Coeliac Disease* Flashcards
What is Coeliac disease
T cell mediated autoimmune inflammation of the small bowel in response to Prolamin(Gluten) (T4 Hypersensitivity)
What does Prolamin sensitivity result in
Villous Atrophy
Malabsorption
What is the epidemiology of Coeliac
Female>Male
Familial
HLA-DQ2 (T1DM)
HLA-DQ8(T1DM)
What are the risk factors for Coeliac
T1DM
Thyroid disease
Addison’s
IgA deficiency
What is the modified protein which causes coeliac
Gliadin become a-Gliadin (resistant to protease)
What is the pathology of Coeliac
a-gliadin binds to IgA and interacts w/ TTG
- Increase IgA
- Increase IgA anti-ttg
- Endomyseal Antibodies
Why does Coeliac cause Steatorrhea
Villous atrophy and crypt hyperplasia causes malabsorption of fats
This causes greasy stinking stools in steatorrhea
Why does Coeliac cause anaemia
Villous atrophy and crypt hyperplasia causes malabsorption of B12/Folate and Iron
This causes Pernicious and Iron deficient Anaemia
What are the GI symptoms of Coeliac
Abdominal pain
N+V
Diarrhoea
Steatorrhea
What are the clinical presentations of Coeliac
Anaemia Weight loss Apthous Ulcers + Angular stomatitis Osteomalacia (Vit D deficient) DERMATITIS HERPETIFORMIS (Knee rash by IgA deposition) Diarrhoea and Steatorrhea
What are the investigations used in Coeliac
Serum Antibody test (First) -anti-ttg -Increase IgA -Endomyseal Antibodies Stool culture (exclude infection) OGD with duodenal biopsy (GOLD) DEXA (Risk of osteoporosis)
What is the first line investigation for Coeliac
Serum antibody test
-Anti-TTG IgA (First)
if IgA deficient measure Anti-TTG IgG
if IgG deficient measure Anti endomyseal antibody
What are the possible antibodies associated with Coeliac
Anti-TTG IgA/IgG Anti endomyseal antibody Anti gliadin (not recommended)
What is the management for Coeliac
Life long Gluten diet with regular monitoring of Osteoporosis with DEXA
What are some complications of coeliac
Anaemia
Hypersplenism
Osteoporosis
EATL (branch of non Hodgkins)
