coeliac disease

Question 1

what is it

Answer 1

condition in which there is inflammation of the mucosa of the upper small bowel

Question 2

when does mucosa improve

Answer 2

when gluten is withdrawn

Question 3

what is gluten present in

Answer 3

• cereals
• wheats
• barley
• rye

Question 4

what is the damaging factor of gluten

Answer 4

prolamins

• gliadin from gluten
• hordeins from barley
• secalins from rye

Question 5

what are prolamins resistant to

Answer 5

digestion by pepsin and chymotrypsin because of their high glutamate and proline content

so they remain in intestinal lumen triggering immune response

Question 6

what is gliadin demented by

Answer 6

tissue transglutaminase

Question 7

what does gliagin peptide bind to

Answer 7

antigen-presenting cells which interact with CD4 in the lamina propria

Question 8

how does gliadin interact with CD4

Answer 8

via HLA class II

Question 9

what else does CD4 interact with

Answer 9

B cells to produce endomysial and tissue transglutaminase

Question 10

what else can gliadin cause release of

Answer 10

IL-5

Question 11

what does the inflammatory cascade release

Answer 11

metalloproteins

Question 12

what does metalloproteinases contribute to

Answer 12

villous atrophy and crypt hyperplasia

Question 13

is it genetic inherited

Answer 13

unsure

Question 14

what virus in infancy increases risk

Answer 14

rotavirus

Question 15

what can be seen in blood test to diagnose

Answer 15

• raised MCV

- iron deficiency in pregnancy

Question 16

symptoms

Answer 16

• tiredness
• malaise
• anaemia
• IBS
• diarrhoea
• steatorrhoea
• abdominal pain
• weight loss
• mouth ulcers
• infertility
• anxiety
• depression

Question 17

complications

Answer 17

• tetany
• osteomalacia
• gross malnutrition
• peripheral oedema
• parasthesia
• ataxia
• muscle weakness
• polyneuropathy

Question 18

gold standard for diagnosis

Answer 18

small bowel biopsy

Question 19

what are the endoscopic signs

Answer 19

• absence of mucosal folds
• mosaic pattern of surface
• scalloping of mucosal folds

Question 20

what is most common cause of villous atrophy

Answer 20

coeliac disease

Question 21

what does histological examination show

Answer 21

• crypt hyperplasia
• chronic inflammatory cells in lamina propria
• villous atrophy

Question 22

what happens to the enterocytes

Answer 22

they become cuboidal with an increase in number of intraepithelial lymphocytes

Question 23

when would you test someone

Answer 23

• persistent diarrhoea
• folate or iron deficiency
• unexplained abnormal liver biochemistry
• family history of coeliac disease

Question 24

what is useful for risk assessment

Answer 24

HLA typing

Question 25

treatment

Answer 25

- replace minerals and vitamins e.g. iron, folic acid, calcium, vitamin D - gluten free diet

Question 26

what should patients have every 5 years

Answer 26

pneumococcal vaccinations

Question 27

complications

Answer 27

- IBD - small bacterial overgrowth - lactase deficiency - T cell lymphoma - small bowel adenocarcinoma - ulcerative jejunitis

Question 28

what does ulcerative jejunitis present with

Answer 28

- fever - abdominal pain - perforation - bleeding

Question 29

what is diagnosis of the complications done

Answer 29

MRI or barium studies

Question 30

what is treatment of ulcerative jejunitis

Answer 30

- steroids | - immunosuppressive agents such as azathioprine

Question 31

what is dermatitis herpetiforms

Answer 31

blistering, subepidermal eruption of the skin

Question 32

what is dermatitis herpetiformis associated with

Answer 32

gluten-sensitive enteropathy