Coeliac disease Flashcards

1
Q

Define coeliac disease

A

Inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption

Leads to subtotal villous atrophy & crypt hyperplasia

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2
Q

Aetiology of coeliac disease

4

A

Due to sensitivity to GLIADIN component of gluten
Exposure to gliadin triggers immunological reaction in small intestine —> mucosal damage & loss of villi
10% risk of 1st degree relative being affected
Clear genetic susceptibility associated w/ HLA-B8, HLA-DR3, HLA-DQW2 haplotypes

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3
Q

Epidemiology of coeliac disease

UK, rare

A

1/2000 in UK

Rare in East Asia

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4
Q

Presenting symptoms of coeliac disease

general +6

A

May be asymptomatic

Abdo discomfort, pain & distention
Steatorrhoea - pale bulky stool, offensive smell & difficult to flush
Diarrhoea
Tiredness, malaise, weight loss (despite normal diet)
Failure to thrive in children
Amenorrhoea in young adults

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5
Q

Signs of coeliac disease on physical examination

1, 4, 2, 1

A

Signs of anaemia
- pallor

Signs of malnutrition

  • short stature
  • abdo distention
  • wasted buttocks in children
  • triceps skin fold thickness give indication of fat stores

Signs of vitamin/mineral deficiencies

  • osteomalacia
  • easy bruising

Intense itchy blisters on elbows, knees or buttock (dermatitis herpetiformis)

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6
Q

Investigations for coeliac disease

5

A
Bloods
Serology
Stool
D-xylose test
Endoscopy
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7
Q

Investigations for coeliac disease - bloods

5

A
FBC - low Hb, iron & folate
U&Es
Albumin
Calcium
Phosphate
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8
Q

Investigations for coeliac disease - serology

2

A

IgG anti-gliadin antibodies, IgA & IgG anti-endomysial transglutaminase can be diagnostic
IgA deficiency quite COMMON (1/50 with coeliac) so Ig levels should be measured to avoid false negatives

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9
Q

Investigations for coeliac disease - stool

A

Culture to exclude infection, faecal fat tests for steatorrhoea

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10
Q

Investigations for coeliac disease - d-xylose test

A

Reduced urinary excretion after oral xylose indicates small bowel malabsorption

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11
Q

Investigations for coeliac disease - endoscopy

3

A

Allows direct visualisation of villous atrophy in small intestine (mucosa appears flat & smooth)
Biopsy shows villous atrophy & crypt hyperplasia in duodenum
Epithelium has cuboidal appearance - inflammatory infiltrate of lymphocytes in lamina propria

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12
Q

Management of coeliac disease

advice + 2 medical

A
ADVICE -
Avoid gluten (wheat, rye, barley products)

MEDICAL -
Vitamin & mineral supplements
Oral corticosteroids if disease does not subside w/ avoidance of gluten

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13
Q

Complications of coeliac disease

6

A
Iron, folate & B12 deficiency
Osteomalacia
Ulcerative jejunoileitis
GI lymphoma (particularly T cell)
Bacterial overgrown 
Cerebellar ataxia (rarely)
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14
Q

Prognosis of coeliac disease

2

A

FULL RECOVERY for most patients who adhere strictly to gluten free diet (for life)

Symptoms usually resolve in weeks but histological changes may take longer

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