Celiac's dz Flashcards
Hep B vaccine
b. 3 doses at 0, 2, 6 months (varying schedules)
c. Post-exposure prophylaxis
d. High risk individuals
The inflammation in celiac disease occurs primarily in
the mucosa of the small intestine, which leads to villous atrophy
Gluten is a mixture of two main protein families
gliadin and glutenin both of which can trigger a toxic T-cell response
why isn’t gluten digested like everything else
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
role of TTG
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
HLA-DQ2 and DQ8
Human leukocyte antigen genes seen in pts with CD that determine what MHC/HLA molecules serve
what is the classification or epithelial villi
MARSH
see crypt hyperplasia during chronic inflammation and infiltration of immune cells
need endoscopic biopsy of this tissue for definitive diagnosis
CD is predominantly seen in
iv. Females predominate (2.9:1)
abnormal presentation of CD
as unexplained iron deficiency, abnormal liver function, IBS
Monosymptomatic (50%)
Anemia, diarrhea, lactose intolerance
when are pts usually diagnosed
The mean delay between onset of symptoms and diagnosis is 11 years
what are some common deficiencies seen as a result of CD
Iron deficiency anemia b/c of malabsorption
Osteopenia (small women under 130 lbs for example)
what is acute abdomen presentation of CD
rare
Intussusception, small bowel lymphoma, SB carcinoma, perforation
The most common illness associated with celiac is
thyroid
what % of patients is seen with severe mucosal changes
viii. Only half the patients had severe mucosal changes on duodenal biopsy.
what tests can be done to diagnose CD
IgA AB + TTG AB
but biobsy is definitive
most common nutritional anemia associated with celiac disease is
is iron deficiency.
other than iron deficiency what deficiencies could you see with CD
folate and cobalamin deficiency are known complications of celiac disease
extra-intestinal manifestations of celiacs
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
when should you do a duodenal biopsy with CD
Duodenal biopsies should be taken in all patients with positive CD serology
what is a Nonresponsive celiac disease (NRCD) and how common is it
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
what do you do for a NRCD pt
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
there is a high association between CD and disease
pancreatitis
also associated with thyroid
T or F osteopenia is part of the classic presentation of CD
true
increase cancer risk associated with CD
pancreatic lung colon SI BCC
