Coeliac and IBS Flashcards
What is coeliac disease
T-cell mediated autoimmune inflammatory condition
What happens when gluten is eaten
Gluten activates an abnormal response
Leads to production of IPA antibodies and t-cell mediated inflammatory response that targets bowel
Leads to chronic inflammation if eaten long term
Vilous atrophy forms (damage to the lining of the small intestine)
This decreased surface area leads to malabsorption
Which bowel mostly affected in coeliac
Small
Histology finding in coeliac
Increase in intraepithelial lymphocytes
Vilous atrophy
Crypt hyperplasia
Chronic inflammatory cells (lymphocytes) in lamina propria
Peak age of coeliac
50-60
What isotopes is coeliac disease associated with
HLA DQ2
HLA DQ8
Link between family history and coeliac disease
Those with a first degree relative are more likely to get it
Autoimmune causes of coeliac
Increased risk if concurrent autoimmune illness e.g. thyroid disorders and T1DM
Also with Down and Turner syndromes
What rash can coeliac disease be associated with
Dermatitis herpetiformis
-Uncommon blistering sub epidermal eruption of skin,
-Often itchy
Clinical features of coeliac disease
1/3 asymptomatic
Mouth ulcers
Steatorrhoea
Failure to thrive if child
Diarrhoea
Abdo pain
Bloating
Unexpected weight loss
Malaise and weakness
Complications of untreated disease
Malabsorption
Anaemia
Increased of GI malignancy and T-cell lymphoma
Osteoporosis
Hyposplenism (so pt more prone to infections)
Investigations in suspected coeliac
Blood test
Serological blood sample
Definitive diagnosis- endoscopy and biopsy of small bowel
Which blood tests to do for coeliac
FBC - can find iron deficiency or macrocytic anaemia due to folate deficiency
LFT
U&E
Bone profile
Vitamin D
vitamin b12
Haematinics and albumin to check for nutritional deficiencies
What serological blood samples would you take
1st line- total immunoglobulin A (igA) and IgA tissue transglutaminase (tTG)
2nd line- IgA endomysial antibody (EMA) can be used If IgA tTGA is unavailable or in cases where it is weakly positive
MANAGMENT of coeliac
Lifelong gluten free diet
-Consultation with dietician is important
Which foods always contain gluten
Wheat flour
Barley
Durum
Couscous
Soy sauce
Beer
Cause of IBS
Unknown
Risk factors of IBS
Stress and other psychological factors
Dietary triggers (alcohol, caffein, spicy foods)
Enteric infection
Epidemiology of IBS
More common in women
Mostly affects people aged 20-30
Symptoms of IBS
Abdo pain
Bloating
Change in bowel habit
When to make a diagnosis of IBS
abdo pain which is either:
-Related to defecation and /or
-Associated with altered stool frequency and/or
-Associated with altered stool form or appearance
and at least two from the following:
-Altered passage of stool (straining, urgency, incomplete evacuation)
-Abdo bloating, distension, hardness
-Symptoms aggravated by eating
-Passage of rectal mucus
Conservative management of IBS
Advice on healthy eating and adjusting fibre intake based on symptoms
Avoid dietary triggers like alcohol, spicy and fatty foods
Weight loss
Regular exercise
Stress management
Regular meals and lots of fluid
Low FODMAP diet
medical management of IBS
Loperamide for diarrhoea
Antispasmodics for abdo pain/cramping
peppermint oil
Laxatives for constipation
