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Gastroenterology > Coeliac > Flashcards

Coeliac Flashcards

1
Q

What is Coeliac disease?

A

Immune-mediated inflammatory condition provoked by gluten (alpha-gliadin peptide)

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2
Q

How does Coeliac disease present?

A 
Range of symptoms:
Diarrhoea
Weight Loss
Lethargy
Steatorrhoea
Bloating
Persistent GI symptoms - nausea/vomiting
Faltering growth
Prolonged fatigue
Unexplained weight loss
Severe mouth ulcers (apthous ulcers)
Angular stomatitis
Iron def.
B12 def.
Folate def.
Osteomalacia

FH of Coeliac

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3
Q

Which 3 foodstuffs can you find gluten?

A

Gluten - wheat, rye, barley

also triticale - cross b/w wheat and rye

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4
Q

What is the pathophysiology behind Coeliac disease?

A

Alpha-gliadin is the toxic portion of gluten –> resistant to proteases in GIT –> passes epithelial barrier of the Small Intestine –>

Demination by tissue transglutaminase (increases immunogenicity)

–> interacts with APCs in the lamina propria via HLA DQ2 and DQ8

–> activates gluten-sensitive T cells

–> inflammatory cascade and release of mediators

–> cell damage (villous atrophy and crypt hyperplasia)

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5
Q

What are the 2 genetic associations for Coeliac disease?

A

HLA DQ2

HLA DQ8

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6
Q

What is the prevalence of Coeliac disease in the UK?

A

1/100 in the UK

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7
Q

What would serology show with Coeliac disease?

A

IgA (anti-TTG) tissue transglutaminase antibodies

IgA (Endomysial antibodies)

Alternative: IgG

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8
Q

Aside from antibody screening, what other test can be carried out for Coeliac disease? (DIAGNOSTIC)

A

Distal duodenal biopsy (shows histological changes)

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9
Q

What is the treatment for Coeliac disease?

A

Gluten-free diet

Nutritional supplementation as required.

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10
Q

What is a possible complication of Coeliac disease?

A

Increased incidence of malignancy

Anaemia

Osteoporosis

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11
Q

What are signs of deficiency with Coeliac disease?

A

Anaemia (iron, folate, B12)

Bleeding disorder (vitamin K)

Oedema (decreased protein)

Metabolic bone disease (decreased Vit D)

Neurological features (neuropathy)

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12
Q

What blood tests would you order for someone with Coeliac disease?

A

FBC (raised/low MCV)

Low calcium, iron, B12/folate

Raised INR

Raised lipid profile

IgA, TTG

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13
Q

In which 2 groups of patients does Coeliac disease peak in?

A

Infancy

50-60 year olds

M=F

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14
Q

List some differentials for Coeliac disease

A

IBS

Lactose + other food intolerance

Colitis (inc IBD)

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15
Q

What characteristic rash can be seen with Gluten?

A

Dermatitis herpetiformis

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16
Q

Basically, what are the tests that can be done for Coeliac disease?

A

Tissue IgA Anti-TTG, EMA

Distal duodenal biopsies *gold

FBC blood test (mild anaemia, folate deficiency, iron deficiency)

DEXA scan

Gastroenterology (3 decks)

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