Celiac Disease Flashcards
inflammation of the small bowel 2/2 ingesting gluten-containing foods
celiac dz
common gluten containing foods
wheat
barley
rye
some oats
malt
durum (semolina)
what causes the immune rxn in cd
gliaden
what predisposes pt’s to cd
genetics
mc celiac pt population
caucasian
Northern European ancestry
t/f cd is more prevalent than is recognized
t!
cd usually presents btw __ to
__ yo
10-40
gi sx of cd
diarrhea w. bulky, foul smelling stools
steatorrhea w. floating stool
flatulence
abd distension
generalized sx of cd
wt loss
weakness
ftt in peds
hematologic sx of cd
iron deficiency anemia
osteo sx of cd
osteopenia
osteoporosis
often the presenting sx of cd
dermatitis herpetiformis
describe dermatitis herpetiformis
grouped pruritic papule and vesicles
where is dermatitis herpetiformis mc found
elbows
distal forearms
knees
scalp
back
buttocks
other conditions (besides dermatitis herpetiformis) associated w. cd
T1DM
Down’s syndrome
liver dz
menstrual/reproductive issues
reproductive issues associated w. cd
recurrent miscarriage
infertility
later menarche
earlier menopause
preterm delivery
low birth weight
low probability of cd criteria (3)
no significant sx of malabsorption
no fh cd
Chinese, Japanese, or sub-saharan African descent
what testing should low probability pt’s receive
serologic
high probability of cd criteria (2)
classic presentation
rf present
rf for cd
1st or 2nd degree relative w. confirmed cd
T1DM
AI thyroiditis
down’s syndrome
Turner syndrome
testing for high probability of cd pt
serologic testing
PLUS
small bowel bx
definitive dx for cd
small bowel bx x 4
preferred serologic test for cd
and 2nd line test
- tTg-IgA → 90-98% sensitivity
- anti-endomysial (EMA-IgA)
if serology is (+) what test should be done
small bowel bx
does negative serology r.o cd
no!
reasons for negative serology in cd
IgA deficiency
low gluten/gluten free diet
mild dz
scalloping
atrophic appearing mucosa w. lots of folds
visible fissures
modularity
prominent submucosal vascular
endoscopic findings of cd
cd bx is graded using __
and at least __ bx’s are recommended for dx
marsh-oberhuber classification
4
increased intraepithelial lymphocytes
atrophic mucosa w. villi loss
epithelial apoptosis
crypt hyperplasia
bx findings of cd
tx for cd
gluten-free diet
RD referral
replete deficiencies
DXA
pneumococcal vaccination
consider screening family
what should pt’s know about dermatitis herpetiformis
healing is more delayed than intestinal manifestations
cd pt’s have increased risk in overall mortality dt
CVD
malignancy
cd also increases risk for what 2 cancers
lymphoma
GI cancers
