Celiac Disease Flashcards

1
Q

Celiac disease is also called what?

A

Gluten sensitivity or enteropathy

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2
Q

What is celiac disease?

A

Malabsorption disorder caused my immunologic response to gluten

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3
Q

Gluten is a storage protein found in what?

A

Wheat, barley, rye

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4
Q

The problem with celiac disease is with what component of gluten?

A

Gliadin

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5
Q

What kind of damage occurs with celiac disease?

A

Diffuse damage to proximal SI mucosa and villous atrophy

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6
Q

Has the incidence of celiac disease increased or decreased in the last 50 years?

A

Increased

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7
Q

Largest affected population with celiac disease?

A

Whites of Northern European ancestry but also present in worldwide populations

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8
Q

Etiologies of celiac disease?

A

Genetics, environmental gluten, overexposure, incidence in 1st degree relatives: 10%

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9
Q

What is steatorrhea?

A

Fat in the stool

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10
Q

How long does it take to diagnose celiac disease?

A

Delayed dx, s/s present usually 10 yes before dx

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11
Q

How fast is the dx of celiac disease in infancy if failure to thrive?

A

Usually rapid testing/dx

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12
Q

Signs and symptoms occur at what age for celiac disease?

A

Any age, infancy through 8th decade of life (10-40 y/o MC**)

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13
Q

How many patients are asymptomatic at initial finding of celiac disease?

A

40%
(Starting to see a shift toward asymptomatic pts)

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14
Q

Classic symptoms of celiac disease?

A

Diarrhea, steatorrhea, weight loss, weakness, abdominal distention, glossitis
In children: failure to thrive, stunted growth, delayed puberty

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15
Q

Atypical symptoms of celiac disease?

A

Fatigue, depression, delayed puberty, amenorrhea, infertility, peripheral neuropathy

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16
Q

Celiac disease symptoms may be related to which specific nutrient deficiencies ?

A

Iron, Vit K, Vit A, Vit B12

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17
Q

Iron deficiency signs w celiac?

A

Fatigue, pallor (look for pallor inside of mouth as well)

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18
Q

Vit K deficiency symptoms in celiac?

A

Easy bruising

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19
Q

Vit A deficiency symptoms in celiac?

A

Hyperkeratosis, skin abnormally thickened on palms and soles

20
Q

Vit B12 deficiency in celiac?

A

Peripheral neuropathy

21
Q

Celiac disease may coincide w what?

A

Lactose intolerance

22
Q

Physical exam is usually normal for celiac unless there is a finding related to what ?

A

Nutrient deficiency

23
Q

What is dermatitis herpetiformis?

A

Cutaneous variant of celiac disease: pruritic raised papulovesicles over extensors of extremities, trunk, scalp, neck (very itchy!!) w little to no GI symptoms

24
Q

Small intestine biopsy will show what with dermatitis herpetiformis?

A

Histology correlated w celiac

25
Q

How many patients w celiac have DH?

A

Few

26
Q

Treatment of HD?

A

Dapsone- anti inflammatory, also alleviate itching to avoid infection

27
Q

Will DH lesions respond to a GF diet?

A

Yes but response is slow, attempt to start GF diet and dapsone simultaneously and wean off dapsone to hopefully control w only diet once responding

28
Q

Ddx for celiac disease?

A

IBS, eosinophilic gastroenteritis, bacterial overgrowth (surg complication, slower gut transit,obstruction), lactose intolerance, IBD

29
Q

Gold standard for evaluation of celiac disease?

A

Small intestinal biopsy: taken from proximal & distal duodenum

30
Q

Histopathology of SI biopsy shows what for celiac?

A

Partial to complete villous atrophy and intraepithelial lymphocytes

31
Q

What does celiac serology check for?

A

Antibodies IgA endomysial and IgA tissue transglutaminase 

32
Q

What is the sensitivity and specificity of celiac serology?

A

Both blood tests have a greater than 90% sensitivity and greater than 95% specificity

33
Q

What should you consider about serology testing for somebody following a gluten-free diet?

A

If someone is gluten-free on their own, already at can skew the results

34
Q

Which serology test is usually the initial test and which test is used to confirm results?

A

TTG usually initial test and endomysial to confirm

35
Q

Lab test for celiac disease may have abnormal value is related to what?

A

Specific nutrient deficiency such as anemias, low vitamin levels, and low calcium

36
Q

What is the treatment for celiac disease?

A

Lifelong strict, elimination of gluten from diet, correct, nutritional deficiencies, support groups

37
Q

When will symptom improvement be evident after switching to a gluten-free diet?

A

Within a few weeks

38
Q

When will antibody levels become undetectable and somebody with celiac disease?

A

Undetectable after 3 to 12 months on gluten free diet

39
Q

What kind of referral should you give somebody with celiac disease?

A

Dietitian

40
Q

What’s important to remind patients about food, especially processed food when on a gluten-free diet?

A

Food may be cross contaminated 

41
Q

Which grains are safe for someone with celiac disease?

A

Rice, corn, potatoes, buckwheat, soybean, tapioca flours safe
Caution w oats

42
Q

Why are support groups beneficial for those with celiac disease?

A

There is usually an increase in anxiety and depression in a newly diagnosed patient

43
Q

What are associations and complications of celiac disease?

A

Increased incidence of G.I. and non-G.I. cancer and intestinal lymphoma, development of intestinal ulceration, association with type one diabetes, down syndrome, turner syndrome, other autoimmune diseases

44
Q

What is the prognosis for celiac disease?

A

Excellent with proper diagnosis, treatment, strict diet, adherence

45
Q

What is a non-celiac gluten sensitivity?

A

A symptomatic response to gluten ingestion with no serologic or histologic changes

46
Q

What kind of symptoms does non-celiac gluten sensitivity have?

A

Similar symptoms to celiac disease: abdominal pain, bloating, change in bowel patterns

47
Q

How fast are the onset of symptoms for non-celiac gluten sensitivity?

A

Hours to days after ingestion