Coeliac disease and bowel cancer Flashcards
What are common malabsorption diseases? (3 points)
- Pernicious anaemia
- Coeliac disease
- Crohn’s disease
What are common GI diseases in the large bowel? (4 points)
Inflammatory bowel disease:
- Crohn’s disease
- Ulcerative Colitis
Colonic Ca
What is meant by malabsorption?
- Issues stopping you from absorbing things altogether
What is pernicious anaemia?
- When the body can’t make enough healthy RBC’s because it lacks Vit B12
- The reason this happens is often due to the lack of stomach protein called ‘intrinsic factor’. Your body can’t absorb B12 without it
What is Coeliac disease?
- Common digestive condition where the small intestine becomes inflamed and unable to absorb nutrients
- It is caused by an adverse reaction to gluten
What is Crohn’s disease?
- A life-long condition in which part of the digestive system becomes inflammed
- Can be anywhere from mouth to anus
Can infections and tumours cause malabsorption issues?
- Yes
Which bit of gluten are people with Coeliac disease sensitive to?
- Sensitive to alpha-gliaden component of gluten
What is the true prevalence of Coeliac disease?
- 1 in 300
Give 6 examples of foods in which gluten can be found?
- Wheat
- Barley
- Spelt
- Rye
- Kamut
- Oats (usually contained with gluten grains)
What is the aetiology of coeliac disease? (3 points)
- Genetic - DQw2
- T lymphocytes
- Villous atrophy
What does enteropathy mean?
A disease of the intestine
What percentage of people with Coeliac disease show clinical effect and what can these be? (3 points)
- 30-40%
- Growth failure & oral ulceration
What is meant if someone with coeliac disease has a subclinical disease?
- No effects seen
- Have disease process but don’t have any symptoms but they will be malabsorbing
What are classic symptoms of Coeliac disease? (8 points)
- Weight loss
- Lassitude
- Weakness
- Abdominal pain/swelling
- Diarrhoea
- Aphthae/Glossitis
- Steatorrhoea
- Dysphasia
What is lassitude?
- Lack of energy
What is Aphthae?
- Small ulcer found in groups in the mouth
What is glossitis?
- Inflammation of the tongue
What is steatorrhoea?
- Excretion of abnormal quantities of fat within the faeces
In coeliac disease, What can you things can you have malabsorption issues with? (4 points)
- Iron
- Folate
- Vitamin B12
- Fat
What investigations can be used to detect Coeliac disease? (4 points)
Jejunal biopsy (most important)
- Capsule
- Endoscope
Faecal fat
Haematinics
Autoantibodies
- Serum Transglutaminase (antibody test)
- Anti-gliadin/anti-endomyseal antibodies
Where in the small intestine does most of the absorption occur?
- Jejunum and ileum
How can a gluten free diet help with someone with Coeliac disease? (3 points)
- Reversal of jejunal atrophy
- Improved well-being
- Reduced risk of lymphoma
Coeliac disease is associated with Dermatitis Herpetiformis. What is this?
- associated skin conditions (can be oral disease)
- Little skin blisters (granular IgA deposit in skin and mucsa) - in response to gluten
What is a very common form of bowel carcinoma?
- Colorectal adenocarcinoma
What is the second most common malignancy in the western world?
- Colonic carcinoma
What are common symptoms of colonic carcinomas? (3 points)
- None
- Anaemia
- Rectal blood loss
What are the different ways for screening for a colonic carcinoma? (5 points)
- FOB
- Barium enema
- Endoscopy
- CT/MRI scan
- Carcinoembryonic antigen (CEA)
What would happen if an adult went for an FOB to test for co lonic carcinomas and the test came back negative?
- Would have a 5 year repeat
What would happen if an adult went for an FOB to test for colonic carcinomas and the test came back positive?
- Would get and endoscopy
Most carcinomas arise in polyps. What is a polyp? (4 points)
- A small abnormal tissue growth
- May be pedunculated or flat
- Most will bleed due to irritation and trauma
- Most take 5 years to progress to malignancy
What are the causes of colonic carcinomas? (7 points)
- Diet ( less fibre, more fat, more meat, less veg)
- Increased smoking
- Alcohol
- Less exercise
- Genetics (P53 in 75 %)
- Ulcerative colitis
- Intestinal polyps
What is Peutz-Jehgers Syndrome?
- Hereditary cancer syndrome identified by the presence of GI polyps and altered pigmentation of certain skin and mucosal surfaces
- Polyps are often found in the small intestine
What is Gardiner’s syndrome?
- Inherited disease characterised by GI polyps, multiple osteomas and skin and soft tissue tumours
What is Cowden’s syndrome?
- Autosomal genetic condition characterised by multiple benign tumour growths in the skin and mucous membranes
Which classification system do you use to determine the stage of bowel cancer?
- Dukes’ classification
What are the 4 stages of dukes’ classification in determining the stage of bowel cancer?
A - Submucosal
B - Muscularis
C - Lymph nodes
D - Liver
What are the possible treatments of colonic carcinomas? (4 points)
- Surgery (to get rid of lesion)
- Hepatic metastases
- Radiotherapy
- Chemotherapy
