Pathology Lab Bhakkar

We need Electrolyte Analyzer with following parameters; Na, K, Cl, Ca, PH, TCO2.

🔺️Histopathologic evaluation of duodenal mucosal biopsies (preferably 1–2 from the bulb and 4 from the distal duodenum) remains a diagnostic pillar for Celiac Disease.

🔹️The classic diagnostic triad includes intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy.

Core Histologic Features
1️⃣: Increased Intraepithelial Lymphocytes (IELs): > or = 25 IELs per 100 enterocytes along the sides and tips of the villi (highlighted via H&E or CD3 immunohistochemistry). This is often the earliest detectable change.

2️⃣: Crypt Hyperplasia: Elongation and mitotic expansion of the mucosal crypts of Lieberkühn, leading to an increased crypt-to-villus ratio.

3️⃣: Villous Atrophy: Blunting, shortening, or complete loss of mucosal villi, reducing the effective surface area.

4️⃣: Lamina Propria Infiltration: Increased density of plasma cells, lymphocytes, and occasionally eosinophils or mast cells within the stroma.

5️⃣: Epithelial Changes: Cytoplasmic vacuolation, loss of basal nuclear polarity, and brush border microvillus degeneration in surface enterocytes.

♦️Modified Marsh-Oberhuber♦️ Classification:
Pathologists grade mucosal damage using the modified Marsh criteria to standardize biopsy reporting:
See table for Marsh criteria.

🔹️Differential Considerations for Marsh 1–2 Changes
An isolated increase in IELs (Marsh 1) is non-specific and requires correlation with serology (anti-tTG IgA, EMA IgA). Other causes include:
* H. pylori gastritis
* Non-steroidal anti-inflammatory drug (NSAID) enteropathy
* Small intestinal bacterial overgrowth (SIBO)
* Tropical sprue or autoimmune enteropathy

Thyroid lesions are quite common in our territory. These may be summarised as below.

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