Clin Med - Celiac Dz and Diarrhea Flashcards
NCGS
- non-celiac gluten sensitivity
- diagnosis of exclusion
- gluten reaction in which there is no allergic or autoimmune component
What is celiac dz?
- intolerance to gluten
- autoimmune condition triggered and sustained by the ingestion of gluten in genetically predisposed individuals
gluten
general name for storage protein found in wheat, rye, barley
What does celiac dz lead to?
- inflammatory damage of the mucosa of the small intestine
- results in mucosal villous atrophy and malabsorption of nutrients
Who does celiac dz affect?
- mainly people of northern european descent
- F>M
- onset is generally in childhood
- 10-20% first degree relatives
Who is at risk of celiac dz?
- lymphocytic colitis
- Down Syndrome
- DM type 1
- Hashimoto thyroiditis
general S/S of celiac dz
- variable
- some are asymptomatic or have only signs of nutritional deficieny
- other have significant GI sx
What are the s/s in children after cereal is introduced to the diet?
- failure to thrive
- abdominal distension
- muscle wasting
- stools: soft, bulky, clay colored and foul smelling
- older children may present w/ anemia or failure to grow
S/s of celiacs in adults
- mild-intermittent diarrhea
- steatorrhea
- weight loss
- bloating/abd pain
- flatulence
- anemia
- vit. D and Ca deficiencies
- reduced fertility
- amenorrhea in women
What is a dermatological manifestation of celiacs?
- dermatitis herpetiformis
- intensely pruritis papulovesicular rash that is symmetrically distributed over the extensor areas of elbows, knees, butt, shoulders and scalp
What should be on your ddx when working up a celiac pt?
- IBS
- NCGS
- inflammatory bowel dz
- lactose intolerance
- other carb intolerance
- eosinophilic gastroenteritis
- SIBO
- intestinal lymphoma
How do you diagnose celiac dz?
- suspected clinically and by evidence of malabsorption
- fam hx is valuable
- should be strongly considered in a pt w/ iron deficiency w/o obvious GI bleeding
confirmation of celiac dz diagnosis
- seriologic markers:
- IgA anti-tissue transglutaminase antibody (tTG)
- IgA anti-endomysial antibody (EMA)
- if either test is + the pt needs small bowel biopsy
- if both are - celiac dz is unlikely
endoscopic markers suggestive of celiac dz (4)
- loss or reduction in duodenal Kerkring’s folds
- mosaic mucosal pattern
- scalloped configuration of duodenal folds
- micronodular pattern of the mucosa
What additional lab work can be done in the diagnosis of celiacs?
- CBC w/ diff
- iron panel, serum ferritin, folate
- CMP: albumin, Ca, K, alk phos
- malabsorption tests
possible complications of celiacs dz
- refractory dz
- intestinal lymphomas (6-8%)
- incidence of other GI cancers increases
- adherence to GF diet can significantly reduce the risk of cancer
Tx of celiac dz
- GF diet (response is rapid, 1-2 weeks)
- dietician consult
- support group
- repeat biopsy after 3/-4 mos of GF diet
- serial serological markers
What if the celiac pt responds poorly to GF diet?
- diagnosis is wrong
- or dz has become refractory
tx for refractory celiac dz
corticosteroids can control sx
define diarrhea
- increased stool frequency, liquidity, volume
- objectively defined as passing a stool weight or vol. greater than 200 g or ml per 24 hrs
What is important to consider w/ diarrhea?
- it is a symptom or a sign, not a dz
- can be caused by numerous conditions
- eval and tx can be hard
first steps in the approach to diarrhea
- do they really have it?
- r/o med causes
- distinguish acute vs chronic
- categorize it (inflammatory, fatty, watery)
- consider factitious diarrhea
What is the MC cause of diarrhea?
viral gastroeneteritis (self-limited)
time cut off for acute vs chronic diarrhea
- acute: <4 weeks
- chronic: > 4 weeks
