Coeliac disease and malabsorption

Question 1

Which specific blood tests would you request to investigate coeliac disease?

Answer 1

IgA, IgA-tTg or IgA EMA

Question 2

Name three histological features would you see in coeliac disease?

Answer 2

crypt hyperplasia, villous atrophy, intraepithelial lymphocytosis

Question 3

List four complications of coeliac disease?

Answer 3

lactose intolerance, hyposplenism, osteoporosis and bone fractures, malignancy

Question 4

Which genetic mutation is present in coeliac disease?

Answer 4

HLA-DQ2, DQ8

Question 5

Describe three features of malabsorption in coeliac disease

Answer 5

Abdo distension
N/V
Steatorrhoea
Anaemia
Vitamin deficiencies
fatigue
weakness
weight loss

Question 6

Coeliac disease can result in vit D, K, B2, B1, and B6 deficiencies. Describe clinical signs of these deficiencies

Answer 6

 Vit D and Ca → bone pain, osteoporosis
 Vit K → petechiae and ↑INR
 B2 (riboflavin) → angular stomatitis
 B1 and B6 → polyneuropathy

Question 7

Aside from GI features, name two other features of coeliac disease

Answer 7

dematitis herpetiformis
Anaemia
Lymphoma and carcinoma
IgA deficiency
T1DM (remember OSCE!!!)

Question 8

List four blood tests you would conduct for coeliac disease

Answer 8

FBC 
LFTs
INR
Vit D and bone profile
B12

Question 9

Which antibody tests would you carry out in coeliac disease?

Answer 9

Anti-TTG IgA
Anti-endomysial IgA
IgA incr

Question 10

List three seminal histological features of coeliac disease you would find in biopsy

Answer 10

subtotal villous atrophy
crypt hyperplasia
intra-epithelial lymphocytes

Question 11

You advise a newly diagnosed coeliac patient on their diet. Provide three foods they should avoid

Answer 11

Barley, rye, oats (??), wheat

Question 12

Three features of malabsorption presentation?

Answer 12

diarrhoea/steatorrhoea
weight loss
lethargy

Question 13

List three causes of malabsorption

Answer 13

coeliac disease
chronic pancreatitis crohn's
pancreatic insufficiency
bacterial overgrowth
infection

Question 14

List three investigations to conduct in malabsorption

Answer 14

1. coeliac tests
2. stool microscopy
3. Faecal elastase
4. hydrogen breath test
5. Small bowel endoscopy
6. ERCP (chronic pancreatitis)

Question 15

Hydrogen breath test is used to diagnose which condition?

Answer 15

small intestinal overgrowth