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Difference between revisions of "Duodenum"
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==Giardiasis== | ==Giardiasis== | ||
=== | ===General=== | ||
*Flagellate protozoan ''Giardia lamblia''. | *Etiology: | ||
**Flagellate protozoan ''Giardia lamblia''. | |||
=== | *Treatment | ||
*Loss of villi. | **Antibiotics, e.g. metronidazole (Flagyl). | ||
===Microscopic=== | |||
Features: | |||
*+/-Loss of villi. | |||
*Intraepithelial lymphocytes. | *Intraepithelial lymphocytes. | ||
**+Other inflammatory cells, especially PMNs, close to the luminal surface. | **+Other inflammatory cells, especially PMNs, close to the luminal surface. | ||
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*[http://commons.wikimedia.org/wiki/File:Giardiasis_duodenum_low.jpg Giardiasis - low mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Giardiasis_duodenum_low.jpg Giardiasis - low mag. (WC)]. | ||
=== | ==Acute duodenitis== | ||
* | ===Etiology (DDx)=== | ||
*Infection. | |||
**Helicobactor organisms in the [[stomach]]. | |||
*Medications (NSAIDs). | |||
*Crohn's disease (usually focal/patchy). | |||
*Celiac sprue. | |||
===Microscopic=== | |||
Features: | |||
*Intraepithelial lymphocytes. | |||
*Neutrophils - "found without searching" - '''key feature'''. | |||
*Eosinophils - "found without searching" - '''key feature'''. | |||
*Plasma cells (increased). | |||
Notes: | |||
*One needs stomach concurrent biopsies to r/o Helicobactor. | |||
*Erosions make celiac sprue much less likely. | |||
*Presence of chronic inflammation useful for NSAIDS vs. Helicobacter organisms: | |||
**NSAIDs not commonly assoc. with acute inflammation;<ref name=pmid8406146>{{cite journal |author=Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Russell RI |title=Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs |journal=Gut |volume=34 |issue=9 |pages=1162–6 |year=1993 |month=September |pmid=8406146 |pmc=1375446 |doi= |url=}}</ref> thus, without chronic inflammation NSAIDs are unlikely. | |||
***Acute NSAID-related duodenitis reported.<ref name=pmid18158085>{{cite journal |author=Hashash JG, Atweh LA, Saliba T, ''et al.'' |title=Acute NSAID-related transmural duodenitis and extensive duodenal ulceration |journal=Clin Ther |volume=29 |issue=11 |pages=2448–52 |year=2007 |month=November |pmid=18158085 |doi=10.1016/j.clinthera.2007.11.012 |url=}}</ref> | |||
==Whipple's disease== | ==Whipple's disease== | ||