Small Bowel Pathology

Question 1

Celiac sprue is a type ______ hypersensitivity

Answer 1

type IV

Question 2

What part of gluten is the most immunogenic?

Answer 2

Gliadin

Question 3

Histologically, a person with Celiac sprue has what characteristics?

Answer 3

blunting/destruction of Villi
hyperplasia of Crypts
lymphocytes in lamina propria

Question 4

What enzyme deamidates gliadin in pts with celiac sprue?

Answer 4

tissue Transglutaminase (tTG)

Question 5

A patient presents with diarrhea+steatorrhea after eating wheat products. What area of the digestive tract will most likely be affected?

Answer 5

distal duodenum/proximal jejunum

Question 6

A patient presents with steatorrhea. Bx of the proximal jenunum reveals crypt hyperplasia and blunted villi. Where is he most likely from?

Answer 6

Northern Europe

Question 7

A patient presents with steatorrhea after eating wheat. He also has little itchy spots on his skin. What is the cause of his dermatologic symptoms?

Answer 7

IgA deposition @ tips of dermal papillae

dermatitis herpetiformis

Question 8

A patient from Sweden presents with an itchy rash and steatorrea. She has anti-gliadin antibodies. Which HLA molecules are most associated?

Answer 8

HLA-DQ2

HLA-DQ8

Question 9

A patient presents with steatorrhea. Bx reveals that there is crypt hyperplasia of the ileum. Diagnosis?

Answer 9

Tropical sprue

usually Caribbean

Question 10

What type of malabsorptive syndrome responds to antibiotics?

Answer 10

tropical sprue

Question 11

Tropical sprue can lead to _______ deficiencies

Answer 11

B12 or Folic acid

affects the ileum

Question 12

Celiac sprue is to lymphocytes as Whipple Disease is to __________

Answer 12

PAS+ foamy macrophages

Question 13

The characteristic immune cell found in Whipple Disease will compress _________ of the villi, causing ________

Answer 13

lacteals

massive fat malabsorption and steatorrhea

Question 14

A 50 yr old white male presents with steatorrhea and joint pain. It is found that he is Vitamin D deficient. Bx reveals PAS+/acid fast - macrophages. What is the causative agent?

Answer 14

Tropheryma whippelli (G+ rod)

Question 15

Whipples disease commonly presents as?

Answer 15

steatorrhea/fat malabsorption
arthralgia
cardiac issues
neuro issues

Question 16

An infant presents with steatorrhea. Bx of the intestine reveals enterocytes with huge intracellular accumulations of fat. What fat transporting particle(s) is most likely deficient?

Answer 16

chylomicrons AND VLDL

Question 17

Abetalipoproteinemia presents during infancy. What gene is resposible?

Answer 17

MTTP gene (microsomal triglyceride transfer protein)

Question 18

An infant presents with steatorrhea. Bx of the intestine reveals enterocytes with huge intracellular accumulations of fat. What apolipoproteins are deficient?

Answer 18

this kid has Abetalipoproteinemia

doesn’t have B48 or B100 (duh, without beta!)

Question 19

What type of diverticulum involves all 3 gut wall layers (true)?

Answer 19

Meckel’s

Question 20

Meckel’s diverticulum is to partial opening as Vitelline fistula is to _______ opening

Answer 20

complete

poop outta belly button!

Question 21

A young patient presents with melena (tarry stool) and pain in the RLQ. Pancreatic mucosa is found on bx of the ileum. What is the function of the structure that is malformed?

Answer 21

Vitelline duct is Vital for getting nutrients from yolk sac

weeks 4-7

Question 22

Describe the rule of 2’s with a Meckel’s

Answer 22

2 feet from ileocecal valve
2 inches long
2% of population
presents in first 2 years
2 types of ectopic tissue (gastric+pancreatic)