Coeliac disease and bowel cancer Flashcards
(28 cards)
What are the different types of significant gastrointestinal disease
- oesophagus and upper GI
- malabsorption
- large bowel
What falls under the malabsorption category of GI disease
- pernicious anaemia
- coeliac disease
- crohn’s disease
- infections
- tumours
what is coeliac disease
sensitivity to alpha-gliaden component of gluten
What foods is gluten found in
- wheat
- barley
- spelt
- rye
- kamut
- oats
What is another name for coeliac disease
gluten sensitive enteropathy
What gene is linked to coeliac disease
DQw2
How does coeliac disease develop
progressive change in villi (villous atrophy) caused by the immune response to the component (alpha-gliaden) in gluten
what part of the gut is afected by coeliac disease
villous atrophy of the jejunum
What are the effects of jejunal atrophy
They vary:
Clinical (30-40%)
- growth failure oral ulceration
Subclinical - no effects
Symptoms of coeliac disease
- weight loss
- lassitude
- weakness
- abdominal pain/swelling
- diarrhoea
- aphthae/glossitis
- steatorrhoea
- dysphagia
What is malabsorbed if you have coeliac disease
- iron
- folate
- vitB12
- fat
Investigations for coeliac disease?
- jejunal biopsy
- faecal fat
- haematinics
- autoantibodies
why should patients with coeliac disease go on a gluten free diet
- reversal of jejunal atrophy
- improved well-being
- reduced risk of lymphoma
what condition is associated with coeliac disease
hermatitis herpetiformis (oral disease, granular IgA deposit in skin and mucosa)
Why are all aphthae patients screened by haematinic assays
to detect deficiency of folate or combined ferritin and folate. This would suggest malabsorption and maybe coeliac disease
What is another name for bowel carcinoma
colorectal adenocarcinoma
Symptoms of colonic carcinoma?
- none unless advanced
- anaemia
- rectal blood loss (key)
How is screening done for colonic carcinoma
- FOB
- barium enema
- endoscopy
- CT/MRI scan
- carcinoembrionic antigen (CEA)
What is the screening process for colonic carcinoma in the UK
- all UK adults over 50 invited (FOB sample by post)
- 5 year repeat if negative
- endoscopy if positive
what is the aetiology of colonic carcinoma
most carcinomas arise in polyps
characteristics of polyps
- may be pedunculated or flat
- most will bleed due to irritation and trauma
- most take 5 years to progress to malignancy
if polyps are found on endoscopy, what happens
screening interval reduced from 5 years
what are risk factors for colonic carcinoma
Diet - low fibre - high fat - high meat - low veg Smoker Low exercise Genetics - p53 in 75% Ulcerative colitis Intestinal polyps
is alcohol a risk factor for colonic carcinoma
no
