Tutorial Cases

Question 1

Most patients with celiac disease have which HLA?

Answer 1

DQ2 or DQ8

Question 2

How are Tcells activated in celiac disease?

Answer 2

presentation of gliadin to HLA –> CD4+ activation of Th1 cells –> secrete IFN gamma

Question 3

Criteria for Dx of Celiac disease

Answer 3

1 biopsy with morphologic abnormlaities +/- presence of serum gliadin or endomysial ab’s + clinical remission on gluten free diet

Question 4

Food hypersensitivity/allergy reactions in children are associated with what esophageal disease?

Answer 4

eosinophilic esophagitis

Question 5

Clinical findings in eosinophilic esophagitis

Answer 5

asthma, rhinitis, eczema hx + normal/elevated IgE

Question 6

Tx of eosinophilic esophagitis

Answer 6

corticosteroids, AA formula, restriction diet

Question 7

What is allergic proctocoltis?

Answer 7

allergy mediated disease in infants who are otherwise well

Question 8

M/F allergic proctocolitis

Answer 8

M>F

Question 9

Clinical symptoms of allergic proctocolitis

Answer 9

blood streaked stool, diarrhea, mild abdominal pain

Question 10

Allergens associated with allergic proctocolitis

Answer 10

cows milk, soymilk, breast milk

Question 11

Tx of allergic proctocolitis

Answer 11

remove allergen leads to rapid clearance (72 hours) but can reintroduce milk after a few years

Question 12

Dx criteria for eosinophilic gastroenteritis?

Answer 12

eosinophilic infiltrate in GI tract w/ exclusion of known causes of GI eosinophilia –> usually in gastric antrum

Question 13

Tx of eosinophilic gastroenteritis

Answer 13

most difficult to treat eosinophilic disorder of GI tract!

Question 14

Clinical presentation of crohns

Answer 14

rectal bleeding, diarrhea, weight loss, growth failure, perianal disease

Question 15

Clinical presentation of UC

Answer 15

like crohn’s but less weight loss/growth failure and no perianal disease but more bleeding and diarrhea

Question 16

Crohn’s or UC? mucosa and submucosa

Answer 16

uc

Question 17

Crohn’s or UC? transmural

Answer 17

crohn’s

Question 18

Crohn’s or UC? fissuring ulcers

Answer 18

crohn’s

Question 19

Crohn’s or UC? fistulas

Answer 19

crohn’s

Question 20

Crohn’s or UC? sarcoid-like granulomas

Answer 20

crohn’s

Question 21

Crohn’s or UC? submucosal fibrosis and neuronal hyperplasia

Answer 21

crohn’s > UC

Question 22

Crohn’s or UC? diffuse inflammation (vs. focal)

Answer 22

UC (only diffuse) > Crohn’s (both focal and diffuse)

Question 23

Pathophysiology of CGD

Answer 23

chronic granulomatous disease is a group of hereditary diseases caused by failure of phagocytes to form ROS for killing pathogens –> looks like Crohn’s but isn’t –> need hematopoetic stemm cell transplant

Question 24

Presentation of CGD

Answer 24

stomatitis, oral ulcers, esophageal gastric strictures, intestinal involvement

Question 25

T/F IgA deficiency is associated with Crohn’s

Answer 25

T –> in addition to a whole bunch of other immune diseases