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Fall 2020 Exam 2 > Celiac Disease > Flashcards

Celiac Disease Flashcards

1
Q

Celiac genetics

A

HLA-D2Q (90%) & HLA-DQ8 (10%) gene

must be present to have disorder

must also have one of 39 other non HLA genes to develop celiac

higher incidence in first-degree relatives, monozygotic twins, HLA-identical siblings

seroconversion to CD may occur at any point if gene is present

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2
Q

enviornmental factors

A

GI infections

lack of BF

timing of gluten introduction

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3
Q

Exposure to gluten protien in succeptable individuls results in

A

triggers infl cascade, leads to villous atrophy, crypt hyperplaisa, initiated the producation of antigliadin antibody (AGA), transglutamanase (TTG) and antiendomysium antibody (EMA)

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4
Q

G&D

A

usually not growing

leads to FTT, short stature, weight loss

weight gain can be a sympt in older children

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5
Q

associated genetic syndromes

A

DS, turner, williams

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6
Q

Infections exposure RF

A

Rotavirus

Enterovirus

toxins that change mucosa

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7
Q

autoimmune disorders RF

A

fam hx DM1

addisons

lupus

RA

autoimmune thyroiditis

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8
Q

prognosis

A

excellent with diagnosis and treatment

deadly without treatment

4% of diarrheal deaths are undiagnosed celiac

may be asymptomatic

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9
Q

s/s in young children

A

irritability - fussy infant with suboptimal growth

FTT

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10
Q

s/s in older children

A

fatigue, joint pain, short stature, wt loss or gain, deratitis herpetiforms, delayed puberty, decresed bone density, dental enamel defects, iron def anemia, low serum albumin levels, recurrent infections, easy brusing, depr/anxiety, hair loss, irr menses, mouth ulers, numbness/tingling in extremities

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11
Q

stools

A

foul smelling

oily

sticks to toilet when flushed

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12
Q

Adverse effects if not properly treated

A

osteoporosis, kyphosis, fractures, splenic malfunction, infertility, repeat pregnancy loss, LWB offspring, UC, neurologic impairment, intestinal lymphoma

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13
Q

celiac crisis

A

severe diarrhea

electrolyte imbalance

hypoproteinemia

vascular compromise

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14
Q

celiac labs

always reach out to GI if unsure what labs to order

A

Pt must be actively eating gluten and have functioning immune system for acurate results

CBC- anemia

CMP- detect low serum albumin levels

PT, B12, Vit D, TTG (tissue transglutanimase), total serum IGA level

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15
Q

Additional lab for kids <2 years

A

DGP-IgA

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16
Q

If TTG is questionable then order

A

antiendomysium immunoglobulin A (EMA) antibody measurements

17
Q

What if serologic markers are positive?

A

refer to GI for biopsy

definite diagnosis requires endoscopic duodenal tissue biopsy

Negative serologic markers but high suspicion refer to GI, biopsy still considered

18
Q

How often are labs drawn after diagnosis?

A

every 6 months until normalized, then annually

19
Q

Treatment

A

Life-long completely gluten free diet

20
Q

FDA definition of GF

A

Item contains no ingredients that:

  • are gluten containg grains (spelt wheat)
  • derived from grain which gluten hasnt been removed (wheat flour)
  • derived from something that gluten has been removed but still has > 20 PPM or gluten remaining

-

21
Q

One slice of bread contains how much gluten

A

1600 mg

patients can tolerate 10-50 per day

22
Q

Results of gluten free diet

A

reverses malabs, nutr def & sympotms, decreases morbidities

Intestinal mucosa healing begins and serum antibody levels normalize within a few months of beginning the diet

23
Q

Negative S/E of gluten free

A

obesity, new onset insulin resistance, meatbolic syndrome, weight gain, constipation, risk of toxicity with high quantities of some products such as arsenic in rice.

Not all GF products are fortified, can result in def of B vitamins, folate and iron

24
Q

GF and labeling of meds

A

no requirements to list gluten on meds

talk to pharmacist or manufacturer

beyond celiac- resource on gf meds for families

25
Q

Diet

A

get dietitian involved

adherance is important

26
Q

educate families

A

s/s of celiac crisis, go to ER

reading labels when old enough

27
Q

screening for celiac

A

begin at age 3 even with no symptoms

28
Q

school lunches

A

schools are required to provide GF alt to kids who get free or reduced meals at school

29
Q

sexuality

A

can have delayed puberty, delayed sexual maturity

future children are predisposed

infertility, repeat loss or LBW are common if not controlled

30
Q

cost of food increases by

A

1/3

31
Q

celiac resources for families

A

ROCK: raising our celiac kids

beyond celiac.org

Fall 2020 Exam 2 (7 decks)

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