Coeliac Disease Flashcards
Which organ does coeliac disease affect?
Small intestine
What is gluten?
A protein found in wheat
Explain the difference between macro- and microcytic anaemia.
Anaemia = decreases in amount of RBC’s or Hb
Macrocytosis = increases RBC MCV
Macrocyctic anaemia = reduced RBC number with remaining having increased MCV
Microcytic anaemia follows the same rule but for reduced MCV
What can a low folate indicate?
May be due to not being absorbed properly, meaning in GI terms celiac or crohns due to where it s absorbed from
What is the main serological test for coeliac?
The connective sheath around smooth muscle = endomysium
Anti-endomysial antibodies (EMA) produced in coeliac
Anti-transglutaminase (Anti-tTG)
IgA TTG and EMA therefore serological tests
What structural changes occur in coeliac disease?
1) crypt hyperplasia (enlargement)
2) villous atrophy
What type of disease is coeliac?
It is an auto-immune disease (T-cell mediated)
What is the treatment of coeliac?
Strict gluten free diet
Describe the genetics surrounding coeliac including genes associated?
What do these genes code for?
All CD sufferers have:
- HLADQ2 (95%)
- HLADQ8 (5%)
But not all positive for this gene have CD (does not work both ways)
These code for MHC
What is the gold standard for coeliac diagnosis?
What other tests/steps can help confirm diagnosis?
OGD with duodenal biopsy looking for structural changes associated with CD
Others = antibody testing, reversal with gluten free diet
What is the name of the classification for duodenal biopsies?
Marsh classification
What is the most common associated malignancy with coeliac disease?
Enteropathy-associated T-cell lymphoma (EATL)
What is affected in coeliac due to the structural changes seen?
Absorption
Why do coeliacs become anaemic?
Deficient absorption = reduced iron uptake = anaemia
What kind of anaemia is associated with reduced iron intake?
Microcytic
What is coeliac incidence?
Are males or females more affected?
1:100
1% of population
Females X2 more likely
Does smoking increase coeliac risk?
No
What are some key determinants between coeliac and IBD?
Pain (sometimes)
Bleeding
Giardia can be a differential for coeliac type symptoms.
What is it?
What are it’s symptoms and how can it be differentiated from other GI pathology?
A water bourne parasite
Symptoms come and go in cycles
What serology measurement can rise with infection, therefore is important to check against the CRP?
Ferratin
A deficiency of what can cause macrocytic anaemia?
Folate and B12
Why does coeliac disease cause iron deficient anaemia (microcytic) and not B12 deficient anaemia (macrocytic)?
Coeliac affects the proximal small bowel = iron absorption here
B12 = distal small bowel (ileum) = not affected by coeliac
What region of the small bowel is biopsies in suspected coeliac?
Duodenum = D2
