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A 21-year-old woman presents to her obstetrician because she has stopped getting her period, after being irregular for the last 3 months. Upon further questioning, the patient reveals that she has had a 17 lb unintended weight loss, chronic diarrhea, abdominal pain, and constipation that waxes and wanes. Family history is notable only for an older brother with type 1 diabetes. She is healthy and is eager to gain back some weight. Her gynecologist refers her to a gastroenterologist, but first sends serology laboratory studies for IgA anti-tissue transglutaminase antibodies (IgA-tTG). These results come back positive at > 10x the upper limit of normal. Which of the following is the gastroenterologist likely to find on endoscopy and duodenal biopsy?
Foamy macrophages, which stain PAS positive
Cobblestoning with biopsy showing transmural inflammation and noncaseating granulomas
Friable mucosal pseudopolyps with biopsy notable for crypt abscesses
Normal appearing villi and biopsy
Villous atrophy with crypt lengthening and intraepithelial lymphocytes
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A 29-year-old woman presents to her gastroenterologist with complaints of fatigue and frequent diarrhea over the last 6 months. The diarrhea resolves when the patient fasts. She has lost 10 pounds over this time frame. She has eliminated dairy from her diet with no change in her symptoms. Her temperature is 97.6°F (36.4°C), blood pressure is 118/77 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a thin woman. A rectal exam and a fecal occult blood test are within normal limits. Physical exam is notable for the finding in Figure A. Which of the following would be found in this patient on confirmatory testing?
Crypt abscesses in the colon
Graulomatous inflammation of the colon
Lymphocytic infiltration of the gastric mucosa
Mucosal flattening and blunting of villi
Normal appearing intestinal mucosa