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25 Cards in this Set
- Front
- Back
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What is the normal Villous to crypt length ratio?
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3-5 villous to 1 crypt length
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What is the external layer of the small intestine?
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serosal layer
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How many IEL (lymphocytes) are present in the small bowel normally?
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There are less than 10 Intra Epithelial Lymphocytes/ 100 epithelial cells
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What structure is only present in the duodenum of the small bowel?
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Brunner's glands
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What structure is only present in the ileum of the small bowel?
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Peyer's patches (lymphoid follicles)
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Celiac Disease
Symptoms |
Abdominal pain
Diarrhea Steatorrhea Dermatitis herpetiformis (vesicular lesion on abdomen... cutaneous disease) Fatigue (lack of energy due to lack of nutrients from food) |
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Celiac Disease
Pathology |
An immune – mediated disorder in genetically susceptible hosts with damage to SI mucosa & malabsorption
2 or more genes involved: class I HLA-B8 & class II HLA-DR3 & DQW2 Exposure to gliadin results in humoral & cell mediated injury (CD8+ cells, lymphocytes, Abs) Possible relationship to prior infection with adenovirus I2 E1B viral protein homologous with gliadin possibly resulting in cross reactivity Serum endomysial and tissue transglutaminase autoantibodies |
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Celiac Disease
Epidemiology |
Worldwide in distribution
Occurs mostly in European whites Clinical onset anytime from infancy to late adulthood |
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Which HLA phenotypes predispose you to Celiac Disease?
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2 or more genes involved: class I HLA-B8 & class II HLA-DR3 & DQW2
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Gliadin
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is a component of the gluten portion of wheat
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What is the treatment for Celiac Disease?
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Gluten free diet... allows absorption and histology to return to normal
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What happens to the mucosa in celiac disease?
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the luminal surface is flat because of atrophy and blunting of villi
crypt hypertrophy overall thickness of the mucosa is not changed increased lymphocytes within the epithelium (much more than 10 IES/100 epithelial cells espansion by plasma cells |
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Refractory Sprue
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Absent or incomplete clinical response to gluten free diet
Abnormalities in T cells in many patients with loss of CD4 & CD8 & with monoclonal rearrangements in TCR gamma gene Early T cell lymphoma (may indicate an early form of cancer) A subset of pts with refractory sprue develop collagenous sprue |
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What is the most common intestinal parasite in US?
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Giardia
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Clinical Presentation of Giardiasis
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More common in children
Abrupt or gradual onset of diarrhea More severe and protracted with underlying immunodeficiency (renal transplants, AIDS) or malnutrition |
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How do you get Giardia lamblia?
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infects via ingestion of water or food contaminated by CYSTS
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Giardiasis
Histology |
At higher magnification there are eosinophilic (pink) triangles that create a blockade to stop absorpion
Do not invade mucosa |
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Crohn's Disease
Epidemiology |
Worldwide distribution
- More common in western nations In US, incidence is rising; 8/100,000 Genetic susceptibility Most often presents in 2nd decade 2nd smaller peak in 8th decade |
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Crohn's Disease
Pathology |
Thickened wall with firm, stiff consistency due to fibrosis (and scarring of submucosa), muscular hypertrophy & fat wrapping
Strictures (result of wall thickening) Fistulas In early or mild disease, mucosa has aphthous ulcers With progression, fissures (small based linear hole that can make fistula with adjacent sxr) or wide based longitudinal ulcers; cobblestone mucosa (due to edema and scaring) Skip areas (healthy tissue between dzed tissue) |
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Crohn's Disease
Symptoms |
RLQ pain
crampy no hematemesis |
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How do you cure Crohn's disease?
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you cannot cure it
you can treat it |
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Aphthous Ulcer
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small shallow ulcer
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What does a pathologist look for on a surgically resected specimen for crohn's disease?
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1. transmural chronic inflammation
2. Fibrosis (esp. in submucosa) 3. Non-caseating granulomas |
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Non-caseating granulomas of small bowel make you think of what in US? in other countries?
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In US, Crohn's Disease
In other country, Tuberculus bovium. |
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Histopathology of Crohn’s Disease
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- Transmural chronic inflammation with lymphoid nodules (string of beads)
- Fibrosis - Muscular & neuronal (myenteric plexus) hypertrophy - Basilar plasmacytosis - PMNs in lamina propria & epithelium (cryptitis) - Ulcers, including fissures - Pseudopyloric metaplasia - Non-necrotizing granulomas - (biopsies 30%; resections 60%) - Vasculitis - Variability in changes |
