coeliac disease

Question 1

what is it

Answer 1

exposure to gluten causes an autoimmune reaction that causes inflammation to small bowel

auto-antibodies created in response to gluten exposute

Question 2

what does the inflammation do to intenstinal cells

Answer 2

atrophy of intestinal villi

malabsorption of nutirens

Question 3

presentation

Answer 3

FTT
diarrhoea
fatigue 
weight loss
mouth ulcers
anaemia: iron, B12, folate def 
dermatitis herpetiformis

Question 4

all new cases of XXX get tested for coeliac

Answer 4

t1DM

Question 5

genetic associations

Answer 5

HLA-DQ2

HL-DQ8

Question 6

autoantibodies

Answer 6

tissue-transglutaminase antibodies
endomysial antibodies

demainated gliadin peptide antibodies

Question 7

types of Ig are anti-TTG and EMAs

Answer 7

IgA

so if pt has IgA deficiency coeliac test will be negative even if have disease

Question 8

Investigations must be carried out whilst patient reamins on…

Answer 8

diet containing gluten

otherwise may not be possible to detect antibodies or bowel inflammatoin

Question 9

Ix - antibodies

Answer 9

check IgA first to exclude IgA deficiency

coeliac specific antibodies:

• raised anti-TTG
• raised anti-endomysial antobodies

Question 10

Ix- endoscopy with biopsy shows

Answer 10

crypt hypertrophy

villous atrophy

Question 11

coeliac associations

Answer 11

T1DM 
thyroid disease
autoimmune hepatitis 
primary biliary cirrhosis
primary sclerosing cholangitis

Question 12

complications of untreated coeliac disease

Answer 12

vitamin deficiency
anaemia
osteoporosis
ulcerative jejunitis

Question 13

treatment

Answer 13

lifelong gluten free diet