Coeliac Disease Flashcards

1
Q

What is coeliac disease?

A

A condition in which T cell responses to gluten in the small bowel causes villous atrophy and malabsorption

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2
Q

What gene mutation is associated with coeliac disease?

A
  • HLA DQ2

- HLA DQ8

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3
Q

What % of cases of coeliac disease are associated with HLA DQ2?

A

95%

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4
Q

What conditions are associated with coeliac disease?

A
  • Autoimmune disease

- Dermatitis hepatoformis

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5
Q

What age does coeliac disease occur?

A

Can occur at any age, but peaks are in childhood and 50-60 years

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6
Q

What are the risk factors for coeliac disease?

A
  • Family history
  • Immunoglobulin A deficiency
  • Type 1 diabetes
  • Autoimmune thyroid disease
  • Down’s syndrome
  • Sjorgen’s syndrome
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7
Q

By how much does having a first degree relative with coeliac disease increase the risk?

A

6x

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8
Q

What are the signs and symptoms of coeliac disease?

A
  • Steatorrhoea
  • Diarrhoea
  • Abdominal pain
  • Bleeding
  • Nausea and vomiting
  • Apththous ulcers
  • Angular stomatitis
  • Weight loss
  • Fatigue
  • Weight loss
  • Osteomalacia
  • Failure to thrive
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9
Q

What investigations are done in coeliac disease?

A
  • Serological testing
  • Blood tests
  • Duodenal biopsy whilst on gluten containing diet
  • HLA DQ2 and DQ8 genotyping
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10
Q

What is looked for in serological testing in coeliac disease?

A

Test for total IgA and IgA tTG (tissue transglutminase antibody)

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11
Q

What should be done if IgA is weakly positive on coeliac disease testing?

A

Test for IgA endomysial antibodies (EMA)

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12
Q

What is it important to do when serologically testing for coeliac disease?

A

Tell patient to continue to eat gluten until they have had the blood test, as removing or reducing gluten will affect the results

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13
Q

What will be found on blood tests in coeliac disease?

A
  • Decreased Hb
  • Decreased B12
  • Decreased ferratin
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14
Q

What will be found on duodenal biopsy in coeliac disease?

A
  • Subtotal villous atrophy
  • Increased intra-epithelial WBCs
  • Crypt hyperplasia
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15
Q

Is a duodenal biopsy needed to diagnose coeliac disease?

A

Yes

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16
Q

How is coeliac disease managed?

A

Lifelong gluten-free diet

17
Q

How should the response to gluten free diet in coeliac disease be monitored?

A

Symptoms and repeat serology

18
Q

What are the complications of coeliac diseae?

A
  • Anaemia
  • Dermatitis herpetiformis
  • Osteopenia or osteoporosis
  • Hyposplenism
  • Gi T-cell lymphoma
  • Increased risk of malignancy
  • Neuropathies
19
Q

What malignancies are those with coeliac disease at increased risk of?

A
  • Lymphoma
  • Gastric
  • Oesophageal
  • Colorectal