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GI > Coeliac disease > Flashcards

Coeliac disease Flashcards

1
Q

What is coeliac disease?

A

Autoimmune condition

Inflammation of mucosa of upper small bowel when exposed to gluten

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2
Q

What happens when exposed to gluten?

A

Autoantibodies created which target epithelial cells of intestine and lead to inflammation

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3
Q

Autoantibodies?

A

An antibody produced by the immune system that is directed against one or more of the individual’s own proteins.

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4
Q

2 important antibodies?

A

Anti-tissue transglutaminase (anti-TTG)

Anti-endomysial (anti-EMA)

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5
Q

Where does inflammation mostly affect?

A

Jejenum

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6
Q

Describe what occurs when coeliac patient consumes gluten containing cereal?

A

Proteins are resistant to digestion by pepsin & chymotrypsin and remain in the intestinal lumen, triggering immune response
This causes inflammation leading to villous atrophy and crypt hyperplasia
Leads to malabsorption

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7
Q

Villous atrophy?

A

Intestinal villi erode away and leave virtually flat surface

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8
Q

Crypt hyperplasia?

A

Grooves are elongated compared to a normal intestinal lining which has short crypts

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9
Q

Associated diseases?

A 
Thyroid disease 
Type 1 diabetes
Sjogren syndrome
IBD
IgA deficiency
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
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10
Q

Symptoms?

A 
Abdo pain
Weight loss - failure to thrive in kids
Diarrhoea/ steato
Angular stomatitis
Mouth ulcers
Dermatitis herpatiformis
Anaemia, malnutrition
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11
Q

Long term problems?

A

Iron/ folate deficiency

Osteoperosis

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12
Q

Genetic associations?

A

HLA DQ2 gene

HLA DQ8 gene

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13
Q

1st line investigations?

A

Serology

  • tTG antibodies (IgA tissue transglutaminase antibodies)
  • EMA ( IgA endomysial antibodies)
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14
Q

2nd line investigations?

A

Endoscopy & biopsy!

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15
Q

What may be seen in biopsy?

A

Scalloping of mucosal folds - villous atrophy

Crypt hypertrophy

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16
Q

Other investigations?

A

HLA typing - specialist
Other blood tests - iron & folate
DEXA scan

17
Q

What must be excluded at the start and why?

A

IgA deficiency
Anti-TTG and anti-EMA antibodies are IgA.
Important to test for deficiency first as if these antibodies are tested for and are low because of IgA deficiency - could get negative coeliac test when patient actually has it

18
Q

All new type 1 diabetes patients are tested for coeliac - true or false?

A

TRUE

19
Q

Treatment?

A 
Gluten free diet!!!
Vitamin supplements
Pneumoccoal vaccine (those with splenic atrophy)
Annual blood tests (serology & FBC)
Screen for other AI
20
Q

Dx ?

A

IBS

IBD

GI (9 decks)

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