Coelic Disease Flashcards
What is coeliac disease
Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten.
What is the intestinal characteristic of cealiac disease
Villous atrophy due to replayed exposure to gluten
What other conditions are associated with cealiac disease
dermatitis herpetiformis (a vesicular, pruritic skin eruption)
autoimmune disorders -
type 1 diabetes mellitus
autoimmune hepatitis
Hashimoto thyroiditis / autoimmune thyroid disease
Eneteropathy associated T cell lymphoma of small intestine
Which human leukocyte antigen (HLA) genes is most strongly associated with celiac disease
It is strongly associated with HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).
According to NICE guidelines which patients should be screened for celiac disease according to its clinical manifestations :
Chronic or intermittent diarrhea
Failure to thrive
Persistent unexplained gastrointestinal symptoms - nausea , vomiting
Prolonged fatigue
Recurrent abdominal pain , cramping or distension
Sudden or unexpected weight loss
Unexplained iron deficiency anemia
What are some of the complications for celiac disease
Anemia - iron or folate , vit b12 deficient
Osteomalacia - calcium / vit d defieicnecy
Functional Hyposplensism
Lactose intolerance ?
Subfertility and unfavourable pregnancy outcomes
Diagnosis of coeliac disease
immunoglobulin (IgA) deficiency - common
immunoglobulin A-tissue transglutaminase (IgA-tTG) -normal titre does not exclude coeliac disease, as seronegative coeliac disease occurs in a minority of patients
EMA is an alternative to IgA-tTG with greater specificity but lower sensitivity
IgG DGP (deamidated gliadin peptide)
Test of choice for individuals with IgA deficiency.
skin biopsy
Order this test initially in any patient with skin lesions suggestive of dermatitis herpetiformis.
Both sensitivity and specificity are high, if normal-appearing skin adjacent to a lesion is biopsied
granular deposits of IgA at the dermal papillae of lesional and perilesional skin by direct immunofluorescence
Test
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Golden standard
Small-bowel histology is essential and the gold-standard test to confirm the diagnosis.
Biopsies should be performed while on a gluten-containing diet. Patients with an elevated IgA-tTG level should be referred for duodenal biopsy
Two biopsies of the duodenal bulb and at least four biopsies of the distal duodenum
What are some of the uncommon features of celiac disease ?
aphthous stomatitis(Uncommon)
mostly reported in children. [85] Caused by various nutritional deficiencies; may be triggered by gluten exposure and responds to a gluten-free diet.
dental enamel hypoplasia
easy bruising(Uncommon)
Vitamin K deficiency may lead to a coagulopathy.
peripheral neuropathy(Uncommon)
The aetiology neurological dysfunction may be the result of either vitamin deficiencies (B12, E, or D; folate or pyridoxine) or autoimmune activity against neural antigens.
Dermatitis herpetiformis is associated with ?
HLD-DR3 !
NICE issued guidelines on the investigation of coeliac disease in 2009. If patients are already taking a gluten-free diet they should be asked
reintroduce gluten for at least 6 weeks prior to testing.
Due to functional hyposplenism in celiac disease
are offered the pneumococcal vaccine
Coeliac UK recommends that everyone with coeliac disease is vaccinated against pneumococcal infection and has a booster every 5 years
encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.
