Coeliac disease and bowel cancer

Question 1

What are the different types of significant gastrointestinal disease

Answer 1

• oesophagus and upper GI
• malabsorption
• large bowel

Question 2

What falls under the malabsorption category of GI disease

Answer 2

• pernicious anaemia
• coeliac disease
• crohn’s disease
• infections
• tumours

Question 3

what is coeliac disease

Answer 3

sensitivity to alpha-gliaden component of gluten

Question 4

What foods is gluten found in

Answer 4

• wheat
• barley
• spelt
• rye
• kamut
• oats

Question 5

What is another name for coeliac disease

Answer 5

gluten sensitive enteropathy

Question 6

What gene is linked to coeliac disease

Answer 6

DQw2

Question 7

How does coeliac disease develop

Answer 7

progressive change in villi (villous atrophy) caused by the immune response to the component (alpha-gliaden) in gluten

Question 8

what part of the gut is afected by coeliac disease

Answer 8

villous atrophy of the jejunum

Question 9

What are the effects of jejunal atrophy

Answer 9

They vary:

Clinical (30-40%)
- growth failure oral ulceration

Subclinical - no effects

Question 10

Symptoms of coeliac disease

Answer 10

• weight loss
• lassitude
• weakness
• abdominal pain/swelling
• diarrhoea
• aphthae/glossitis
• steatorrhoea
• dysphagia

Question 11

What is malabsorbed if you have coeliac disease

Answer 11

• iron
• folate
• vitB12
• fat

Question 12

Investigations for coeliac disease?

Answer 12

• jejunal biopsy
• faecal fat
• haematinics
• autoantibodies

Question 13

why should patients with coeliac disease go on a gluten free diet

Answer 13

• reversal of jejunal atrophy
• improved well-being
• reduced risk of lymphoma

Question 14

what condition is associated with coeliac disease

Answer 14

hermatitis herpetiformis (oral disease, granular IgA deposit in skin and mucosa)

Question 15

Why are all aphthae patients screened by haematinic assays

Answer 15

to detect deficiency of folate or combined ferritin and folate. This would suggest malabsorption and maybe coeliac disease

Question 16

What is another name for bowel carcinoma

Answer 16

colorectal adenocarcinoma

Question 17

Symptoms of colonic carcinoma?

Answer 17

• none unless advanced
• anaemia
• rectal blood loss (key)

Question 18

How is screening done for colonic carcinoma

Answer 18

• FOB
• barium enema
• endoscopy
• CT/MRI scan
• carcinoembrionic antigen (CEA)

Question 19

What is the screening process for colonic carcinoma in the UK

Answer 19

• all UK adults over 50 invited (FOB sample by post)
• 5 year repeat if negative
• endoscopy if positive

Question 20

what is the aetiology of colonic carcinoma

Answer 20

most carcinomas arise in polyps

Question 21

characteristics of polyps

Answer 21

• may be pedunculated or flat
• most will bleed due to irritation and trauma
• most take 5 years to progress to malignancy

Question 22

if polyps are found on endoscopy, what happens

Answer 22

screening interval reduced from 5 years

Question 23

what are risk factors for colonic carcinoma

Answer 23

Diet
- low fibre
- high fat
- high meat
- low veg
Smoker
Low exercise
Genetics - p53 in 75%
Ulcerative colitis
Intestinal polyps

Question 24

is alcohol a risk factor for colonic carcinoma

Answer 24

no

Question 25

How does the whereabouts of intestinal polyposis affect the risk of getting carcinoma

Answer 25

Small intestine = low risk
(Peutz-Jehgers syndrome)

Large intestine = high risk (Gardiners and Cowdens syndrome)

Question 26

How does 5 year survival % differ depending on colonic carcinoma grading

Answer 26

Well differentiated = 80%
Moderately differenetiated = 60%
Poorly differentiated = 25%

Question 27

What is the duke’s classification of colonic carcinoma and what is the relevant 5 year survivals

Answer 27

Class A - submucosal (80%)
Class B - muscularis (65%)
Class C - lumph nodes (45%)
Class D - Liver (5%)

Question 28

What is the treatment for colonic carcinoma

Answer 28

• surgery
• hepatic metastases
• radiotherapy
• chemotherapy