coeliac disease Flashcards
what is it
condition in which there is inflammation of the mucosa of the upper small bowel
when does mucosa improve
when gluten is withdrawn
what is gluten present in
- cereals
- wheats
- barley
- rye
what is the damaging factor of gluten
prolamins
- gliadin from gluten
- hordeins from barley
- secalins from rye
what are prolamins resistant to
digestion by pepsin and chymotrypsin because of their high glutamate and proline content
so they remain in intestinal lumen triggering immune response
what is gliadin demented by
tissue transglutaminase
what does gliagin peptide bind to
antigen-presenting cells which interact with CD4 in the lamina propria
how does gliadin interact with CD4
via HLA class II
what else does CD4 interact with
B cells to produce endomysial and tissue transglutaminase
what else can gliadin cause release of
IL-5
what does the inflammatory cascade release
metalloproteins
what does metalloproteinases contribute to
villous atrophy and crypt hyperplasia
is it genetic inherited
unsure
what virus in infancy increases risk
rotavirus
what can be seen in blood test to diagnose
- raised MCV
- iron deficiency in pregnancy
symptoms
- tiredness
- malaise
- anaemia
- IBS
- diarrhoea
- steatorrhoea
- abdominal pain
- weight loss
- mouth ulcers
- infertility
- anxiety
- depression
complications
- tetany
- osteomalacia
- gross malnutrition
- peripheral oedema
- parasthesia
- ataxia
- muscle weakness
- polyneuropathy
gold standard for diagnosis
small bowel biopsy
what are the endoscopic signs
- absence of mucosal folds
- mosaic pattern of surface
- scalloping of mucosal folds
what is most common cause of villous atrophy
coeliac disease
what does histological examination show
- crypt hyperplasia
- chronic inflammatory cells in lamina propria
- villous atrophy
what happens to the enterocytes
they become cuboidal with an increase in number of intraepithelial lymphocytes
when would you test someone
- persistent diarrhoea
- folate or iron deficiency
- unexplained abnormal liver biochemistry
- family history of coeliac disease
what is useful for risk assessment
HLA typing
treatment
- replace minerals and vitamins e.g. iron, folic acid, calcium, vitamin D
- gluten free diet
what should patients have every 5 years
pneumococcal vaccinations
complications
- IBD
- small bacterial overgrowth
- lactase deficiency
- T cell lymphoma
- small bowel adenocarcinoma
- ulcerative jejunitis
what does ulcerative jejunitis present with
- fever
- abdominal pain
- perforation
- bleeding
what is diagnosis of the complications done
MRI or barium studies
what is treatment of ulcerative jejunitis
- steroids
- immunosuppressive agents such as azathioprine
what is dermatitis herpetiforms
blistering, subepidermal eruption of the skin
what is dermatitis herpetiformis associated with
gluten-sensitive enteropathy
