Coeliac Disease

Question 1

This is caused by an abnormal reaction to a constituent of ___- ____ ____ , which damages enterocytes and reduces absorptive capacity - it is an ______ disease

Answer 1

This is caused by an abnormal reaction to a constituent of wheat flour, gluten, which damages enterocytes and redues absorptive capacity - it is an autoimmune disease

Question 2

incidence 1: ____

Answer 2

100

Question 3

there are strong ____ associations with ____ -___

Answer 3

Strong genetic associations (as it is autoimmune) with HLA-B8

Question 4

what other associations are there with this disease?

Answer 4

• dermatitis herpetiformis

- childhood diabetes

Question 5

_____ is a component of gluten and is the suspected toxic agent. Tissue injury may be a bystander effect of abnormal ____ reaction to _____.

Answer 5

Gliadin is a component of gluten and is the suspected toxic agent. Tissue injury may be a bystander effect of abnormal immune reaction to gliadin.

Question 6

1. _____ peptides pass through the epithelium where they interact with ___ ___ cells via HLA class __.
2. The __ cells produce pro inflam cytokines and other inflammatory mediators
3. This inflammatory cascade releases _______ and other mediators that contribute to vilous atrophy

Answer 6

1. Gliadin peptides pass through the epithelium where they interact with CD4+ T cells via HLA class II.
2. The T cells produce pro inflam cytokines and other inflammatory mediators
3. This inflammatory cascade releases metalloproteinases and other mediators that contribute to villous atrophy

Question 7

what is the normal lifespan of an enterocytes ?

Answer 7

72 hours - they are constantly being replaced

Question 8

in coeliac disease the enterocytes are damaged so you get a loss of villous _____, loss of ___ ___ and a reduction in _____ and a ___ duodenal surface

Answer 8

a loss of villous structure, loss of surface area and a reduction in absorption and a flat duodenal surface

Question 9

what does coeliac look like histologically ?

Answer 9

There is increase inflammation in lamina propria

Increased intraepithelial lymphocytes

Question 10

Lesion worse in ____ bowel so ____ biopsy is very sensitive - this is because as you go further down the small intestine the gluten is converted into __ __ products

Answer 10

Lesion worse in proximal bowel so duodenal biopsy is very sensitive - this is because as you go furhter down the small intestine the gluten is converted into non-toxic products

Question 11

how is it diagnosed?

Answer 11

• endoscope
• biopsy
• serology

Question 12

what does it look like on endoscope?

Answer 12

Mucosa may be endoscopically normal or appear attenuated

Question 13

which antibodies are detected on serology ? 3

Answer 13

anti-TTg, anti-endomesial, anti-gliadin

Question 14

what are the metabolic effects of dmaged mucosa?

Answer 14

Malabsorption of sugars, fats, amino acids, water and electrolytes

Question 15

malabsorption leads to ______

Answer 15

steatorrhea

Question 16

what other things can happen to you because of malabsorption? 5

Answer 16

Also loss of weight 
Anaemia 
Abdominal bloating 
Failure to thrive 
Vitamin deficiencies

Question 17

what are the common deficiencies? 3

Answer 17

iron, vit B12, folate

Question 18

Reduced intestinal hormone production leads to reduced _______ secretion and ___ flow (CCK) leading to gall stones

Answer 18

Reduced intestinal hormone production leads to reduced pancreatic secretion and bile flow (CCK) leading to gall stones

Question 19

what are the other complications of coeliac disease? 4

Answer 19

• T-cell lymphomas of GI tract
• Increased risk of small bowel carcinoma
• Gall stones
• Ulcerative-jejenoilleitis

Question 20

Classic story of a complication- Someone who has gone on being a normal weight and then suddely starts losing it again

Answer 20

Classic story of a complication

Someone who has gone on being a normal weight and then suddely starts losing it again