolves with dietary modification. It is associated with which GI pathology?

Answer 11

Lactose (the inability to cleave lactose via lactase causes an osmotic diarrhea)

Question 12

A patient with lactase deficiency undergoes a lactose tolerance test. Following the administration of lactose, what do you expect to see?

Answer 12

Osmotic diarrhea and a rise in blood glucose

Question 13

A 15-year-old boy with chronic respiratory infections due to Pseudomonas has fatty stools. What is the most likely pathophysiology?

Answer 13

Pancreatic insufficiency due to sludging of pancreatic secretions, as a result of cystic fibrosis

Question 14

A chronic alcoholic refuses to stop drinking. He is finally diagnosed with chronic pancreatitis. What do you expect to see on stool studies?

Answer 14

Neutral fat in stool (chronic pancreatitis leads to pancreatic insufficiency, fat malabsorption, steatorrhea, and findings of fat in stool)

Question 15

A patient is diagnosed with ampullary cancer. What do you expect to see on stool studies?

Answer 15

Steatorrhea (obstructive cancers of the pancreatic head lead to pancreatic insufficiency, causing increased neutral fat in the stool)

Question 16

Pancreatic insufficiency causes the malabsorption of which macronutrient(s)?

Answer 16

Fat, the fat-soluble vitamins (A, D, E, K), sometimes vitamin B12

Question 17

An 70-year-old man with arthralgias, cardiac and neurologic symptoms gets a duodenal biopsy. What is likely to be found with PAS stain?

Answer 17

Foamy macrophages (this is Whipple disease—remember foamy whipped cream)

Question 18

A patient with pancreatic insufficiency is given the D-xylose absorption test. What results do you observe?

Answer 18

Normal urinary excretion (if decreased excretion is seen, then the pathology is due to intestinal mucosa defects or bacterial overgrowth)

Question 19

A child has diarrhea and a rash on the extensor surfaces that resolves with dietary modification. It is associated with which GI pathology?

Answer 19

Associated with celiac disease (this is dermatitis herpetiformis)

Question 20

In a patient with celiac disease, what malignancy would the patient be at increased risk for?

Answer 20

T-cell lymphoma

Question 21

A patient with diarrhea that occurs on a wheat-containing diet undergoes colonoscopy. What histologic findings are expected?

Answer 21

Blunting of villi and the presence of lymphocytes in the lamina propria (this is celiac disease)

Question 22

A patient is found to have gluten insensitivity. What is the pathophysiology of his disease?

Answer 22

Antibodies destroy villi (primarily in the distal duodenum and proximal jejunum), thereby decreasing mucosal absorption and causing diarrhea

Question 23

A patient has anti-endomysial, anti-tissue transglutaminase, and anti-gliadin antibodies. What serotypes are associated with this syndrome?

Answer 23

HLA-DQ2, HLA-DQ8

Question 24

man returns from the Bahamas with complaints of diarrhea and decreased mucosal absorption. Will this patient respond to antibiotics?

Answer 24

The patient has tropical sprue and will respond to antibiotics

Question 25

A patient presents with extremely itchy rashes on her knees and elbows. IF shows IgA deposits at dermal papillae. How do you treat her?

Answer 25

A gluten-free diet will resolve the skin lesions. (this is dermatitis herpetiformis, which is a finding in celiac disease)

Question 26

What is generally accepted as the etiology of Crohn disease?

Answer 26

Disordered immune responses to intestinal bacteria

Question 27

A man with ulcerative colitis asks if his condition was caused by a bacteria or virus. You explain that his disease a type of what process?

Answer 27

It is an autoimmune condition, possibly a disordered response to bacteria, but not directly caused by said bacteria

Question 28

A 20-year-old patient has recurrent diarrhea that is sometimes bloody, weight loss, oral ulcers, and perianal fistulas. Likely diagnosis?

Answer 28

Crohn disease

Question 29

What type of inflammatory bowel disease tends to show skip lesions (noncontiguous areas of mucosal involvement)?

Answer 29

Crohn disease

Question 30

A patient has a continuous segment of friable colonic mucosa that abruptly stops in the mid-transverse colon. First-line treatment is what?

Answer 30

Aminosalicylates (this is ulcerative colitis, which typically has colonic inflammation always involving the rectum)

Question 31

A man has transmural colonic inflammation with noncaseating granulomas and lymphoid aggregates. What cell type mediates this pathology?

Answer 31

Th1 cells (this is Crohn disease)

Question 32

Is perianal disease mainly a complication of Crohn disease, ulcerative colitis, or both?

Answer 32

Crohn disease

Question 33

A young woman diagnosed with ulcerative colitis asks if she will have issues with malabsorption. How do you respond?

Answer 33

Malabsorption is unlikely with ulcerative colitis, since it is often limited to the colon (unlike Crohn disease)

Question 34

Is toxic megacolon mainly a complication of Crohn disease, ulcerative colitis, or both?

Answer 34

Ulcerative colitis

Question 35

strictures

Answer 35

Crohn disease (strictures can lead to obstruction and require multiple resections of small bowel)

Question 36

A 26-year-old man with abdominal pain and mucous in the stool has transmural inflammation of the ileum. What complications may occur?

Answer 36

Migratory polyarthritis, erythema nodosum, pyoderma gangrenosum, ankylosing spondylitis, aphthous ulcers, uveitis (this is Crohn disease)

Question 37

A patient suffering from primary sclerosing cholangitis is likely to also carry a diagnosis of which inflammatory bowel disease?

Answer 37

Ulcerative colitis

Question 38

How does mucosal and submucosal inflammation with pseudopolyps and freely hanging mesentery in ulcerative colitis appear on imaging?

Answer 38

Lead-pipe appearance (the loss of haustra, giving the colon its segmented appearance, leads to this appearance)

Question 39

tx ulcerative

Answer 39

ASA preparations Sulfasalazine, 6-mercaptopurine, infliximab, colectomy as last resort (this is ulcerative colitis)

Question 40

Describe the gross morphology typically found in Crohn disease.

Answer 40

Cobblestone mucosa, creeping fat, bowel wall thickening (string sign on X-ray), linear ulcers, fissures, fistulas, transmural inflammation

Question 41

Describe the gross morphology typically found in ulcerative colitis.

Answer 41

Mucosal and submucosal inflammation. friable mucosa with freely hanging mesentery (loss of haustra causes lead-pipe appearance on imaging)

Question 42

Name at least two complications of ulcerative colitis.

Answer 42

Malnutrition, primary sclerosing cholangitis, toxic megacolon, colorectal carcinoma (worse with right-sided colitis or pancolitis)

Question 43

Name at least two extraintestinal manifestations of ulcerative colitis.

Answer 43

Pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis, ankylosing spondylitis, aphthous ulcers, uveitis

Question 44

What mnemonic can help you to remember the basics of Crohn disease?

Answer 44

For Crohn, think of a fat granny and an old crone skipping down a cobblestone road away from the wreck (rectal bleeding)

Question 45

ULCCCERS

Answer 45

Ulcers, Large bowel, Continuous, Colorectal carcinoma, Crypt abscesses, Extend proximally, Red diarrhea, Sclerosing cholangitis