Coeliac Flashcards
Define coeliac disease
Inflammation of the mucosa of the upper small bowel in response to GLUTEN
Coeliac is an intolerance to…
gluten
Prolamin
Coeliac disease causes ..
Villus atrophy leading to malabsorption
Crypt hyperplasia
Intraepithelial lymphocytes
Risk factors for coeliac
Autoimmune diseases
IgA deficiency
Genetic HLA DQ2 + DQ8
What does gliadin (undigested gluten protein) do in coeliac disease
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
What happens after gliadin is ingested by macrophages?
Th cell recognise gliadin > release Interferon gamma + TNF > initiate inflammation damaging and destroying epithelial cells in villi of SI
What do T helper cells do in Coeliac disease
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
clinical presentation of coeloac disease
and smelly poo
anaemia
weight loss
fatigue and weakness
diarrhoea
abdo pain
DERMATITIS HEPIFORMIS
why does stearrhoea occur
inability to properly absorb fat from diet
why would anaemia occur in coelioac disease
due to inability to absorb b12 , folate and iron
what clues in relation to skin would indicate coeliac disease
aphthous ulcers
angular stomatis
osteomalacia
dermatitis herpetiformis
complications of coeliac disease
anaemia
t cell lymphoma
gastric, oesophageal , small bowel cancer
what investigations would you do in coeliac disease
1st line- serum antibody test
gs- duodenal biopsy
what would serum antibody test show for coeliac
IgA tissue transglutaminase
what would you expect to find in duodenal biopsy for coeliac
villous atrophy
intestinal crypt hyperplasia
increased epithelial WBC’S
WHAT would a full blood count show for coelaic disease
Low Hb
Low folate
Low ferritin
Low B12
~50% have mild anaemia
what are you looking to find in genetic testing in coeliac disease
HLA-DQ2 & HLA-DQ8 genotyping
management of coeliac disease
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
why is the pneumococcal vaccine given to coeliac disease sufferers
protection from hyposplenism
triad of symptoms of coeliac disease
diarrhoea
weight loss
anaemia
what part of the small bowel is usually affeced
jejunum
what two auto antibodies are created in response to coelaic
Anti - tissue transglutaminase
anti - endomysial
anti TTG and anti EMA are what type of antibodies
Iga
In coelial histology what is shown
Villous atrophy
Crypt hyperplasia
hla type for coeliac
DQ2
DQ8
What type of hypersensitivity reaction is coeliac
Type 4
