Coeliac Disease Flashcards

1
Q

what does iron and folate deficiency/anaemia indicate?

A

gastrointestinal malabsorption

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2
Q

how does hyposplenism present on blood film?

A
  • howell-jolly bodies
  • target cells
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3
Q

what is coeliac disease?

A

T cell-mediated inflammatory autoimmune disease affecting the small bowel in which sensitivity to prolamin results in villous atrophy and malabsorption

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4
Q

what are the epidemiological risk factors for coeliac disease?

A
  • female
  • infancy and aged 50-60
  • irish
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5
Q

what conditions is coeliac associated with?

A
  • positive family history
  • HLA-DQ2 and HLA-DQ8 allele
  • autoimmune thyroid disease
  • dermatitis herpetiformis
  • IBS
  • type 1 DM
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6
Q

what are the GI symptoms associated with coeliac disease?

A
  • abdominal pain
  • distension
  • nausea and vomiting
  • diarrhoea
  • steatorrhoea
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7
Q

what is steatorrhea?

A

an increase in fat excretion in the stools resulting in looser, smellier and paler stool

sign of malabsorption

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7
Q

what are the systemic features of coeliac disease?

A
  • fatigue
  • weight loss or failure to thrive in children
  • pallor
  • short stature and wasted buttocks - due to malnutrition
  • **dermatitis herpetiformis **
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8
Q

what is dermatitis herpetiformis?

A

pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs and trunk

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9
Q

what are the complications of coeliac disease?

A
  • anaemia - iron, B12 or folate deficiency
  • hyposplenism
  • osteoporosis, osteomalacia
  • lactose intolerance
  • enteropathy associated T-cell lymphoma
  • subfertility
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10
Q

what is the gold standard diagnostic test?

A
  • OGD and duodenal/jejunal biopsy
  • carried out BEFORE gluten withdrawal from diet and repeated AFTER gluten withdrawal
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11
Q

what does histology reveal?

A
  • sub-total villous atrophy
  • crypt hyperplasia
  • intra-epithelial lymphocytes
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12
Q

what test is used to exlude infection?

A

stool culture

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13
Q

what types of anaemia may present in full blood count?

A
  • microcytic = iron deficiency
  • normocytic = chronic inflammation
  • macrocyctic = folate deficiency
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14
Q

what are seen in the blood results?

A
  • FBC = anaemia
  • U&E and bone profile - vitamin D absorption may be impaired
  • LFT - albumin may be low secondary to malabsorption
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15
Q

what serological blood tests are undertaken?

A
  • 1st line = anti-TTG IgA antibody
  • IgA should be measured in conjunction
  • anti-TTG IgG - if patient is IgA deficient
  • anti-endomyseal antibody - if IgA TTG is weakly positive
16
Q

what is the management for coeliac disease?

A

life-long gluten free diet

17
Q

what should be measured if patient has normal anti-TTG antibodies but is symptomatic of coeliac?

A

IgA

IgA deficiency can lead to a false negative anti-TTG

18
Q

what is tissue transglutaminase?

A

the enzyme responsible for the breakdown of gluten

19
Q

what can be prescribed to alleviate itch in dermatitis herpetiformis?

A

dapsone

20
Q

what are the complications of dapsone?

A
  • life-threatening dapsone hypersensitivity syndrome
  • haemolysis