Coeliac Disease and Bowel Carcinoma Flashcards
diseases caused by malabsorption
pernicious anaemia
- intrinsic factor and vitamin B12 at end of ileum (disease caused by Crohn’s or carcinoma)
coeliac disease (small bowel)
crohn’s disease (small bowel)
infections
tumors
malabsorption leads to
Decreased minerals and vitamins absorption, become malnourished can cause chronic issues, inflammation of bowel and no longer able to absorb properly
coeliac disease
Sensitivity to α-gliaden component of Gluten
true prevalence of coeliac disease
1 in 300
gluten sensitive enteropathy spectrum
Some foods not enough to cause clinical symptoms
Wide range of foods can cause issues
- wheat > barley > spelt > rye > kamut > oats
- Oats generally OK but can be contaminated in the factory
aetiology of coeliac disease
genetic (DQw2)
T lymphocytes
Villous atrophy
Wheat being cut up
– Different components absorbed
Cytokines react
– Attacks and causes damage to epithelial cells on surface of bowel
– Inflamed bowel
– Lose villi which increase SA
Malabsorption due to combination of inflammation and reduction in SA
Gluten sensitivity enteropathy
– Wasting away of bowel wall
what are the progressive changes in villi in coeliac disease
Normal healthy bowel progressive changes in villi
– Gradually completely removed
– Flat mucosa
Slower rate of absorption as less SA
impact of removing gluten on patient with coeliac disease
can reverse process
– Get a normal bowel
what investigations are used to assess bowel in coeliac disease cases
Endoscopy and biopsy to assess bowel
– Gluten free diet for a few month and repeat endoscopy to see improvement to confirm diagnosis
effect of jejunal atrophy in clinical cases of coeliac disease
- growth failure
- oral ulceration
30-40%
effect of jejunal atrophy in subclinical cases of coeliac disease
no effect
coeliac disease effects….
children mainly
but can develop with age
effect of coeliac disease on children
Don’t have absorption of nutrients in child - failure of growth, obvious in later life
effect of coeliac disease in adults
Subclinical for adults as less problems seen fully grown
No bowel symptoms
– But malabsorption - mouth ulcers as poor iron absorption
if don’t get treatment from avoiding gluten in coeliac disease
Get areas of chronic immune cell stimulation
Develop lymphoma in small bowel (like H pylori in stomach)
8 classic symptoms of coeliac disease
Weight loss Lassitude Weakness Abdominal pain/swelling Diarrhoea Aphthae/glossitis Steatorrhoea Dysphagia
(most asymptomatic or relatively small reaction to gluten)
malabsorption causes most issues
4 things that can be malabsorbed in coeliac disease cases
iron
folate
vitamin B12
fat
Suspicious of small bowel malabsorption if more than one
4 investigations for coeliac disease
Jejunal biopsy (grab biopsy through endoscopy, capsule take section out)
- Capsule
- Endoscope – best test
Faecal fat
Haematinics
Autoantibodies – look for antibodies associated with coeliac disease in blood
- Serum transglutaminase
- Anti-gliadin/anti-endomyseal antibodies
Cheap, very sensitive but not very specific, can show positive when don’t have disease
Negative = don’t have disease
Positive = do other tests, all positive then have but if they return negative then false positive result
3 areas of small bowel
duodenum
jejunum
ileum
what areas of small bowel are most effected in coeliac disease
jejunum
ileum
how can a gluten free diet help in coeliac disease (3)
Reversal of jejunal atrophy
Improved well- being
- Feel better, less immune response
Reduced risk of lymphoma
what is coeliac disease associated with
dermatitis herpetiformis: antibody mediated problems in response to gluten - reaction
- Oral disease
- Blisters on skin, shoulders and back
- Granular IgA deposit in skin and mucosa
what does folate or combined ferritin and folate deficiency suggest
malabsorption
can lead to mouth ulcers
change in pattern of occurence of mouth ulcers can indicate
Iron or folic acid low due to mouth ulcers
- Maybe underlying bowel issue
