UWORLD: Celiac vs Tropical Sprue

[soccerboy2288]

I had a question in UWorld that said a Caucasian women had periodic diarrhea, weight loss, and abdominal distention. Then showed a classic picture of celiac sprue, saying it was a biopsy from the Jejunum. The question asked for best treatment.

In Pathoma, it says that Tropical sprue affects jejunum/ileum, while celiac affects mainly duodenum. Since the biopsy was from the jejunum, I thought it was Tropical sprue. The answer was Celiac.

I know in FA it says celiac affects duodenum and jejunum the most. So is pathoma flat out wrong?

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[Phloston]

Coeliac's is proximal small intestine. Tropical sprue is the whole small intestine.

One of the hardcore lessons you'll need to learn is NOT to overthink things. You sound like someone who pays attention to small details, which is good, but the big picture concept is that Coeliac's is proximal small bowel. The jejunum is commonly affected.

As far as I'm aware, you just Tx Coeliac's with dietary change (no gluten). Tropical sprue Tx is tetracyclines. But perhaps someone with clinical experience knows more specifically.

 

[soccerboy2288]

Thanks Phloston!

You're right, I make a lot of mistakes from over thinking questions and I keep reminding myself the test is NOT trying to trick me!

Strangely, Pathoma lecture specifically pointed out that "it is VERY HIGH YIELD" to know that celiac = duodenum and tropical sprue = ileum/jejunum and so I thought this was a key distinguishing feature. But other sources say what you wrote. I will go with that next time.

And your right, I picked Antibiotic for the answer (thinking it was tropical) and the correct answer (celiac) was diet. Thanks for your help!

 

[Bouddha]

Thanks Phloston!

You're right, I make a lot of mistakes from over thinking questions and I keep reminding myself the test is NOT trying to trick me!

Strangely, Pathoma lecture specifically pointed out that "it is VERY HIGH YIELD" to know that celiac = duodenum and tropical sprue = ileum/jejunum and so I thought this was a key distinguishing feature. But other sources say what you wrote. I will go with that next time.

And your right, I picked Antibiotic for the answer (thinking it was tropical) and the correct answer (celiac) was diet. Thanks for your help!

I see your confusion here, I actually am watching this lecture right now and got the same impression as you. I have 2 points though:

1. Don't forget about the presentation. Pathoma points out that tropical sprue occurs in tropical regions (based on my experience with the QBanks, they would include this detail), as well as arising after infectious diarrhea, which doesn't fit with the periodic diarrhea in the question stem.

2. Not all resources agree on everything. RR states that celiac is particularly in the duodenum and jejunum, whereas like you said, Pathoma highlights the duodenum but admittedly doesn't rule out the jejunum, just says that celiac occurs there less frequently.

Bottom line, if one part of the question seems fuzzy, go to another for hints to the answer. I haven't seen this question, but I'm guessing the presentation fit's celiac much better.

 

[Jonari]

Was this the question that had the answer choice between "antibiotics" or "change the diet", lol? Yeah, I got this wrong as well, lol...

 

[soccerboy2288]

I see your confusion here, I actually am watching this lecture right now and got the same impression as you. I have 2 points though:

1. Don't forget about the presentation. Pathoma points out that tropical sprue occurs in tropical regions (based on my experience with the QBanks, they would include this detail), as well as arising after infectious diarrhea, which doesn't fit with the periodic diarrhea in the question stem.

2. Not all resources agree on everything. RR states that celiac is particularly in the duodenum and jejunum, whereas like you said, Pathoma highlights the duodenum but admittedly doesn't rule out the jejunum, just says that celiac occurs there less frequently.

Bottom line, if one part of the question seems fuzzy, go to another for hints to the answer. I haven't seen this question, but I'm guessing the presentation fit's celiac much better.

The above information I wrote was literally the entire stem. And I think your right, the patient was Caucasian. I just remembered how much Pathoma emphasized it and went with it. However, other sources say that duodenum and jejunum and are most affected. (also read that ileum and jejunum are equally affected in tropical sprue).

Also, are you saying tropical sprue usually preceded by an identifiable/distinguishing infection, then progresses to chronic symptoms?

 

[soccerboy2288]

Yeah I picked antibiotcis

 

[redpanda]

I don't know which is right, but every celiac question I've ever seen in UWorld/Kaplan/CBSSAs has involved a description or image that was from a jejunal biopsy.

 

[calvnandhobbs68]

Yeah it isn't gonna be tropical sprue unless they say something about the patient being from somewhere tropical or they give you a slice of the ileum.

Even then that'd be really douchey to give a totally typical celiac presentation (white middle aged female no hx of tropic travels or infectious diarrhea presenting with vague diarrhea, weight loss, etc) and then expect you to recognize that the slide is ileal. I really think they'll give more clues for tropical sprue than that, at least say it's somebody who just came back from the Carribean or something.

Pathoma does say that tropical sprue arises after infectious diarrhea.

Look in FA 2013 too p. 326.
Celiac sprue: "Primarily affects distal duodenum or proximal jejunum"

 

[Bouddha]

The above information I wrote was literally the entire stem. And I think your right, the patient was Caucasian. I just remembered how much Pathoma emphasized it and went with it. However, other sources say that duodenum and jejunum and are most affected. (also read that ileum and jejunum are equally affected in tropical sprue).

Also, are you saying tropical sprue usually preceded by an identifiable/distinguishing infection, then progresses to chronic symptoms?

Pathoma states that tropical sprue "arises after infectious diarrhea," and Dr, Sattar emphasized this in his lecture. There wasn't much of a discussion about chronicity.

 

[soccerboy2288]

Thanks guys that was helpful.