Coeliac disease

Question 1

What gene is it associated wit

Answer 1

HLA DQ2

lesser extent DQ8

Question 2

What are the associated conditions?

Answer 2

Dermatitis herpetiformis

Autoimmune disorders

Question 3

What is the pathophysiology

Answer 3

T cell response to gluten in small bowel causes villous atrophy and malabsorption

Question 4

What are the clinical features?

Answer 4

1. Steatorrhoea
2. Diarrhoea
3. Abdo pain
4. Bloating
5. N+V
6. Aphthous ulcers
7. Angular stomatitis
8. WL
9. Fatigue + weakness
10. Osteomalacia
11. FTT

Question 5

what investigations would u do?

Answer 5

1. Immunology:
   - Tissue transglutaminase IgA abs
   - Anti-endomysial abs
2. Duodenal biopsy:
   - Villous atrophy
   - increased intraepithelial lymph
   - crypt hyperplasia
   - Lamina propria infiltration w lymphocytes
3. Bloods:
   - anaemia, low B12, ferritin

Question 6

What is the management?

Answer 6

lifelong gluten free diet

avoid: wheat, bread pastry, pasta, barley, beer, rye, oats

Question 7

What are the complications?

Answer 7

anaemia
dermatitis herpetiformis
osteopenia/porosis
hyposplenism - offer pneumococcal vaccine
GI T cell lymphoma 
increased risk of malignancy
neuropathies