Bowel disorders

Question 1

Which component of gluten causes coeliac disease?

Answer 1

Gliadin - found in wheat, rye, barley

Question 2

Describe the pathology of coeliac disease

Answer 2

Inflammatory response to gluten
Increased levels of intra-epithelial lymphocytes
Can cause villous atrophy - villi become inflamed and flatten together, and can eventually disappear

Question 3

Give two genes that are associated with coeliac disease

Answer 3

HLA-DQ2

HLA-DQ8

Question 4

Describe the presentation of coeliac disease

Answer 4

Wide variation in signs and symptoms
Multi-systemic, main symptoms include:
- Persistant, unexplained GI symptoms
- Nausea/vomiting
- Diarrhoea, excessive wind and/or constipation
- Recurrent stomach pain, bloating
- Fatigue, anaemia, unexplained weight loss
- Unexplained iron, vit B12 or folate deficiency
- Mouth ulcers

Question 5

Give some examples of neurological and spychiatric disorders which may sometimes be associated with coeliac disease

Answer 5

migraine
encephalopathy
choroa
brainstem dysfunction
myelopathy
mononeuritis multiplex
(may be initial presentation)

Question 6

What investigations would be done to test for coeliac disease?

Answer 6

Distal duodenal biopsy
Serology
FBC
Liver function tests, albumin tests

Question 7

Why is gluten withdrawal still important in asymptomatic patients?

Answer 7

Due to risk of long term complications

Question 8

Give six conditions that are associated with coeliac disease

Answer 8

Dermatitis herpetiformis
Diabetes mellitis
Autoimmune thyroid disease
Autoimmune hepatitis/gastritis
Primary biliary cirrhosis
IgA

Question 9

Describe the potential complications of coeliac disease

Answer 9

Refractory coeliac disease
Small bowel lymphoma
Oesophageal carcinoma
Colon cancer

Question 10

Describe the possible causes of malabsorption

Answer 10

Mucosal inflammation
Infection
Infiltration
Impaired motility
Iatrogenic
Pancreatic

Question 11

Give three classifications of bowel ischaemia

Answer 11

Acute mesenteric ischaemia
Chronic mesenteric ischaemia
Ischaemic colitis (most common)

Question 12

What causes ischaemic colitis? Which part of the colon is most susceptible?

Answer 12

Compromised blood circulation to the colon

Splenic flexure most at risk due to watershed area

Question 13

How might ischaemic colitis present on a barium enema?

Answer 13

Thumbprinting

Question 14

When is surgery indicated in the management of ischaemic colitis?

Answer 14

In cases with perforation and/or gangrene