Celiac Disease Flashcards
What is celiac disease?
- autoimmune condition where exposure to prolamins (wheat, barley, rye) causes inflammation in the small bowel.
- Usually develops in early childhood but can start at any age.
What genes are associated in celiac disease?
- HLA-DQ2 (majority)
- HLA-DQ8
What antibodies are associated c celiac disease?
- IgA tTG (anti tissue transglutaminase)
- anti-EMA (endomyseal)
What signs causes high suspicion of celiac disease?
- diarrhoea
- weightloss
- anaemia
- b12 deficient
What are the pathological changes of intestinal mucosa in celiac disease?
- Villous atrophy
- Crypt hypertrophy
What are the presentations for celiac disease?
- Asymptomatic (often)
- Failure to thrive in young children
- Diarrhoea, bloating, wind, abdo cramps
- Weight loss
- Mouth ulcers
- Anaemia secondary to iron, B12 or folate deficiency
- Dermatitis herpetiformis (an itchy blistering skin rash typically on the abdomen)
- Steatorrhoea
- Abdominal pain
What are the clinical features of celiac disease?
Symptoms
- Weight loss
- Fatigue
- Weakness
- Abdominal pain
- Bloating
- Flatulence
- Loose stools
- Steatorrhoea
- Failure to thrive (babies and young children)
Signs
- Mouth ulcers
- Angular stomatitis
- Abdominal distension
- Ecchymosis
- Muscle wasting
- Neuropathy
What are the extraintestinal manifestations of celiac disease?
- Anaemia
- due to malabsorption of B12 and folate
- Osteoporosis
- malabsorption of calcium and vtiD
- Dermatitis Herpetiformis
- Bruising
- malabsorption of vitK
What Ix would you order for celiac disease?
*exlapin what bloods and what will yu find on endoscopy
Pt should be reitroduced to prolamin for at least 6weeks before testing
Bloods
- tissue transglutaminase (TTG) antibodies (IgA)
- Total IgA antibodies
- Blood film
- Microcytes (iron)
- Macrocytes (B12/folate)
- Hypersegmented neutrophils (B12/folate)
- Haematinics
Upper GI Endoscopy
- villous atrophy
- crypt hyperplasia
- Intraepithelial lymphocytosis
- lamina propria infiltration with lymphocytes
What diseases is celiac disease associated with?
- Type 1 Diabetes
- Thyroid disease
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
How would you Mx celiac disease?
- Lifelong gluten free diet
What are the cx of celiac disease?
- Dermatitis herpetiformis (common)
- Enteropathy-associated T-cell lymphoma
- Vitamin deficiency
- Anaemia
- Osteoporosis
- hyposplenism
- Ulcerative jejunitis
- T-cell lymphoma
- Non-Hodgkin lymphoma (NHL)
- Small bowel adenocarcinoma (rare)
How would you diagnose celiac disease?
- Serology
- autoantibodies (anti-tTGA, anti-EMA)
- refer to gastro if (+)
- Histology (definitive diagnosis)
- Villous atrophy
- Crypt hyperplasia
- Inflammatory infiltration
What are the 3 classical features of celiac disease?
- villous atrophy
- crypt hyperplasia
- inflammatory infiltration
