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Pathology > C - Coeliac > Flashcards

C - Coeliac Flashcards

1
Q

typical presentation for coeliac

A

tiredness, muscle aches, weight loss
+/- GI symptoms

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2
Q

TATT bloods

A

FBC
U&Es
LFTs
Glucose

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3
Q

what type of anaemia is seen in coeliac

A

microcytic, hypochromic

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4
Q

3 causes of microcytic anaemia

A

iron deficiency
thalassaemia trait
anaemia of chronic disease

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5
Q

what things are you looking at on a blood film

A

cell types
number of each cell type
morphology of cells - ie shape
inclusions
colour (RBCs)

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6
Q

what does a poikilocyte RBC indicate

A

iron deficiency

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7
Q

what does anisopoikilocytosis

A

variation in shape and size

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8
Q

what does anisopoikilocytosis on blood film indicate

A

iron deficiency

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9
Q

what is basophilic stippling

A

aggregated ribosomal material of basophils

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10
Q

what causes basophilic stippling

A

beta thalassaemia trait
lead poisoning
alcoholism
sideroblastic anaemia

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11
Q

what does a hypersegmented neutrophil indicate

A

megaloblastic anaemia (impaired DNA synthesis)

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12
Q

what causes hypersegmented neutrophils / megaloblastic anaemia

A

b12 deficiency
folate deficiency
drugs

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13
Q

what do target cells indicate

A

iron deficiency
thalassaemia
hyposplenism
liver disease

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14
Q

what are target cells aka

A

codocytes

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15
Q

what is the SA:vol ratio like in target cells

A

high SA:vol ratio

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16
Q

what are howell jolly bodies

A

nuclear remnants in RBC

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17
Q

what do howell jolly bodies look like

A

dark dot in RBC

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18
Q

what do howell jolly bodies indicate

A

hyposplenism

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19
Q

causes of iron deficiency

A

blood loss
poor diet
malabsorption
combination of any of these

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20
Q

causes of megaloblastic change

A

b12 deficiency
folate deficiency
poor diet
pernicious anaemia

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21
Q

causes of hyposplenism

A

absent spleen
- trauma
- therapeutic
poor functioning spleen
- SLE
- IBD
- coeliac
- sickle cell

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22
Q

what is the biochem of coealic

A

low Ca
high ALP, normal LFTs
low vit D
high PTH

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23
Q

low Ca
high ALP, normal LFTs
low vit D
high PTH
what is this also the biochem of

A

secondary hyperparathyroidism (vitamin D deficiency)

24
Q

why is ALP high in coeliac

A

secondary hyperparathyroidism due to low vit D causes chronic low Ca –> osteoclasts take Ca from bone to maintain blood levels –> chronic bone loss

25
Q

DDx of coeliac

A

Crohns
stress
lesser:
menorrhagia
pancreatic disease
lymphoma

26
Q

what blood levels would be different in crohns and coeliac

A

coealiac = low iron, b12, folate, fat, ca
crohns = low b12, bile salts

27
Q

Ix for coeliac

A

CRP, ESR
anti TTg and anti e
upper GI endoscopy / duodenal biopsy
foecal calprotectin

28
Q

what HLA do 90% of coeliacs have

A

HLA DQ2

29
Q

how is pathogenicity of crohns and coeliac different

A

crohns is autoinflam
coeliac is autoimmune (therefore has auto ABs)

30
Q

what is coeliac

A

abnormal immune response to gluten

31
Q

what component of gluten causes the issue in coeliac

A

gliadin

32
Q

how are gliadin peptides broken down

A

deaminated by TTG

33
Q

what cell mediates the damage done in coeliac & how

A

gamma delta T cells expressing IEL
–> damaging duodenal epithelial cells

34
Q

what type of ABs are anti TTG / anti e

A

IgA ABs

35
Q

how specific are anti TTG

A

95%

36
Q

what can cause a false negative with anti TTG ABs

A

if the patient is IgA deficient, the AB will be negative as they’re anti TTG ABs

37
Q

when are the anti TTG ABs gone in coeliac

A

when gluten is avoided

38
Q

if the ABs come back positive, do you still need OGD? why / why not?

A

YES - need a baseline and need to confirm diagnosis

39
Q

gold standard diagnosis of coeliac

A

duodenal biopsy

40
Q

what is the normal villi:crypt ratio

A

4:1

41
Q

how many lymphocytes does a normal duodenal villus have per 100 epithelial cells

A

<20

42
Q

where should the duodenal biopsy be taken from in the duodenum & why

A

2nd part of duodenum
- first contains Brunner’s gland which can distort the architecture

43
Q

what is characteristic of coeliac on biopsy (3)

A

villous atrophy
crypt hyperplasia
>25 lymphocytes / 100 epithelial cells

44
Q

what other diseases look like coeliac on biopsy

A

Sprue
enteropathy
Giardia

45
Q

how can a pt have coeliac but have normal biopsy

A

if they’re currently on a gluten free diet

46
Q

what can’t you eat if you’re on a gluten free diet

A

wheat
barely
rye
some oats
additives !!

47
Q

what are the long term complications of coeliac

A

lymphoma !!
malabsorption
osteoporosis / osteomalacia
epilepsy
hyposplenism
cerebral calcification

48
Q

why do coeliacs need ongoing monitoring

A

ensuring adherence to diet

49
Q

what Ix are done for ongoing monitoring in coeliac

A

haem: FBC, iron, B12, folate, PT
biochem: Ca, PO43, LFT, U&E
anti TTG and anti e
DEXA of hip and spine every 3-5yrs

50
Q

what can cause a persistent anti TTG AB+ in coeliac

A

not adherence to diet
LYMPHOMA

51
Q

if coeliac is undiagnosed, what complications are they at risk of

A

low vit D, B12, folate, iron, K
++++ malignancy risk
2x mortality risk

52
Q

associated conditions with coeliac

A

dermatitis herpetiformis
T1DM
AI thyroid disease
Down’s
all other AIDs

53
Q

what is the prevelance of dermatitis herpetiformis in coeliac

A

100%

54
Q

where is dermatitis herpetiformis

A

elbows

55
Q

what % of coeliacs have T1DM

A

7%

56
Q

when should you consider coeliac tests (4)

A

iron def anaemia
chronic diarrhoea
recurrent mouth ulcers
IBS

Pathology (87 decks)

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