cheliac

Question 1

gluten composition

Answer 1

gliadine + glutenine

Question 2

celiac pathophisiology

Answer 2

Undigested molecules of gliadin which are resistant to degradation remain in the intestinal lumen after gluten ingestion
submucosal infiltration 
deamination by tissue Transglutaminase (tTG)
Uptake and presentation by HLA-DQ 2/8
CD4 activation 
cytokine release
B cell activation 
antigens release

Question 3

silent celiac disease

Answer 3

some intestinal damage

HLA-DQ 2/8 serology possitve

Question 4

latent celiac disease

Answer 4

intestine apears normal

HLA-DQ 2/8 serology possitve

Question 5

classic celiac symptoms?

Answer 5

villous atrophy

symptoms of malabsorption (steatorrhea, weight loss, nutrient or vitamin deficiency) => tendensy to bone fractures

resolution of the mucosal lesions and symptoms upon withdrawal of gluten

Question 6

Atypical celiac disease symptoms?

Answer 6

only minor gastrointestinal complaints

can also display:
 anemia
 dental enamel defects
 osteoporosis
 arthritis
 increased transaminases
 neurological symptoms
 infertility

Question 7

celiac related auto immune diseases

Answer 7

longer exposure to gluten before diagnosis of CD increase risk of autoimmune disorders

60% of CD-associated susceptibility loci involved in other autoimmune diseases (D1T, sarcoidosis, etc.)

Question 8

where to look for celiac?

Answer 8

GI supportive manifistations- 
diarreah
constipation
bloating 
malabsorption

extra GI manifistation-
iron deficiency anemia
folate or vitamin B12 deficiency
persistent elevation in serum aminotransferases, dermatitis herpetiformis
reduced fertility
etc.

Question 9

celiac diagnosis?

Answer 9

histology + serology
dermatitis herpatiformis Bx + tTG
HLA DQ 2/8 negative is contraindicative

Question 10

celiac serology?

Answer 10

IgA tTG antibody is the preferred test

2y => sensitivity of serologic tests is lower:
DGP (Deamidated gliadin peptide) antibody (IgA and IgG), along with the IgA tTG

selective IgA deficiency:
IgG DGP antibodies is the recommended test

Question 11

endoscopic celiac

Answer 11

scalloping

Question 12

Marsh classification

Answer 12

villus (hight)
crypt (depth)
ratia of the two (<1:1 is severe)
intraepithelial lymphocytes (IEL) to every 100 epithel cells

Question 13

celiac DD?

Answer 13

infection
immune related
malignancy
IBD
IBS

Question 14

Non-Responsive Celiac Disease

Answer 14

GFD abandonment

20% misdiagnosis of wheat alergy (IgE mediated)

Question 15

Refractory celiac disease

Answer 15

villous atrophy with, usually, increase of intraepithelial lymphocytes (IELs) in the small bowel in spite of a strict GFD

Question 16

Refractory celiac disease epidemiology

Answer 16

5% of celiacs
2:1 F:M
50’s

Question 17

Refractory celiac disease type 1 treatment

Answer 17

nutrition
low steroids
Imuran- 90% responsive

Question 18

Refractory celiac disease type 2 treatment

Answer 18

no treatment
nutrition, low steroids, lymphoma protocols

Enteropathy associated T cell lymphoma (EATL)

Question 19

complications of celiac

Answer 19

Non-Responsive Celiac Disease
Refractory celiac disease
Ulcerative Jejunoileitis (tend to deteriorate to lymphoma)
Collagenous Sprue (sub-epithelial collagen over 10um)