Celiac's dz

Question 1

Hep B vaccine

Answer 1

b. 3 doses at 0, 2, 6 months (varying schedules)
c. Post-exposure prophylaxis
d. High risk individuals

Question 2

The inflammation in celiac disease occurs primarily in

Answer 2

the mucosa of the small intestine, which leads to villous atrophy

Question 3

Gluten is a mixture of two main protein families

Answer 3

gliadin and glutenin both of which can trigger a toxic T-cell response

Question 4

why isn’t gluten digested like everything else

Answer 4

The high proline content of glutens renders these proteins resistant to proteolytic digestion by gastric, pancreatic, or brush border enzymes this results in a intact 33 aa peptide gliadin which get’s

engulfed by macrophages and is presented on MHC which usually just grabs proteins and shows them to the immune cells for fun

Question 5

role of TTG

Answer 5

the target auto-antigen of anti-endomycial antibodies, deaminates the glutamine residues into negatively charged glutamic acid residues increasing binding to HLA-DQ2 and DQ8

Question 6

HLA-DQ2 and DQ8

Answer 6

Human leukocyte antigen genes seen in pts with CD that determine what MHC/HLA molecules serve

Question 7

what is the classification or epithelial villi

Answer 7

MARSH

see crypt hyperplasia during chronic inflammation and infiltration of immune cells

need endoscopic biopsy of this tissue for definitive diagnosis

Question 8

CD is predominantly seen in

Answer 8

iv. Females predominate (2.9:1)

Question 9

abnormal presentation of CD

Answer 9

as unexplained iron deficiency, abnormal liver function, IBS

Monosymptomatic (50%)

Anemia, diarrhea, lactose intolerance

Question 10

when are pts usually diagnosed

Answer 10

The mean delay between onset of symptoms and diagnosis is 11 years

Question 11

what are some common deficiencies seen as a result of CD

Answer 11

Iron deficiency anemia b/c of malabsorption

Osteopenia (small women under 130 lbs for example)

Question 12

what is acute abdomen presentation of CD

Answer 12

rare

Intussusception, small bowel lymphoma, SB carcinoma, perforation

Question 13

The most common illness associated with celiac is

Answer 13

thyroid

Question 14

what % of patients is seen with severe mucosal changes

Answer 14

viii. Only half the patients had severe mucosal changes on duodenal biopsy.

Question 15

what tests can be done to diagnose CD

Answer 15

IgA AB + TTG AB

but biobsy is definitive

Question 16

most common nutritional anemia associated with celiac disease is

Answer 16

is iron deficiency.

Question 17

other than iron deficiency what deficiencies could you see with CD

Answer 17

folate and cobalamin deficiency are known complications of celiac disease

Question 18

extra-intestinal manifestations of celiacs

Answer 18

peripheral neuropathy
dental
psoriasis eczema and hari thinking
lane hamilton syndrome
acute pancreatitis
increased ris of glomerulonephritis
reproductive 
anemia
hepatitis
loss of short term memory
psychosis
irratability

Question 19

when should you do a duodenal biopsy with CD

Answer 19

Duodenal biopsies should be taken in all patients with positive CD serology

Question 20

what is a Nonresponsive celiac disease (NRCD) and how common is it

Answer 20

lack of response to 6 months on a GFD or recurrence of celiac-related features despite compliance.

b. NRCD is common, reported in 10%-19% with CD

Question 21

what do you do for a NRCD pt

Answer 21

Inadvertent or intentional exposure to gluten is the most common reason for NRCD

referral to a gastroenterologist is indicated to rule out the differential of persistent symptoms in the setting of a GFD

Question 22

there is a high association between CD and disease

Answer 22

pancreatitis

also associated with thyroid

Question 23

T or F osteopenia is part of the classic presentation of CD

Answer 23

true

Question 24

increase cancer risk associated with CD

Answer 24

pancreatic
lung
colon
SI
BCC

Question 25

decreased cancer risk associated with cd

Answer 25

PANCREATIC
LUNG
BLADDER
RENAL 
BREAST