What is celiac disease?
immune mediated damage of small bowel villi
hypersenstivity type 4 rxn as a result of gluten exposure
What HLAs are associated with celiac?
HLA DQ2 and 8
What is the most pathogenic form of gluten?
gliadin
What are the clinical presentations of celiac disease in adults and children?
children - growth retardation, abd distension, diarrhea
adults - chronic diarrhea and bloating
What skin condition is associated with celiac disease? why?
dermatitis herpetiformis - IgA deposition at dermal papillae
What igA antibodies can be found in celiac disease?
against:
- endomysium
- tTG
- Gliadin
If someone with celiac disease is IgA deficient how can you tell?
presence of igG antibodies instead of igA
What is the pathological appearance of celiac disease?
flattening of villi, hyperplasia of crypts
intraepithelial lymphocytes
Where in the small bowel does celiac disease tend to affect?
duodenum
Symptoms of celiac disease usually dissapear with a gluten free diet, if this is not the case, what complications can occur?
enteropathy associated T cell lymphoma
small bowel carcinoma
What is tropical sprue?
damage to small bowel villi due to unknown organism
What are 3 ways celiac disease and tropical sprue differ?
Tropical sprue:
- tropical regions
- arises after infectious diarrhea and responds to antibiotics
- damage mostly in jejunum and ileum
Since damage in tropical sprue disease is in the jejunum and ileum, what temporary malabsorption issues could you see?
folic acid and vit B 12 deficiency
What is the classic site of infection of T whippeli?
small bowel lamina propria
What is the pathogenesis of T whippeli?
infiltration of mucosa with macros
What clinical features occur in whipple disease?
malabsorption and steatorrhea - compression of lacteals by macros CAN: -Cardiac -arthralgia -neuro
What is abetalipoproteinemia?
auto recessive deficiency of apoB48 and B100
- malabsorption - can’t form chylos - B48
- absent plasma VLDL, LDL -B100
What is the most common cause of infantile diarrhea?
rotavirus
Where does the norwalk virus tend to infect? What is seen pathologically?
upper small intestine
patchy mucosal lesions and malabsorption
