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Old 05-19-2013
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Default Gastroenterology q5

A 54-year-old man is evaluated by a gastroenterolo-gist for diarrhea that has been present for approximately 1 month. He reports stools that float and are difficult to flush down the toilet; these can occur at any time of day or night, but seem worsened by fatty meals. In addition, he reports pain in many joints that lasts days to weeks and is not relieved by ibuprofen. His wife notes that the patient has had difficulty with memory for the last few months.
He has lost 30 pounds and reports intermittent low-grade fevers. He takes no medications and is otherwise healthy.
Endoscopy is recommended. Which of the following is the most likely finding on small-bowel biopsy?

A. Dilated lymphatics
B. Flat villi with crypt hyperplasia
C. Mononuclear cell infiltrate in the lamina propria
D. Normal small-bowel biopsy
E. PAS-positive macrophages containing small bacilli
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Old 05-19-2013
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Originally Posted by cingulate.gyrus View Post
A 54-year-old man is evaluated by a gastroenterolo-gist for diarrhea that has been present for approximately 1 month. He reports stools that float and are difficult to flush down the toilet; these can occur at any time of day or night, but seem worsened by fatty meals. In addition, he reports pain in many joints that lasts days to weeks and is not relieved by ibuprofen. His wife notes that the patient has had difficulty with memory for the last few months.
He has lost 30 pounds and reports intermittent low-grade fevers. He takes no medications and is otherwise healthy.
Endoscopy is recommended. Which of the following is the most likely finding on small-bowel biopsy?

A. Dilated lymphatics
B. Flat villi with crypt hyperplasia
C. Mononuclear cell infiltrate in the lamina propria
D. Normal small-bowel biopsy
E. PAS-positive macrophages containing small bacilli
Multisystemic Malabsorption points to whipple disease... Rx is bactrim for a year
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Old 05-19-2013
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Originally Posted by XpaezX View Post
Multisystemic Malabsorption points to whipple disease... Rx is bactrim for a year
Good

The answer is E.

The patient presents with symptoms suggestive of Whipple’s disease with a chronic multisystem disease often including diarrhea/steatorrhea, migra-tory arthralgias, weight loss, and CNS or cardiac problems. Generally the presentation is of insidious onset, and dementia is a late finding and poor prognostic sign. The disease primarily occurs in middle-aged white males. The diagnosis requires small bowel biopsy and demonstration of PAS-positive macrophages within the small bowel. Small bacilli are often present and suggest the diagnosis of Whipple’s disease. Similar macrophages may be found in other affected organs, e.g., the CNS. Dilated lymphatics are present in patients with intestinal lymphangiectasia. Mononuclear cell infiltrate in the lamina propria is often demonstrated in patients with tropical sprue, and flat villi with crypt hyperplasia are the hallmark of celiac disease.
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