Celiac Disease (short case) Flashcards

1
Q

HPI of Pt with Celiac Disease

A
  • 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.
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2
Q

DDx Celiac Disease

A
  • 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
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3
Q

Celiac Disease: PE findings

A

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.

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4
Q

Diagnosis:

Serologic Testing for Celiac Disease

A
  • *Endomysial IgA Ab

- *Transglutimase Ab (TTG)

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5
Q

What is the Gold standard diagnostic test for Celiac Disease?

A

small bowel biopsy=definitive dx

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6
Q

Celiac Disease:

-Pathophysiology

A

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)

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7
Q

Celiac disease: clinical manifestations

A
  1. Malabsorption: diarrhea, abdominal pain/distention, bloating, steatorrhea, weight loss
  2. Dermatitis herpetiformis: pruritic, papulovesicular rash on extensor surfaces, neck, trunk and scalp
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8
Q

Celiac Disease: Management

A

gluten free diet (avoid wheat, rye, barley)

-avoid beer

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9
Q

T/F: Oats, rice, and corn cause celiac disease

A

FALSE. These foods don’t cause celiac dz

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10
Q

Celiac Disease: demographic

A

•Mostly in Caucasian patients with northern European ancestry
•Many undiagnosed
•More prevalent than recognized
Usually presents between ages 10-40

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11
Q

T/F: negative serology excludes celiac disease dx

A

False. Negative serology doesn’t 100% exclude celiac disease. Could be negative because of:
•IgA deficiency
•Low gluten/gluten free diet

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12
Q

Celiac disease:

  • Referrals?
  • Other aspects of tx plan
A
•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
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