Coeliac Disease Flashcards

1
Q

what is coeliac disease

A

autoimmune condition which results in a sensitivity to gluten, causing inflammation as well as villi atrophy

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2
Q

what can coeliac disease lead to

A

chronic intestinal malabsorption

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3
Q

aetiology

A

the body is sensitive to gliadin which is a component of gluten; ingestion leads to an immunological reaction in the small bowel which leads to villi atrophy as well as mucosal damage

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4
Q

risk factors

A

family Hx as there is genetic susceptibility (10% first degree)
type 1 diabetes and autoimmune thyroid (autoimmune diseases make you more susceptible to more autoimmune conditions)
IgA deficiency

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5
Q

epidemiology of coeliac disease

A

UK; 1/2000
Western Ireland; 1/300
East Asia; rare

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6
Q

Presenting symptoms of coeliac disease

A

bloating, abdominal discomfort, pain and abdominal distension, steatorrhoea, diarrhoea, tiredness, malaise and unintentional weight loss, failure to thrive in children, amennhorea in young adults, osteopenia and osteoporosis

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7
Q

can coeliac disease be asymptomatic

A

yes

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8
Q

what is steatorrhoea

A

too much fat in faeces, white bulky stool, offensive smell and more difficult to flush

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9
Q

Physical Examination findings

A

signs of anaemia (pallor),
signs of malnutrition (short stature, abdominal distension, wasted buttocks in children)
signs of vitamin and mineral deficiency (osteomalacia and easy bruising)
dermatitis herpetiformis

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10
Q

what vitamin deficiency leads to osteomalacia

A

D

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11
Q

what vitamin deficiency leads to easy bruising

A

C and K

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12
Q

what investigations will be done to diagnose Coeliac disease

A

bloods, serology, stool tests, endoscopy and biopsy

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13
Q

what would you look for in bloods

A

FBC, U&E’s, albumin, calcium (osteoporosis is a complication and leads to low calcium), phosphate (high phosphate)

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14
Q

serology investigation

A

IgG anti-gliadin antibodies (IgAandG anti-endomysial antibodies can be diagnostic factors for coeliac and dermatitis herpetiformis)

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15
Q

why don’t you rely solely on IgA levels

A

IgA deficiency is quite common (1/50) and won’t always mean the patient is coeliac

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16
Q

stool test

A

culture to check for bacterial infection and also do faecal fat tests for steatorrhea

17
Q

D-xylose test

A

if there is reduced urinary output when a patient takes oral xylose, it indicates small bowel malabsorption

18
Q

Endoscopy and Biopsy

A

will show villous atrophy and crypt hyperplasia. epithelium will appear cuboidal due to inflammation

19
Q

management

A

advice; avoid gluten - wheat, barley and rye

medical; vitamin and mineral supplements. oral corticosteroids if disease doesn’t subside with gluten-free diet

20
Q

possible complications

A
iron, folate, B12 deficiency 
osteomalacia, 
ulcerative jejunoilelitis
GI lymphoma,
bacterial overgrowth 
and in RARE cases, cerebellar ataxia
21
Q

prognosis

A

full recovery if gluten-free diet is stuck to for life. takes weeks for symptoms to improve after dietary change