Celiac Disease (short case) Flashcards
HPI of Pt with Celiac Disease
- 35 yo female in a family clinic
- CC is stomach issues: Her stomach “never feels good”
- “Crampy” and it comes and goes (colicky pain)
- Generally feels worse AFTER meals
- She has diarrhea- 1 episode per day
- Sx have been going on for several months.
- Onset: gradually, she cant recall when sx started
- She has never tried cutting out gluten
- She has a well-rounded diet
- Her parents never discussed their medical issues so she doesn’t know if they have any GI issues
- Tums didn’t help, she denies upper GI issues. She points to the pain in her lower abdomen.
- Alleviates: feels slightly better after going to the bathroom
- Severity: 3/10
- She has maybe lost 5 lbs
- She denies fever, nausea, vomiting, sweating
- She denies blood in her stools, She denies dysuria.
DDx Celiac Disease
- Ulcerative colitis, traveler’s diarrhea, food allergy, PUD, PID/STI
- IBS
- Crohn’s
- Cholecystitis
- Colorectal cancer
- Lupus
- GI infection
- Depression/anxiety
- Lactose intolerance
- hyperthyroidism
- pancreatitis
Celiac Disease: PE findings
Skin: No ecchymoses. (+) Scattered maculopapular rash on the elbows with excoriations around it. Otherwise skin is normal
Neck: No thyromegaly. No nodules. No LAD.
Abdominal: Normal active BS in all 4 quadrants. Soft non tender non distended. No organomegaly. No guarding or rebound, no peritoneal signs.
Respiratory: No abnormal findings.
Cardiac: RRR, no murmurs, rubs, or gallops, no heaves. No edema. Pulses are 2+ throughout.
Digital Rectal Exam: sphincter tone is normal. No gross blood or occult blood.
Diagnosis:
Serologic Testing for Celiac Disease
- *Endomysial IgA Ab
- *Transglutimase Ab (TTG)
What is the Gold standard diagnostic test for Celiac Disease?
small bowel biopsy=definitive dx
Celiac Disease:
-Pathophysiology
Small bowel autoimmune inflammation 2/2 alpha-gliadin in gluten –> loss of villi & absorptive area–> impaired fat absorption.
*Increased incidence: females, European Descent (irish/finnish)
Celiac disease: clinical manifestations
- Malabsorption: diarrhea, abdominal pain/distention, bloating, steatorrhea, weight loss
- Dermatitis herpetiformis: pruritic, papulovesicular rash on extensor surfaces, neck, trunk and scalp
Celiac Disease: Management
gluten free diet (avoid wheat, rye, barley)
-avoid beer
T/F: Oats, rice, and corn cause celiac disease
FALSE. These foods don’t cause celiac dz
Celiac Disease: demographic
•Mostly in Caucasian patients with northern European ancestry
•Many undiagnosed
•More prevalent than recognized
Usually presents between ages 10-40
T/F: negative serology excludes celiac disease dx
False. Negative serology doesn’t 100% exclude celiac disease. Could be negative because of:
•IgA deficiency
•Low gluten/gluten free diet
Celiac disease:
- Referrals?
- Other aspects of tx plan
•Gluten-Free diet •Refer to a RD! •Replete any nutritional deficiencies •Evaluate for bone loss with DXA •Pneumococcal vaccination •Improvement of dermatitis herpetiformis may be more delayed than the response to intestinal manifestations --Consider screening family members --False negative more common in mild disease