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Liver & GIT

9 out of 10

Macrophages containing large quantities of undigested and partial digested bacteria in intestine are seen in

A Whipple's disease

B Amyloidosis

C Immunoproliferative small intestinal disease

D Vibro cholerae infection

Ans. A Whipple's disease

It is a chronic multi system disease.

Etiology – Gram positive bacillus – Tropheryma whippelii.

Clinical features-

a. Diarrhea steatorrhea, abdominal pain, weight loss, protein losing enteropathy with hypoalbuminemia.

b. Migratory large joint polyarthritis is non-deforming

c. Pleurisy, pulmonary infiltrates.

d. Cardiac involvement – Coronary arteritis, pericarditis, conduction defects, endocarditis, valvular involvement.

e. CNS involvement (10%)- Depression, seizures, myoclonus, meningitis, dementia (M/C), hypothalamic syndrome (Insomnia, hyperplasia, polydipsia).

f. Ocular involvement- Ophthalmoplegia, Papilledema, scotoma, uveitis, nystagmus.

g. Lymphadenopathy

h. Chylous/ serous ascites.

Jejunal biopsy is done by Crosby’s Capsule

Laboratory diagnosis- (It is diagnostic)-

The diagnosis is established by histopathological examination of duodenum which demonstrate infiltration of the lamina

propria with PAS-positive macrophages that contain gram positive bacilli.


a. Drug of choice is double strength trimethoprim/ sulfamethoxazole for 1 year.

b. If trimethoprim/sulfamethoxazole is not tolerated, chloramphenicol is an appropriate second choice. (H-18th Pg- 2474)

Protein losing enteropathy - (Ref. H-18th edi, Pg 2475)

There is loss of both albumin and globulin in stool. Clinically patient develop généralisé anasarca.

Diagnosis: Radioactive alpha1 antitrypsin clearance in stool.

Table : Disease producing protein-losing enteropathy

Disease of the stomach

Ménétrier’s disease

Disorders of intestinal lymphatics

Intestinal lymphangiectasia, primary or secondary

Inflammatory disease of the gut

Inflammatory bowel disease

Parasitic infections

Blind loop syndrome


Gastric, small intestinal, colonic, familial polyposis

Miscellaneous Causes

Coeliac disease

Tropical sprue

Radiation enteritis

Collagen-vascular disease

Whipple’s disease

Allergic gastroenteropathy

Constrictive pericarditis

Clinical features- The two important clinical features are-

a. Peripheral edema due to hypoalbuminemia.

b. Steatorrhea due to lymphatic block.


a. Treatment of underlying cause.

Table: Consequences of small intestinal resection including ileal resection (Ref. H-17th edi, Pg 1882)



Bile acids cannot be absorbed and enter the colon where they have a purgative effect. The remaining small intestine may act as a stagnant loop

Fat malabsorption


Insufficient bile acids in the upper small intestine because of their loss in the Stool; fat malabsorption and fatty acid diarrhea


Supersaturated bile because of diminished bile acid pool

Oxalate nephrolithiasis

Increased absorption of oxalate because calcium, which normally binds to oxalic acids, binds instead to the excess fatty acids in the intestine.

Table: Causes of stagnant loop syndrome



Gastric surgery

Reduction in acid

Duodenal blind loop after Polyp operation

Jejunal diverticula

Diverticula act as blind loop

Enterocolic fistulas e.g. in Crohn’s disease

Delivery of colonic bacteria to small intestine via the fistula

Strictures, e.g. in Crohn’s disease

Delay of the fecal stream

Extensive bowel resection

Proximity of remaining small intestine to the colon

Diabetic autonomic neuropathy

Abnormal small intestinal motility


Abnormal small intestinal motility


Lack of antibody in the intestine

Liver & GIT Flashcard List

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