Coeliac

Question 1

What is coeliac disease associated with

Genotyopically

Answer 1

HLA -DQ8

HLA-DQ2

Question 2

Pathophysiology of coeliac

Answer 2

Autoimmune disorder of the small intestine
Immune reaction triggered by prolamines-proteins found in wheat, rye and barely include gluten
These proteins are broken down by tissue transglutaminases TTG on the brush border
Antibodies to TTG trigger a T cell mediated immune response - T cell mediated hypersensitivity reaction the component of gluten
This results in damage to the structure of the small bowel mucosa leading to malabsorption
Loss of villi - Vilnius atrophy
Immune activation causes infiltration of lymphocytes into the mucosa = intrathelial lymphocytsis

Question 3

Symptoms

Answer 3

Huge spectrum
Severe - staetorrhoae, diarrhoea, weight loss, abdo pain, failure to thrive in children
Mild - IBS symptoms bloating mild abdo discomfort
Can be asymptotic routine blood tests

Question 4

Examination

Answer 4

Often normal 
Signs of iron /B12 def 
Oral aphthous ulcers 
Rare: clubbing oedema ascites 
Protein malabsorption 
Dermatitis heroeiformis

Question 5

Investigation

Answer 5

FBC
Low iron/ ferritin 
Low b12/folate 
Ant TTG AB 
Biopsy whilst consuming gluten in diet

Question 6

Treatment

Answer 6

Gluten free diet

Question 7

Complications of uncontrolled coeliac

Answer 7

Osteoporosis
Inc incidence of malignancies
Small bowel lymphoma
Inc in oesophageal and colorectal cancers
Dermatitis herpetiformis cluster of blisters
Manage with dapsone