WBR0175

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 45-year-old man presents to the physician's office with complaints of diarrhea and stools that have been difficult to flush for the past 6 weeks. Upon further questioning, the patient reports abdominal cramps and weight loss despite a normal appetite. He explains that he recently returned from Peru after a three month long business trip. The patient undergoes an extensive work-up and is diagnosed with tropical sprue. Which of the following endoscopic findings is most likely observed in this patient?]]
Answer A	AnswerA::Inflammation exclusive to the duodenum
Answer A Explanation	AnswerAExp::Patients with tropical sprue do not typically have inflammation exclusive to the duodenum. Patients with celiac disease, however, usually experience inflammation of the distal duodenum or the proximal jejunum.
Answer B	AnswerB::Inflammation exclusive to the ileum
Answer B Explanation	AnswerBExp::Patients with tropical sprue do not typically have inflammation exclusive to the ileum.
Answer C	AnswerC::Inflammation exclusive to the jejunum
Answer C Explanation	AnswerCExp::Patients with tropical sprue do not typically have inflammation exclusive to the jejunum. Patients with celiac disease, however, usually experience inflammation of the distal duodenum or the proximal jejunum.
Answer D	AnswerD::Inflammation of the entire small bowel
Answer D Explanation	AnswerDExp::Patients with tropical sprue usually have inflammation of all segments of small bowel.
Answer E	AnswerE::Inflammation of the entire small and large bowels.
Answer E Explanation	AnswerEExp::Frequently, patients with tropical sprue have inflammation of the entire small bowel. Large bowel inflammation is not typically involved in tropical sprue.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Tropical sprue is an intestinal disease of unknown etiology, most likely a manifestation of an infectious process. The most common regions of distribution are the Caribbeans, South America, and India. Patients with tropical sprue frequently present with chronic diarrhea and steatorrhea. Other findings associated with tropical sprue, such as fatigue, weight loss, abdominal colics, glossitis, angular stomatitis, anemia, and hypoproteinemia, are often also indicative of malabsorption. The disease is diagnosed endoscopically, displaying features of inflammation involving the entire small bowel as opposed to celiac sprue that is usually confined to the proximal small bowel. Histologically, variable villous atrophy (partial, subtotal, total) may be observed. Educational Objective: Patients with tropical sprue have inflammation of the entire small bowel with variable villous atrophy. References: Baker SJ. Tropical sprue. Br Med Bull. 1972;28(1):87-91.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Tropical sprue, WBRKeyword::Inflammation, WBRKeyword::Small bowel, WBRKeyword::Small intestine, WBRKeyword::Jejunum, WBRKeyword::Duodenum, WBRKeyword::Ileum, WBRKeyword::Celiac sprue, WBRKeyword::Sprue, WBRKeyword::Malabsorption, WBRKeyword::Steatorrhea, WBRKeyword::Tropical diseases
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