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GI > 24. Gluten Sensitivity > Flashcards

24. Gluten Sensitivity Flashcards

1
Q

What is the presentation of classic celiac disease?

A

Diarrhea
Bloating
Abdominal pain
Weight loss

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2
Q

What are the components of atypical sprue?

A 
Iron deficiency
Osteoporosis
Dermatitis herpetiformis
IBS
DM type I
Elevated LFTs
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3
Q

What is the prevalence of CD in people of Northern European descent?

A

1 in 100

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4
Q

What is the prevalence of CD in the following at-risk populations:

  • With first degree relative with CD
  • Second degree relative
  • Monozygotic twin
  • HLA id sibling
A

1 in 10
1 in 39
70-80%
40%

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5
Q

What is the area of the bowel that is most commonly affected by celiac disease?

A

duodenum

proximal jejunum

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6
Q

What vitamin deficiencies are often seen with celiac disease?

A

Iron deficiency
Folic acid deficiency
B12 deficiency

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7
Q

Why is reduced serum albumin seen with celiac disease?

A

Chronic malnourishment

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8
Q

What are other auotimmune disorders are associated with celiac disease?

A 
Type I DM (2-15%) *
Thyroid dysfunction (2-7%) *
Addison disease
PBC
Sjogren's 
AI hepatitis
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9
Q

What two genetic defects are associated with celiac disease?

A

Down syndrome

Turner syndrome

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10
Q

Patients with celiac disease often have selective deficiency of what Ig?

A

IgA

**9% of all IgA deficient patients have CD

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11
Q

What is dermatitis herpetiformis?

A

Pruritic papulovesicles on the extensor surfaces of the extremities and trunk

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12
Q

What is the most common non-GI presentation of CD?

A

Osteopenia in 70% of patients with untreated CD
Osteoporosis in 25% of all CD patients
**all patients with CD should have bone density scan

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13
Q

What are the neurologic sx of CD?

A 
Ataxia (B12 def)
Night blindness (vit A)
Seizures
Headaches
Epilepsy
Mood disturbances 
Peripheral neuropathy
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14
Q

Gyneocologic and fertility problems with CD

A
  • Amenorrhea in 1/3 untreated CD
  • Infertility common in untreated CD
  • Spontaneous abortions
  • Intrauterine fetal growth retardation
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15
Q

What happens to gluten in the intestines?

A

Degraded into gliadin
Tissue transglutaminase deaminates gliadin
HLA DQ2 or DQ8 presents deaminated gliadin to T cells
B cells make anti-gliadin, anti-endomysium, anti-tTG antibodies

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16
Q

What are the most powerful and clinically useful tests for suspected celiac disease?

A

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

17
Q

If a small intestine biopsy is done in an adult with suspected CD, what will be seen?

A
  1. Scalloping or notching of the small bowel folds
  2. Villous atrophy
  3. Intraepithelial lymphocytosis
  4. Crypt hyperplasia (deepening)
18
Q

What are two main reasons that one might get false negatives for CD serologic testing?

A
  1. Antibody levels fall on a gluten-free diet: may fall within a day with mild disease, usually 6-8wk
  2. Celiac patient that is IgA deficient
19
Q

What is the best way to assess CD in a celiac patient that is IgA deficient?

A

IgG deaminated gliadin antibody

*can also look at biopsy

20
Q

Pitfall of looking for villous atrophy for CD dx is that other things cause it:

A

NSAIDs
Infections
IBD

21
Q

What HLA is CD associated with?

A 
DQ2 heterodimer (95%)
DQ8 heterodimer (5%)
22
Q

What is HLA DQ2/8 useful for?

A

40% people with european descent have the genes, but it is useful in ruling out CD
**if someone doesn’t have DQ2/8, the don’t have CD

23
Q

Rules for the gluten free diet

A

Avoid foods with wheat, rye, barley gluten
Avoid malt
Read labels, look for gluten in meds

24
Q

What malignancy is most commonly associated with CD?

A

High-grade T cell NHL: entropathy associated T-cell lymphoma

25
Q

entropathy associated T-cell lymphoma occurs __x more frequently in patients with CD?

A

20

**risk normalizes on GFD

26
Q

What is a wheat allergy?

A

CLASSIC food allergy affecting skin, GI tract, and resp tract
IgE mediated
No antibodies, normal intestinal mucosa

27
Q

How is wheat allergy dx made?

A

Allergy pin prick testing

28
Q

Why do people feel better on a GFD?

A

Major change in dietary intake

Fermentable fructans may cause sx

29
Q

What are the downsides to a GFD?

A

Inadequate iron, calcium, vitamin B, and B vitamins
Low in fiber (watch for constipation)
Difficult to eat out/social stigma
Cost

30
Q

What is environmental enteropathy/tropical sprue?

A

Syndrome of stunted growth and diarrhea that is common in developing countries

  • -malnutrition contributes to pathogenesis
  • -recurrent diarrhea est cycle of mucosal injury, malnutrition, infection, and inflammation

GI (28 decks)

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