Pancreatic diseases and malabsorption Pathology.pdf

Front: Define malabsorption syndrome.1

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Back: Pathological interference with digestion, absorption, and transport of nutrients1 . Maldigestion = impaired intraluminal metabolism; Malabsorption = defective mucosal absorption1 .

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Front: List three categories of causes of malabsorption.1

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Back: Luminal phase defect, Mucosal phase defect, Post-mucosal defect1 .

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Front: Give three causes of Luminal phase defect.2

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Back: Pancreatic insufficiency2 , Decreased bile salt synthesis2 , Impaired bile secretion2 .

II. Clinical Presentation (Understand, Apply)

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Front: List five possible extraintestinal signs/symptoms of malabsorption syndrome and the nutrient deficiency associated with each.3

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Back:

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Weight loss, Muscle wasting (proteins)3

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Anemia (Fe, Vit B12)3

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Muscle cramps and tetany (Ca, Vit D)3

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Osteomalacia (Ca)3

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Edema (proteins)3

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Bleeding tendency (Vit K)3

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Front: Describe steatorrhea.3

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Back: Pale, bulky, malodorous stools, greasy, difficult to flush, >7g fat/day3 .

III. Specific Diseases (Remember, Understand, Analyze)

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Front: What is the most common cause of Luminal phase defect?2

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Back: Pancreatic insufficiency2 .

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Front: List three causes of chronic pancreatitis.4

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Back: Cystic fibrosis4 , Chronic alcoholism4 , Biliary calculi (stone)4 .

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Front: Describe Celiac Disease.4

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Back: Immune-mediated reaction to gliadin (gluten) in genetically predisposed individuals4 . Associated with HLA DQ2 and DQ84 .

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Front: What are other names of Celiac Disease?4

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Back: Celiac sprue4 , Non-tropical sprue4 , Gluten intolerance5 , Gluten-sensitive enteropathy5 .

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Front: What is gold standard definitive diagnostic test for Celiac Disease?5

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Back: Small intestinal biopsy (proximal duodenum)5 . Shows Subtotal or total villous atrophy5 and Intense intraepithelial lymphocytic infiltration5 .

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Front: Describe Whipple's disease.6

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Back: Rare bacterial infection caused by Tropheryma whipplei6 , impairs digestion6 .

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Front: What is the morphologic hallmark of Whipple disease?6 ...

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Back: Dense accumulation of distended, foamy macrophages in lamina propria7 . Macrophages contain PAS-positive granules7 .

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Front: What causes Tropical sprue and where does it occur?7

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Back: Infectious etiology, responds to antibiotics7 . Occurs in travelers7 .

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Front: List three characteristics of Crohn's Disease.7 ...

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Back: Skip lesions8 , Transmural affection8 , Cobblestone appearance8 .

IV. Investigations (Understand, Apply)

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Front: Is there a specific test for malabsorption diagnosis?8

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Back: No8 . Investigation is guided by symptoms and signs8 .

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Front: How is steatorrhea diagnosed?8

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Back: Fecal fat study8 .

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Front: How are small bowel diseases diagnosed?9

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Back: Endoscopy (Biopsy of small bowel)9 .

V. Clinical Reasoning (Analyze, Evaluate, Create)

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Front: A child presents with pale, fatty stools and is in the 10th percentile for weight. Symptoms improve on a gluten-free diet. What is the most likely diagnosis?9

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Back: Celiac sprue9 .

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Front: Cobblestone appearance of intestinal mucosa is characteristic of which disease?10

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Back: Crohn’s disease10 .