2: Malabsorption Syndrome, Coeliac Disease, Tropical Sprue, Whipple's Disease

Question 1

What is coeliac disease

Answer 1

Autoimmune disease caused by hypersensitivity to protein gluten

Question 2

In which gender is coeliac disease more common

Answer 2

Females

Question 3

When does coeliac disease present more commonly

Answer 3

Bi-Modal:
8-12months
20-40years

Question 4

What genes are associated with coeliac disease

Answer 4

HLADQ2 (90%)

HLADQ8 (80%)

Question 5

What are two risk factors for coeliac disease

Answer 5

FH

Other autoimmune conditions

Question 6

How does coeliac disease present clinically

Answer 6

Symptoms on consuming gluten:

• Diarrhoea
• Recurrent abdominal pain
• Abdominal bloating
• Flatulence
• Nausea
• Weight Loss
• Lethargy

Question 7

What are three features common for malabsorption syndromes seen in coeliac

Answer 7

1. Weight Loss
2. Lethargy
3. IDA

Question 8

How can children with coeliac disease present

Answer 8

FTT

Question 9

Explain pathophysiology of coeliac disease

Answer 9

• In the stomach gluten is degraded to gliadin
• In coeliac disease, gliadin binds secretory IgA and is transported across the lumen by transferrin receptors
• Tissue transglutimateses then remove an amide form gliadein
• Deaminated gliadin activates CD4 cells which release cytokines damaging villi
• Also stimulate B cells to produce anti-EMA and anti-TTG antibodies

Question 10

What are two blood tests for coeliac disease

Answer 10

anti-TTG

anti-EMA

Question 11

What is a requirement before performing anti-TTG and anti-EMA antibodies

Answer 11

individual must have had a diet containing gluten for at least 6W

Question 12

If anti-TTG and anti-EMA +ve what test is ordered

Answer 12

OGD and duodenal biopsy

Question 13

How will duodenal biopsy present in coeliac disease

Answer 13

Crypt hyperplasia

Villous atrophy

Increased intra epithelial lymphocytes

Question 14

How is coeliac disease managed

Answer 14

Gluten-free diet

Question 15

What type of anaemia will be present in coeliac disease and why

Answer 15

microcytic anaemia - due to iron deficiency. As coeliac disease most commonly affects duodenum, where iron is absorbed.

Question 16

What skin change in seen in coeliac disease

Answer 16

Dermatitis herpetiformis

Question 17

What is dermatitis herptiformis

Answer 17

• Caused by deposition of IgA in skin

- Presents as itchy vesicular lesions on extensor surfaces

Question 18

What are 5 complications of coeliac disease

Answer 18

• Hyposplenism
• Osteoporosis
• Lactose intolerance
• Enteropathic T cell lymphoma
• Subfertility
• Oesophageal cancer

Question 19

What is tropical sprue

Answer 19

Disease characterised by chronic diarrhoea following stay in tropics

Question 20

What causes whiles disease

Answer 20

Infection tropheryma whipplei

Question 21

How can malabsorption diseases be classified

Answer 21

• Intestinal
• Pancreatic
• Biliary

Question 22

What causes intestinal malabsorption

Answer 22

Villous atrophy

Question 23

What diseases cause intestinal malabsorption

Answer 23

Coeliac disease
Crohn's disease
Tropical Sprue 
Whipple's disease 
Lactose intolerance

Question 24

What causes pancreatic malabsorption

Answer 24

Lack of pancreatic enzymes

Question 25

What diseases cause pancreatic malabsorption

Answer 25

Cystic Fibrosis

Pancreatic cancer

Question 26

What diseases cause biliary malabsorption

Answer 26

Deficiency in bile salts needed for fat emulsification

Question 27

What are two causes of biliary malabsorption

Answer 27

Biliary obstruction

Primary biliary cirrhosis