Difference between revisions of "Duodenum"

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Duodenum (view source)

Revision as of 03:19, 21 September 2010

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→‎Celiac sprue
(re-arr, image, Marsh)
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==Celiac sprue==
==Celiac sprue==
{{main|Duodenum}}
===General===
===General===
====Etiology====
*Etiology: autoimmune.
*Autoimmune.


====Epidemiology====
====Epidemiology====
*Associated with:
*Associated with:
**The skin condition ''[[dermatitis herpetiformis]]''.<ref>TN 2007 D22</ref>
**The skin condition ''[[dermatitis herpetiformis]]''.<ref>TN 2007 D22</ref>
***Tx: dapsone.
**IgA deficiency - 10-15X more common in celiac disease vs. healthy controls.<ref name=pmid12414763>{{Cite journal  | last1 = Kumar | first1 = V. | last2 = Jarzabek-Chorzelska | first2 = M. | last3 = Sulej | first3 = J. | last4 = Karnewska | first4 = K. | last5 = Farrell | first5 = T. | last6 = Jablonska | first6 = S. | title = Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis? | journal = Clin Diagn Lab Immunol | volume = 9 | issue = 6 | pages = 1295-300 | month = Nov | year = 2002 | doi =  | PMID = 12414763 }}</ref>
**IgA deficiency - 10-15X more common in celiac disease vs. healthy controls.<ref name=pmid12414763>{{Cite journal  | last1 = Kumar | first1 = V. | last2 = Jarzabek-Chorzelska | first2 = M. | last3 = Sulej | first3 = J. | last4 = Karnewska | first4 = K. | last5 = Farrell | first5 = T. | last6 = Jablonska | first6 = S. | title = Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis? | journal = Clin Diagn Lab Immunol | volume = 9 | issue = 6 | pages = 1295-300 | month = Nov | year = 2002 | doi =  | PMID = 12414763 }}</ref>
**Risk factor for ''gastrointestinal T cell lymphoma'' - known as: ''enteropathy-associated T cell lymphoma'' (EATL).
**Risk factor for ''gastrointestinal T cell lymphoma'' - known as: ''enteropathy-associated T cell lymphoma'' (EATL).


====Treatment====
====Clinical====
Treatment:
*Gluten free diet.
*Gluten free diet.
**''Mnemonic'': BROW = barley, rye, oats, wheat.
**''Mnemonic'': BROW = barley, rye, oats, wheat.


====Serologic testing====
Serologic testing:
*Anti-transglutaminase antibody.
*Anti-transglutaminase antibody.
**Alternative test: anti-endomysial antibody.
**Alternative test: anti-endomysial antibody.
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*If you see acute inflammatory cells, i.e. neutrophils, consider Giardiasis and other infectious etiologies.
*If you see acute inflammatory cells, i.e. neutrophils, consider Giardiasis and other infectious etiologies.
*Biopsy should consist of 2-3 sites.  In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases.
*Biopsy should consist of 2-3 sites.  In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases.
DDx:
*Giardiasis.
**Have giarrdia organisms.
**Always consider ''Giardiasis'' and especially on exams.
*Whipple's disease (very rare).
**Abundant macrophages should make one suspicious.


===Grading===
===Grading===
Most pathologists do not grade celiac sprue.
Rarely done - see ''[[celiac disease]]'' article.
 
The most common system is the ''modified Marsh system'':<ref name=pmid12145668>{{cite journal |author=Wahab PJ, Meijer JW, Dumitra D, Goerres MS, Mulder CJ |title=Coeliac disease: more than villous atrophy |journal=Rom J Gastroenterol |volume=11 |issue=2 |pages=121–7 |year=2002 |month=June |pmid=12145668 |doi= |url=}}</ref><ref name=pmid20844959>{{cite journal |author=Ciaccio EJ, Bhagat G, Tennyson CA, Lewis SK, Hernandez L, Green PH |title=Quantitative Assessment of Endoscopic Images for Degree of Villous Atrophy in Celiac Disease |journal=Dig Dis Sci |volume= |issue= |pages= |year=2010 |month=September |pmid=20844959 |doi=10.1007/s10620-010-1371-6 |url=}}</ref>
{| class="wikitable"
|
| '''Marsh 1'''
| '''Marsh 3A'''
| '''Marsh 3C'''
|-
| Descriptors
| Well-formed villi
| Partial villous atrophy
| Total villous atrophy
|-
| Alternate descriptors
| Normal villous arch.
| Blunted villi
| Flattened mucosa
|}


==Giardiasis==
==Giardiasis==
Michael
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