012115 gluten sensitivity

Question 1

classic celiac disease-symptoms

Answer 1

diarrhea, bloating, abdominal pain, weight loss

Question 2

can you have antibodies of celiac disease but no celiac sprue

Answer 2

yes

Question 3

can you have DQ2 or DQ8 genetic susceptibility for celiac disease but not have celiac disease

Answer 3

yes

Question 4

atypical celiac disease-symptoms

Answer 4

iron deficiency 
osteoporosis
dermatitis herpetiformis
IBS
DM type I
elevated LFTs

Question 5

celiac disease affects what area?

Answer 5

sm intes

most common is duodenum (think Ca, phosphorous, iron absorption)

Question 6

non GI presentation of celiac disease

Answer 6

unexplained iron deficiency anemia
folic acid or vit B12 defic
reduced serum albumin
unexplained elevated LFTs
other autoimmune disorders
Down syndrome and Turner syndrome
selective IgA deficiency
neurologic problems
gynecologic and fertility problems

Question 7

how does dermatitis herpetiformis present?

Answer 7

pruritic
papulovesicles
extensor surface of extremities and trunk
85% have celiac dis

Question 8

most common non-GI presentation of celiac dis

Answer 8

osteopenia/osteoporosis

Question 9

what are neurologic symptoms of celiac dis

Answer 9

ataxia 
night blindness (vit A)
seizures
headaches
epilepsy
mood disturbances
peripheral neuropathies

due to fat and vitamin malabsorption

Question 10

what kind of gynceologic and fertility problems can there be in CD pts?

Answer 10

amenorrhea in untreated
infertility in untreated
spontaneous abortions
intrauterine fetal growth retardation

Question 11

mechanism of celiac dis

Answer 11

gluten in gut gets broken down to gliadin
gliadin is converted to deamidated gliadin by tissue transglutaminase (tTG)

deamidated gliadin is presented by APC with HLA DQ2 or DQ8. activates T cell. activates B cell to produce anti-gliadin, anti-endomysium, anti-tTG

Question 12

how to diagnose CD

Answer 12

IgA endomysial antibody (EMA)
IgA tissue transglutaminase (tTG)
IgA and IgG DEAMIDATED gliadin antibodies

IgA level may be helpful in the case of IgA deficiency

if IgA is positive, do multiple sm intes biopsies

Question 13

biopsy of CD

Answer 13

scalloping or notching of small bowel

villous atrophy, intraepithelial lymphocytosis, crypt hyperplasia

Question 14

genetics of CD

Answer 14

HLA class II:
95% have DQ2 heterodimer
5% have DQ8 heterodimer

Question 15

gluten free diet-what to avoid

Answer 15

wheat, rye, barley
malt
meds with gluten

Question 16

why should you treat asymptomatic CD pt?

Answer 16

long term prognosis-four fold increase in all cause mortality (due to cardiovascular disease and malignancy)

Question 17

malignant complications of CD

Answer 17

enteropathy associated T cell lymphoma

Question 18

wheat allergy

Answer 18

classic food allergy that affects skin, GI tract. (sometimes respiratory tract)

IgE mediated

IgE mediated diseases associated w/ wheat allergy are baker’s asthma, rhinitis, contact urticaria, wheat -dependent exercise induced anaphylaxis

Question 19

what findings are normal in wheat allergy?

Answer 19

normal intestinal mucosa (as opposed to CD)
normal antibodies (as opposed to CD)

Question 20

symptoms of celiac dis vs wheat allergy

Answer 20

in both, you see intestinal and extraintes symptoms

gastorintestinal symptoms are not distinguishable btwn the two

Question 21

tropical sprue

Answer 21

syndrome of stunted growth and diarrhea (common in developing countries)

Question 22

is atypical or classic celiac dis presentaiton more common?

Answer 22

atypical