Coeliac disease Flashcards

1
Q

What is Coeliac disease

A

Immune mediated inflammatory condition provoked by gluten

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2
Q

Clinical presentation of Coeliac disease

A
Range of possible symptoms, with onset at any age (two peaks; infancy and 5th decade). 
Persistent GI symptoms. 
Faltering growth. 
Prolonged fatigue. 
Unexplained weight loss. 
Severe mouth ulcers. 
Iron, B12 or folate deficiency (anaemia). 
IBS. 
Family Hx of Coeliac.
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3
Q

Examination of Coeliac disease - what does DQ stand for

A

Dietary Query

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4
Q

Pathophysiology of Coeliac disease

A

α-Gliadin is the toxic portion of gluten.
It is resistant to proteases in GI tract, and passes epithelial barrier of the small intestine
-> Deamination by tissue transglutaminase (increasing immunogenicity)
-> interacts with antigen presenting cells (macrophages) in the lamina propria via HLA DQ2 and DQ8 and deaminated gliadin is expressed on MHC2.
This activates gluten sensitive T cells
-> Inflammatory cascade and release of mediators
-> Cell damage (villous atrophy and crypt hyperplasia)

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5
Q

Aetiology of Coeliac disease

A

Strong genetic association with HLA DQ2 and DQ8. Attacks caused by the presence of gluten in the diet.

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6
Q

Epidemiology of Coeliac disease

A

1/100 in UK

common in Irish

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7
Q

Diagnosis of Coeliac disease

A

Serology: IgA tissue transglutaminase antibodies (IgA-tTG blood test) have a very high sensitivity and specificity for Coeliacs. Also endomysial antibodies.
Then, Distal Duodenal Biopsy: Histological changes.

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8
Q

Treatment fo Coeliac disease

A

Gluten free diet

Nutritional supplement as required

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9
Q

Complications of Coeliac disease

A

Increased incidence of malignancy, reduced by gluten free e.g. GI t-cell lymphoma

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10
Q

When would you suspect Coeliac disease

A

Diarrhoea + weight loss or anaemia

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11
Q

FBC Coeliac disease

A
low Hb
high RCDW (Red blood Cell Distribution Width)
low B12
low ferritin
IgA levels
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12
Q

Examples of gluten free food

A
Rice
Maize
Soya
Potatoes
Sugar
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13
Q

Prescribe-able gluten free food

A
Gluten-free...
Biscuits
Flour
Bread
Pasta
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14
Q

How does coeliac disease cause damage to the gut

A

Gliadin binds to secretory IgA in the mucosal membrane
The gliadin-IgA is transcytosed to the lamina propia
Gliadin binds to tTG and is deaminated
Deaminated gliadin is taken up by macrophages and expressed on MHC2
T helper cells release inflammatory cytokines and stimulate B cells
This causes gut damage.

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15
Q

Symptoms

A

Bloating, failure to thrive, diarrhoea

Dermatitis Herpetiformis

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16
Q

Describe the cell damage in Coeliac by reaction to gluten

A

Villous atrophy

Crypt Hyperplasia