Coeliac Disease Flashcards
CD is
Chronic systemic, immune mediated disorder in genetically pre disposed patients
Cd is triggered by
Ingesting gluten >- mucosal inflammation, crypt hyperplasia and villous atrophy
How does CD present
Non specific GI symptoms, malabsorption/ diarrhoea/ nutritional deficiencies / anaemia/osteoporosis
Untreated CD has
Significant morbidity and up to 4 fold increases risk of death
CD can be associated with
Other autoimmune conditions
Is CDreversible
Potentially reversible villus atrophy in most cases
All patients with CD carry
HLA-DQ2 or DQ8
Do HLA genes mean you definitely have CD
No 30-50% of population carry these genes but don’t have CD
HLA test is
Good negative predictor
Gold standard for CD
Duodenal biopsy
Key things to look for in duodenal biopsy
Villus atrophy (most important)
Crypt hyperplasia
Intraepithelial lymphocytes
Duodenal histology classification called
Marsh
Marsh 1
Lymphocytosis increSed
Marsh 2
Lymph
Hyperplasia (crypts)
Marsh 3
Lymph
Hyperplasia
Villus atrophy
Clinical manifestations of CD
Gastrointestinal
Diarrhoea Flatulence (farting) Abdominal cramps Nutrient deficiency Weight loss Abnormal liver enzymes
Clinical manifestations of CD
Haematological
Anaemia
Hyposplenism
Bleeding disorders
Cd manifestation NA muscoskeletal
Osteopenia+ osteoporosis
Stunted growth in children
Vitamin D deficiency and hyper calcaemia
Clinical manifestations CD skin
Dermatitis herpetifornis
CD neurological manifestations
Muscle weakness, paraesthisia , ataxia
Seizures
Hormonal CD manifestations
Amenorrhoea
Infertility
Differential diagnosis for CD
Viral/bacterial enteritis Chronsdisease Small bowel bacteria overgrowth IBS microscopic colitis Protein loosing eneropathy Malabsorption Immunodeficiency
