Celiac Diseases Flashcards
Definition
Celiac disease is a chronic, multiple-organ
autoimmune disease that affects the
small intestine in genetically predisposed
children and adults
Definition explanation
Celiac disease is an autoimmune disorder in which the ingestion of gluten, a protein found in wheat, barley, and rye, leads to damage in the small intestine.
Causes
Genetic predisposition: Certain genes, particularly HLA-DQ2 and HLA-DQ8, increase the risk.
* Environmental triggers: Gluten is the primary environmental trigger.
* Immune system response: An abnormal immune response to gluten.
Pathogensis or mechanism of action
Gluten, specifically gliadin, triggers an immune response in the small intestine.
* This response involves T-cells, which attack the lining of the small intestine.
* This leads to inflammation and damage to the villi (tiny finger-like projections that absorb nutrients).
* Villi damage results in malabsorption of nutrients.
Clinical symptoms
Weight loss fatigue anemia muscle weakness
Vitamin D deficiency( joint. Pain seizures Skin disorders, including dermatitis herpetiformis involving the
extensor surfaces of the extremities, trunk, buttocks,
scalp, and neck Hormonal disorders, such as amenorrhea, delayed
menarche, and infertility in women and impotence and
infertility in men, have been described
Physical examination
Physical examination
• Orthostatic hypotension
• Peripheral edema
• Ecchymoses
• Hyperkeratosis or dermatitis herpetiformis
• Evidence of peripheral neuropathy
• Evidence of weight loss, including muscle wasting or
loose skin folds
• Abdominal examination shows a protuberant and
tympanic abdomen due to distention of intestinal loops
with fluids and gas.
• Ascites occasionally can be detected in patients with
severe hypoproteinemia.
• Cheilosis and glossiti
Conditions to consider testing for celiac disease
Conditions to consider testing for celiac disease
• CD common CD less common but treatable
• Symptomatic malabsorption Pulmonary hemosiderosis
• Diarrhea with weight loss Male or female infertility
• Chronic diarrhea with or without abdominal pain Dyspepsia
• Chronic iron deficiency and unexplained anemia Amenorrhea
• Metabolic bone disease and premature osteoporosis Chronic fatigue
• Postprandial bloating and gaseousness Apparent malabsorption of thyroid replacement medication
• Unexplained weight loss • Abnormal elevated liver enzymes Epilepsy or ataxia
Constipation
• Incidental discovery of villous atrophy
• endoscopically or histologically Recurrent abdominal pain
• Dermatitis herpetiformis Chronic arthralgia
• Peripheral neuropathy “Brain fog”
• Oral aphthous ulcers Recurrent headache or migraine
• Growth failure
• Discolored teeth or developmentally
• synchronous enamel loss
• Thyroid disease
• Irritable bowel syndrome
• Down and Turner syndromes
• Unexplained recurrent pancreatitis
CD, celiac disease; GFD, gluten-free die
Lab Studies
Use of serum antibodies to diagnose celiac disease
Hematologic tests
• Anemia due to deficiency in iron, folate, and, rarely,
vitamin B-12.
Electrolytes and chemistries
◦ Electrolyte imbalances, such as hypokalemia,
hypocalcemia, hypomagnesemia, and metabolic
acidosis, can develop.
Electrolytes and chemistries
◦ Electrolyte imbalances, such as hypokalemia,
hypocalcemia, hypomagnesemia, and metabolic
acidosis, can develop.
Oral tolerance tests
• Excretion of breath hydrogen, a product of bacterial fermentation
of unabsorbed lactose, is often elevated in celiac sprue.
• The oral D-xylose tolerance test can reveal carbohydrate
malabsorption. Video capsule endoscopy (VCE)
VCE can detect complications associated with C Small bowel barium studies
Abnormal radiographic findings can include
dilatation of the small intestine,
Histologic Findings
Celiac sprue primarily involves the mucosa of the small
intestine. The submucosa, muscularis, and serosa are usually
not involved.
The villi are atrophic or absent, and crypts are elongated.
The cellularity of the lamina propria is increased with a
proliferation of plasma cells and lymphocytes.
The increased number of intraepithelial lymphocytes per unit
length of absorptive epithelium is increased
Classifications
Marsh stage 0: normal mucosa
Marsh stage 1: increased number of intra-epithelial lymphocytes,
usually exceeding 20 per 100 enterocytes
Marsh stage 2: proliferation of the crypts
Marsh stage 3: partial or complete villous atrophy
Marsh stage 4: hypoplasia of the small bowel architecture
Treatment
Diet therapy no gluten meals wheat barley rye
be advised to eat a high-fibre diet supplemented
with whole-grain rice, maize, potatoes and ample vegetables.
Corticosteroids Prednisone (Deltasone, Orasone, Sterapred
Complications
Risk for malignant disease of the small intestine, including
enteropathy-associated T-cell and non-Hodgkin lymphomas
and adenocarcinomas, is increased.
• Occasionally, ulceration and stricture of the small intestine
might occur.
• Bone disease manifests as osteopenia and early onset of
osteoporosis and osteomalacia
