Coeliac

Question 1

Define coeliac disease

Answer 1

Inflammation of the mucosa of the upper small bowel in response to GLUTEN

Question 2

Coeliac is an intolerance to…

Answer 2

gluten

Prolamin

Question 3

Coeliac disease causes ..

Answer 3

Villus atrophy leading to malabsorption
Crypt hyperplasia
Intraepithelial lymphocytes

Question 4

Risk factors for coeliac

Answer 4

Autoimmune diseases
IgA deficiency
Genetic HLA DQ2 + DQ8

Question 5

What does gliadin (undigested gluten protein) do in coeliac disease

Answer 5

Get to SI > cross intestinal mucosa lined with intestinal epithelial cells from apical to basolateral membrane to lamina propria

Then enzyme tissue transglutaminase (tTG) cuts of amide group from protein and ingested by macrophages

Question 6

What happens after gliadin is ingested by macrophages?

Answer 6

Th cell recognise gliadin > release Interferon gamma + TNF > initiate inflammation damaging and destroying epithelial cells in villi of SI

Question 7

What do T helper cells do in Coeliac disease

Answer 7

stimulate B cells to start producing antibodies, including:
- IgA: anti-tissue transglutaminase (anti-TTG), anti-endomysial (anti-EMA)
- IgG: deaminated gliadin peptides antibodies (anti-DGPs)
- Recruite CD8+ T cells - destoy cells undergoing inflammation

Question 8

clinical presentation of coeloac disease

Answer 8

and smelly poo
anaemia
weight loss
fatigue and weakness
diarrhoea
abdo pain
DERMATITIS HEPIFORMIS

Question 9

why does stearrhoea occur

Answer 9

inability to properly absorb fat from diet

Question 10

why would anaemia occur in coelioac disease

Answer 10

due to inability to absorb b12 , folate and iron

Question 11

what clues in relation to skin would indicate coeliac disease

Answer 11

aphthous ulcers
angular stomatis
osteomalacia
dermatitis herpetiformis

Question 12

complications of coeliac disease

Answer 12

anaemia
t cell lymphoma
gastric, oesophageal , small bowel cancer

Question 13

what investigations would you do in coeliac disease

Answer 13

1st line- serum antibody test
gs- duodenal biopsy

Question 14

what would serum antibody test show for coeliac

Answer 14

IgA tissue transglutaminase

Question 15

what would you expect to find in duodenal biopsy for coeliac

Answer 15

villous atrophy
intestinal crypt hyperplasia
increased epithelial WBC’S

Question 16

WHAT would a full blood count show for coelaic disease

Answer 16

Low Hb
Low folate
Low ferritin
Low B12
~50% have mild anaemia

Question 17

what are you looking to find in genetic testing in coeliac disease

Answer 17

HLA-DQ2 & HLA-DQ8 genotyping

Question 18

management of coeliac disease

Answer 18

Lifelong gluten-free diet
Avoid foods containing wheat, barley, rye, oats
Gluten-free food are now more available
Poor compliance is the main reason for recurrence
Symptoms & serology used to monitor response & compliance

Question 19

why is the pneumococcal vaccine given to coeliac disease sufferers

Answer 19

protection from hyposplenism

Question 20

triad of symptoms of coeliac disease

Answer 20

diarrhoea
weight loss
anaemia

Question 21

what part of the small bowel is usually affeced

Answer 21

jejunum

Question 22

what two auto antibodies are created in response to coelaic

Answer 22

Anti - tissue transglutaminase
anti - endomysial

Question 23

anti TTG and anti EMA are what type of antibodies

Answer 23

Iga

Question 24

In coelial histology what is shown

Answer 24

Villous atrophy
Crypt hyperplasia

Question 25

hla type for coeliac

Answer 25

DQ2
DQ8

Question 26

What type of hypersensitivity reaction is coeliac

Answer 26

Type 4