coeliac disease Flashcards
symptoms of coeliac
lethargy anaemia (b12,fe & folate) abdominal pain diarrhoea weight loss osteoporosis sub-fertility
what is coeliac
autoimmune
reaction to gluten damages the villi lining
3 categories of coeliac
- coeliac
- undiagnosed/ silent (biopsy +, no symptoms)
- latent (serology positive, biopsy negative, no symptoms)
5 serology markers of coeliac
- anti-tissue transglutaminases (ttg-igg/iga)
- anti-deaminated gliadin (dgp iga/igg)
- anti-gliadin (aga-iga/igg)
- anti-caesin
- anti-endomysial (ema-iga)
which marker is most sensitive for coeliac
anti-tissue transglutaminase antibody
investigations for coelaic
- serology
- d2 biopsy
- HLA gene
-gluten challenge
coeliac gene asoc.
HLA DQ2
1st degree relative %
5-15%
endoscopic appearance of coeliac disease7
- villous atrophy
- crypt hyperplasia
- loss of enterocyte height
- lamina propria infiltration with lymphocytes
- increased intra-epithelial lymphocytes
- increased mitotic activity
(scalloping of the mucosa)
treatment coeliac disease
gluten free diet avoid wheat, rye and barely oats are ok dietician codex alimentarius
%effiacacy of gfd
70
reasons gfd fails
non compliant
inadvertent take
another dx
diff dx of coeliac
pancreatic enzyme insufficiency
autoimmune enteropathy
bacterial overgrowth
treatment refractory coeliac disease
steroids prednisolone
consider aza
symptoms of refractory coeliac
unwell weight loss hypoalbuminuria dehydration steatorrhoea
assoc. to coeliac disease
- dermatitis herpetiformis (skin)
- osteoporosis
- sb lymphoma small risk (intestinal t cell lymphoma)
- increase malignancy some others
- iga deficiency
- sbbo
- hyposplenism
- autoimmune conditions eg diabetes, thyroid, addison
what is dermatitis herpetiformis
IgA deposition at basement membrane of the skin
treatment for dermatitis herpetiformis
gfd
dapsone
symptoms of small bowel bacterial overgrowth
diarrhoea pain weight loss bloating flactulence nausea steatorrhoea
nutritional deficiencies with small bowel overgrowth
vit d-tetany
vit a -night blindness
cobalamin neuropathy
vit b12 microcytosis
investigation of sbbo
h2 lactose/ glucose breath test
treatment of sbbo
7-10/7 course
co-amoxiclav and metronidazole
(cephalexin, co-trimoxazole or gentamicin
how many coeliac patients have hyposplenism
80
features of hyposplenism
Howell jolly bodies
target cells
thrombocytopaenia
