Coeliac Disease Flashcards
what does iron and folate deficiency/anaemia indicate?
gastrointestinal malabsorption
how does hyposplenism present on blood film?
- howell-jolly bodies
- target cells
what is coeliac disease?
T cell-mediated inflammatory autoimmune disease affecting the small bowel in which sensitivity to prolamin results in villous atrophy and malabsorption
what are the epidemiological risk factors for coeliac disease?
- female
- infancy and aged 50-60
- irish
what conditions is coeliac associated with?
- positive family history
- HLA-DQ2 and HLA-DQ8 allele
- autoimmune thyroid disease
- dermatitis herpetiformis
- IBS
- type 1 DM
what are the GI symptoms associated with coeliac disease?
- abdominal pain
- distension
- nausea and vomiting
- diarrhoea
- steatorrhoea
what is steatorrhea?
an increase in fat excretion in the stools resulting in looser, smellier and paler stool
sign of malabsorption
what are the systemic features of coeliac disease?
- fatigue
- weight loss or failure to thrive in children
- pallor
- short stature and wasted buttocks - due to malnutrition
- **dermatitis herpetiformis **
what is dermatitis herpetiformis?
pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs and trunk
what are the complications of coeliac disease?
- anaemia - iron, B12 or folate deficiency
- hyposplenism
- osteoporosis, osteomalacia
- lactose intolerance
- enteropathy associated T-cell lymphoma
- subfertility
what is the gold standard diagnostic test?
- OGD and duodenal/jejunal biopsy
- carried out BEFORE gluten withdrawal from diet and repeated AFTER gluten withdrawal
what does histology reveal?
- sub-total villous atrophy
- crypt hyperplasia
- intra-epithelial lymphocytes
what test is used to exlude infection?
stool culture
what types of anaemia may present in full blood count?
- microcytic = iron deficiency
- normocytic = chronic inflammation
- macrocyctic = folate deficiency
what are seen in the blood results?
- FBC = anaemia
- U&E and bone profile - vitamin D absorption may be impaired
- LFT - albumin may be low secondary to malabsorption
what serological blood tests are undertaken?
- 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
what is the management for coeliac disease?
life-long gluten free diet
what should be measured if patient has normal anti-TTG antibodies but is symptomatic of coeliac?
IgA
IgA deficiency can lead to a false negative anti-TTG
what is tissue transglutaminase?
the enzyme responsible for the breakdown of gluten
what can be prescribed to alleviate itch in dermatitis herpetiformis?
dapsone
what are the complications of dapsone?
- life-threatening dapsone hypersensitivity syndrome
- haemolysis
