Coeliac Disease Flashcards
What is coeliac disease?
Immunologically mediated disease in genetically susceptible individuals, driven by an environmental antigen, gluten, found in wheat, rye and barley, which results in chronic inflammation of the small bowel mucosa
What is the prevalence of coeliac disease?
1/100
What genes are associated with coeliac disease?
HLA DQ2 and DG8
What is the treatment for coeliac disease?
gluten free diet
Which part of the GIT is most effected in coeliac disease?
The small intestine
What nutrients are absorbed in the duodenum?
protein, fat, fat soluble vitamins, glucose, iron, water soluble vitamins
Where is vitamin B12 absorbed?
In the ileum
What are the valves of kerkring?
semicircular folds in the duodenum - to increase the surface area
Where is the proliferative zone of the epithelium?
Below the vili, in the crypts
How often to epithelial cells in the small intestine regenerate?
Every 2-3 days
What type of cells make up the villus of the epithelium?
Mature cells
What is the ratio of mature to immature cells in the epithelium?
4:1
Why are there lots of lymphocytes present in the lamina propria of the duodenal epithelium?
It has mild chronic inflammation to keep the microbiota in check
What increases the surface area of the small intestine?
The valves of kerkring, the villi and the microvilli
What is the reduction in surface area with a loss of villi?
60 fold reduction
What is stage 1 of coeliac disease?
Where there are more than 30 intraepithelial lymphocytes per 100 enterocytes
What is stage 2 of coeliac disease?
There is additional elongation of the crypts
What is stage 3 of coeliac disease?
Villi are blunted and the villous to crypt ratio is less than 1:4 - villous atrophy
What type of lymphocytes are the intraepithelial lymphocytes in coeliac disease?
CD8 cells
Where are the CD4 cells located?
In the lamina propria
What happens to the microvilli of the remaining enterocytes in coeliac disease?
Loss, distortion and stunting
What is present at increased levels in the lamina propria in coeliac disease?
Plasma cells
What are some other causes of intraepithelial lymphocytosis and villous atrophy?
tropical sprue, small bowel bacterial overgrowth, common variable immunodeficiency, autoimmune enteropathy, drugs
What is the clinical presentation of coeliac disease?
diarrhoea, bloating, abdominal cramps, flatulence, anemia, vitamin deficiencies, osteoporosis, lethargy, migraines, infertility, mouth ulcers, steatorrhea
