Coeliac's disease

Question 1

Coeliac’s disease

Answer 1

• chronic disorder of digestive tract ehivh results in an inability to tolerate gliadin, component of gluten
• cause inflammation of mucosa in the upper small bowel

Question 2

pathophys of coeliac’s disease

Answer 2

1. gliadin peptides are passed through the epithelium
2. deaminated by transglutaminase enzyme
3. increases gliadin immunogenicity - its ability to provoke immune response
4. gliatin peptides are taken up and presented via HLA molecules by antigen presenting cells
5. antigen presenting cells interact with CD4 T cells and stimulate production of proinflammatory cytokine e.g interferon Y.
6. B cells produce endomysial and tissue transglutaminase antibodies
   VILLOUS ATROPHY AND CRYPT HYPERPLASA

Question 3

Clinical features of coeliac’s disease

Answer 3

1. can present at any age
2. GI symptoms may be none to mild
3. Differential diagnosis : IBS
4. tiredness / anaemia

Question 4

Histology

Answer 4

1. subtotal villous atrophy
2. crypt hyperplasia
3. chronic inflammatory cells in lamina propria
4. Intraepithelial lymphocytes

Question 5

Serology

Answer 5

1. test for
   - endomysial antibodies
   - tissue transglutaminase antibodies
   - selective igA deficiency
   - folate deficiency

Question 6

Folate deficiency

Answer 6

• folate deficiency is common
• iron deficiency is common
• osteomalacia of vertebrae - softening of bones caused by impaired bone metabolism
• Looser’s zone - cortical infarction through the bone

Question 7

Risk factor

Answer 7

• genetic factors
• breast feeding
• introduction of gluten in diet