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Difficulty: MediumGastroenterology and Hepatology

Match each characteristic histological finding and clinical presentation to the corresponding malabsorption disorder.

  • Villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes in the duodenum.Celiac disease
  • Lamina propria packed with PAS-positive, diastase-resistant macrophages containing non-acid-fast bacilli.Whipple disease
  • Normal villous architecture but enterocytes distended with lipid-laden vacuoles; associated with acanthocytes on peripheral smear.Abetalipoproteinemia
  • Flattened villi and chronic inflammatory infiltrate in a patient with a history of extended travel to the Caribbean; responds to antibiotics.Tropical sprue

Answer

Villous atrophy and crypt hyperplasia correspond to Celiac disease. PAS-positive non-acid-fast macrophages correspond to Whipple disease. Enterocytes with lipid-laden vacuoles correspond to Abetalipoproteinemia. Post-travel villous blunting responds to Tropical sprue.
Each malabsorption syndrome possesses a unique histological signature. Celiac disease is defined by immune-mediated villous atrophy and crypt hyperplasia. Whipple disease is identified by PAS-positive, non-acid-fast macrophages containing Tropheryma whipplei. Abetalipoproteinemia is characterized by the accumulation of lipids in enterocytes due to impaired chylomicron assembly. Tropical sprue mimics celiac histology but is distinguished by a relevant travel history and an infectious etiology responsive to antibiotics.

Step-by-Step Solution

1
Analyze the first histological description involving villous atrophy and crypt hyperplasia.
These are the pathognomonic findings for gluten-sensitive enteropathy.
Identifying the classic autoimmune response to gliadin confirms Celiac disease.
2
Evaluate the second description highlighting PAS-positive, non-acid-fast macrophages.
This specific staining pattern differentiates the causative bacteria from Mycobacterium avium complex.
This confirms the presence of Tropheryma whipplei, the agent of Whipple disease.
3
Assess the third description noting lipid-laden enterocytes with normal villi and acanthocytosis.
The inability to export lipids leads to intracellular fat accumulation and abnormal red blood cell membranes.
This pathophysiologic mechanism is the hallmark of Abetalipoproteinemia.
4
Review the final description describing villous blunting combined with a specific travel history.
The context of Caribbean travel and response to antibiotics distinguishes this infectious etiology from autoimmune causes.
These epidemiological and therapeutic clues point directly to Tropical sprue.

Key Concept

Differentiating malabsorption syndromes by integrating small bowel histological findings with key clinical and demographic features.
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Topics

Gastroenterology and Hepatology

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