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2a Liver and GI > Coeliac Disease > Flashcards

Coeliac Disease Flashcards

1
Q

What is coeliac disease?

A

Autoimmune type 4 hypersensitivity to gluten

IgA-tTG + VA

IgA-tTG = autoantibodies produced in response to gluten, target the tissue transglutaminase

VA = villi atrophy, damage and flattening of small intestinal villi and reducing surface area for nutrient absorption

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2
Q

Coeliac disease is a type _ hypersensitivity reaction to _____

A

4
gluten

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3
Q

In Coeliac disease, what are the autoantibodies produced in response to gluten?

A

IgA-tTG (tissue transglutaminase)

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4
Q

What are the 2 key features of Coeliac’s disease?

A

IgA-tTG autoantibodies in response to gluten
and
Villi atrophy

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5
Q

With villi atrophy in Coeliac’s diseae there is damage and flattening of ___ intestinal villi which reduces ____ ____ for nutrient _____

A

small intestinal
surface area
absorption

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6
Q

What is Coeliac’s often associated with?

A

Thyroid disorders and Addison’s disease

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7
Q

What are HLAs?

A

Human Leukocyte Antigens

Genes in MHCs that help code for proteins that differentiate between self and non-self

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8
Q

Which HLA makes people susceptible to Coeliac’s?

A

HLA DQ2 and DQ8

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9
Q

What are prolamins?

A

A group of plant storage proteins with high proline content

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10
Q

In Coeliac’s, what prolamins is in the gluten that primarily causes the hypersensitivity reaction?

A

alpha Gliadins

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11
Q

In Coeliac disease, alpha Gliadins in the gluten bind to ___ then interacts with ___

A

IgA
tTG

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12
Q

The binding of alpha Gliadin to IgA and interacting with tTG leads to increased ___ and the formation of IgA anti-___ and e______ antibodies

A

IgA
IgA anti-tTG
endomysial antibodies

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13
Q

Gluten is resistant to complete digestion in the small intestine, leading to the formation of…

A

gluten peptides

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14
Q

In the lining of the small intestine, gluten peptides present to what kind of cells?

A

T-cells

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15
Q

In Coeliac disease, when gluten peptides are presented to T-cells, the T-cells become activated and release…

A

inflammatory mediators including cytokines

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16
Q

The inflammatory mediators contribute to m_____ d____ and alterations in the structure of the small intestinal lining

A

mucosal damage

17
Q

Chronic inflammation can lead to damage of the small intestinal ____ that aid nutrient absorption causing decreased surface area and potential malabsorption

A

villi

18
Q

The malabsorption of nutrients due to damaged villi can lead to what symptoms?

A

Diarrhoea
Steatorrhea (excess fat in stool)
Weight loss
Abdominal pain
Fatigue
Nutritional deficiencies
Anemia (haematinic deficiency of either Fe, B12 or folate)
Osteopenia (decreased Ca absorption)

19
Q

What is a symptom of Coeliac disease due to IgA skin deposition

A

Dermatitis herpetiformis (papular rash on knees)

20
Q

What are 3 symptoms of anaemia associated with Coeliac’s?

A

Fatigue
Angular stomatitis (fry corners mouth)
Glossitis

21
Q

How is Coeliac disease diagnosed?

A

Combination of serologic tests:
antibodies such as anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies (EMA)

and Small intestinal/ duodenal biopsy:
Crypt hyperplasia, villous atrophy and epithelial lymphocyte infiltration

22
Q

What is first line screening for Coeliac disease?

A

Serology:
anti-tTG
Increased total IgA

Second line = increased EMA (endomysial antibodies)

23
Q

What is the gold standard diagnostic test for Coeliac disease?

A

Duodenal biopsy:
Crypt hyperplasia, villous atrophy and epithelial lymphocyte infiltration

24
Q

How do you manage Coeliac disease?

A

Gluten free diet, strict and lifelong
Dietician review
Bone density assessment
Coeliac UK information
Prescription for gluten free foods
Immunisations

25
Q

What are the main symptoms of Coeliac’s?

A

Diarrhoea, stomach aches and bloating

26
Q

What are risks of not going on a gluten free diet?

A

Enteropathy associated T-cell lymphoma
Small bowel adenocarcinoma
Vitamin deficiencies
Osteoporosis
Hyposplenism
Malnutrition
Depression
Delayed puberty
Anaemia
Iron and folate deficiencies

27
Q

What is dermatitis herpetiformis?

A

Chronic autoimmune condition that causes itchy bumps and blister on skin
Clusters of small, red.

Due to IgA antibodies (produced in response to gluten consumption) depositing in the skin. Neutrophilic infiltration.

Strongly associated with Coeliac Disease

28
Q

What is tropical sprue?

A

Enteropathy associated with tropical travel that gives similar “sprue” biopsy as coeliac disease:
Crypt hyperplasia and villous atrophy

Often responds to antibiotics like tetracycline

2a Liver and GI (61 decks)

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