012115 gluten sensitivity Flashcards
classic celiac disease-symptoms
diarrhea, bloating, abdominal pain, weight loss
can you have antibodies of celiac disease but no celiac sprue
yes
can you have DQ2 or DQ8 genetic susceptibility for celiac disease but not have celiac disease
yes
atypical celiac disease-symptoms
iron deficiency osteoporosis dermatitis herpetiformis IBS DM type I elevated LFTs
celiac disease affects what area?
sm intes
most common is duodenum (think Ca, phosphorous, iron absorption)
non GI presentation of celiac disease
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
how does dermatitis herpetiformis present?
pruritic
papulovesicles
extensor surface of extremities and trunk
85% have celiac dis
most common non-GI presentation of celiac dis
osteopenia/osteoporosis
what are neurologic symptoms of celiac dis
ataxia night blindness (vit A) seizures headaches epilepsy mood disturbances peripheral neuropathies
due to fat and vitamin malabsorption
what kind of gynceologic and fertility problems can there be in CD pts?
amenorrhea in untreated
infertility in untreated
spontaneous abortions
intrauterine fetal growth retardation
mechanism of celiac dis
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
how to diagnose CD
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
biopsy of CD
scalloping or notching of small bowel
villous atrophy, intraepithelial lymphocytosis, crypt hyperplasia
genetics of CD
HLA class II:
95% have DQ2 heterodimer
5% have DQ8 heterodimer
gluten free diet-what to avoid
wheat, rye, barley
malt
meds with gluten
why should you treat asymptomatic CD pt?
long term prognosis-four fold increase in all cause mortality (due to cardiovascular disease and malignancy)
malignant complications of CD
enteropathy associated T cell lymphoma
wheat allergy
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
what findings are normal in wheat allergy?
normal intestinal mucosa (as opposed to CD) normal antibodies (as opposed to CD)
symptoms of celiac dis vs wheat allergy
in both, you see intestinal and extraintes symptoms
gastorintestinal symptoms are not distinguishable btwn the two
tropical sprue
syndrome of stunted growth and diarrhea (common in developing countries)
is atypical or classic celiac dis presentaiton more common?
atypical
