Celiac

Question 1

Small intestin

Circular Folds

Answer 1

Also known as plicae circulares

Deep ridges in the mucosa and submucosa from the start of the duodenum to the mid-ileum

Help facilitate absorption by causing the chyme to spiral through the small intestine

Question 2

small intestine

Villi

Answer 2

Hairlike vascularized projections found within the circular folds

Increase the surface area of the mucosal epithelium

Capillary bed composed of an arteriole, a venule, and a lacteal

Absorption
Occurs by diffusion and active transport
Carbohydrates (glucose) and proteins (amino acids) → venule
Lipids (fatty acids and glycerol) → lacteal

Question 3

Small intestine

Microvilli

Answer 3

Smaller villa found on the villi that create a brush border
200 million microvilli per square millimeter
Contains enzymes that complete the digestion of carbohydrates and proteins

Question 4

Celiac Disease

general

Answer 4

Immunologically mediated disease in genetically susceptible individuals caused by intolerance to gluten
Results in mucosal inflammation and villous atrophy of the small bowel → malabsorption
Affects 1 in 200 individuals
♀>♂
Bimodal age distribution (more common in childhood):
8‒12 months of age
3rd to 4th decades of life

Question 5

celiac

etiology

Answer 5

Etiology:
Sensitivity to the gliadin fraction of gluten
Protein found in wheat, barley, and rye

Question 6

Celiac

S/Sx

Answer 6

Abnormal stools (diarrhea)
Children: soft, bulky, clay-colored and foul-smelling
Adults: bulky, foul-smelling, floating stool (steatorrhea)
Abdominal cramping and/or distention
Weight loss and muscle wasting
Failure to thrive in infants and children

Dermatitis herpetiformis (10%)
Intensely pruritic papulovesicular rash in a symmetrical distribution over the extensor surfaces of the elbows, knees, buttocks, and scalp

Anemias → impaired iron and folate absorption

Osteoporosis, osteopenia, osteomalacia →defective calcium transport and vitamin D deficiency

Question 7

celiac

labs and Dx

Answer 7

Clinical suspicion
Family incidence
Iron deficiency without obvious gastrointestinal bleeding

Serologic markers
Used for screening, diagnosis, and monitoring dietary adherence
Patients must be on a gluten-containing diet when used for screening or diagnosis
Anti-tissue transglutaminase (tTG) antibody – preferred
Total IgA- paired with tTG
IgA anti-endomysial antibody (EMA)
IgAdeamidatedgliadin peptide (DGP)
Anti-gliadin antibody

Positive test → small-bowel biopsy
All are negative → celiac disease is highly unlikely

Question 8

celiac

Small-bowel biopsy

Answer 8

Taken from the lower portion of the duodenum
Mucosal inflammation
Lack of or shortening of the villi (villous atrophy)

Question 9

Answer 9

DGP: deamidated gliadin peptide
EMA: anti-endomysial antibody
tTG: tissue transglutaminase
ULN: upper limit of normal

Question 10

celiac

Histocompatibility testing

Answer 10

Looks at proteins called human leukocyte antigens (HLAs) on the surface of almost all cells in the body
HLA-DQ2 or HLA-DQ8
Seen in >95% of celiac patients
Not specific for celiac disease
Testing that fails to show either can effectively rule out celiac disease

Question 11

celiac

Evaluation of Malabsorption

Answer 11

HIGH fecal fat bc cant absorb

Question 12

celiac

Tx

Answer 12

Gluten-free diet

Avoiding foods containing wheat, rye, or barley
Consultation with a dietitian
Response to the diet is usually rapid (symptoms resolving within 2 weeks)

Supplements to replace deficiencies
Corticosteroids and immunosuppressantsto control symptoms of refractory disease

Question 13

celiac

complications

Answer 13