Coeliac Disease

Question 1

intolerance to what causes coeliac disease

Answer 1

gliadin

• gluten triggers production of IgA antibodies and a T-cell mediated autoimmune process targets the skin and gut

Question 2

age of onset

Answer 2

any, peaks in infancy and 50-60

Question 3

histology

Answer 3

flattened villi (atrophy) and a reduced capacity for absorption

Question 4

what skin rash is it associated with

Answer 4

dermatitis herpetiformis

• itchy
• vescicular
• symmetrical and found on extensor surfaces
• appear in groups/clusters

Question 5

which type of hypersensitivity reaction is it

Answer 5

IV

Question 6

which part of the small intestine is most affected

Answer 6

duodenum (first?)

Question 7

associated with which genes

Answer 7

HLA DQ2 and DQ8

Question 8

family relative risk?

Answer 8

1st relative - 10-15%

Question 9

female to male risk?

Answer 9

2:1

Question 10

symptoms

Answer 10

• diarrhoea
• steatorrhoea, odour
• abdominal pain
• weight loss
• excessive flatulence
• anaemia and vit deficiencies
• aphthous ulcers and angular cheilitis
• weight loss
• fatigue and weakness

Question 11

reason for steatorrhoea

Answer 11

malabsorption of fats

Question 12

blood test performed

Answer 12

tTGA

Question 13

investigations

Answer 13

small bowel biopsy tTGA DEXA bone scan for osteoporosis

Question 14

cause of osteoporosis in coeliac

Answer 14

chronic malabsorption of Ca

Question 15

what will small bowel biopsy show you

Answer 15

subtotal villous atrophy and crypt hyperplasia and lots of lymphocytes

Question 16

treatment

Answer 16

gluten free diet vitamin and mineral replacement

Question 17

complications

Answer 17

• T cell lymphoma ( - Small bowel carcinoma - Gallstones - Osteoporosis

Question 18

when would u suspect T cell lymphoma as a complication

Answer 18

refractory symptoms or weight loss

Question 19

immunology

Answer 19

helper t cel mediated tissue damage following presentation by antigen presenting cells via MHC class II

Question 20

how do children present

Answer 20

abdominal distension, diarrhoea and failure to thrive

Question 21

how do a adults present

Answer 21

chronic diarrhoea and bloating

Question 22

one should suspect coeliac disease in all patients with what

Answer 22

weight loss anaemia and diarrhoea

Question 23

what is gliadin found in

Answer 23

wheat

rye

barley

(rice, oats, sugar and potatoes are ok)