coeliac and pernicious anaemia

Question 1

what is coeliac disease?

Answer 1

sensitivity to alpha-gliaden component of gluten

Question 2

where is gluten found?

Answer 2

wheat
barley
spelt
rye

Question 3

what is the aetiology of coeliac?

Answer 3

t lymphocytes damage mucosal tissue
villous atrophy
-reduced surface area
-jejunum

Question 4

what are the effects of jejunal atrophy?

Answer 4

growth failure

oral ulceration

Question 5

what are the symptoms of coeliac?

Answer 5

weight loss
lassitude
weakness
abdominal pain/swelling
diarrhoea
oral aphthae
tongue papillary loss
steatorrhoea
dysphagia

Question 6

what are the typical malabsorption issues caused by coeliac?

Answer 6

iron
folate
vit B12
fat

Question 7

what are the investigations for coeliac?

Answer 7

autoantibody test
-TTG
-anti-gliadin/anti-endomyseal antibodies
jejunal biopsy
-capsule
-endoscopic biopsy
faecal fat
-increased if malabsorption
haematinics
-B12, folate, ferritin

Question 8

what is the outcome of a gluten free diet?

Answer 8

reversal of jejunal atrophy
improved well-being
reduced risk of lymphoma

Question 9

what is coeliac skin disease?

Answer 9

dermatitis herpetoformis
oral diease
-ulceration & blisters
granular IgA deposit in skin and mucosa
-itch and blisters
-common on shoulders

Question 10

what should be done with a px presents with oral aohthous ulcer?

Answer 10

screened by haematinic assays to detect deficiency
folate/combines ferritin & folate deficiency suggests malabsorption
TTG test also usually done
-high sensitivity
-low specificity

Question 11

what is pernicious anaemia?

Answer 11

disease caused by vitB12 deficiency
complex absorption process
needs intrinsic factos from gastric paretal cells
needs functioning of discrete area of terminal ilium-only absorption site for B12`

Question 12

what causes pernicious anaemia?

Answer 12

lack of vitB12 in diet
disease of gastric parietal cells
-auto-immune
inflammatory bowel disease of ternimal ilium
-crohn's 
bowel cancer at ileo-coecal junction
-resection removes absorptive tissue

Question 13

how is vitB12 deficiency tx by px?

Answer 13

diet with adequate quantity vit B12

supplements

Question 14

how is vit B12 treated medically?

Answer 14

arrange IM ingestions if GI absorption not possible
-gastric parietal cell antibodies
gastric disease or atrophy
terminal ileal crohns disease
ileo-caecal malignancy