Colorectal CA and Celiac

Question 1

Celiac disease is?

Answer 1

AKA gluten sensitive enteropathy and nontropical sprue

Inflammation of the small bowel secondary to ingesting gluten-containing foods (wheat, barely, rye, some oats)

Question 2

What causes Celiac disease?

Answer 2

Immune disorder, triggered by an environmental agnet (the gliaden in gluten) in people who are genetically predisposed.

Question 3

Clinical manifestations of celiac disease?

Answer 3

Diarrhea with bulky, foul smelling, floating stools - steatorrhea, flatulence

Weight loss

Weakness

Abdominal distension

FTT in kids

IDA

osteopenia and osteoporosis.

Question 4

What are associated findings of celiac disease?

Answer 4

Dermatitis herpetiformis

DM type 1

Down syndrome

Liver disease

Menstural & reproductive issues.

Question 5

Describe Dermatitis herpitiformis

Answer 5

Grouped pruritic papules and vesicles

Elbows, dorsal forearms, knees, scalp, back and buttocks common sites.

Question 6

If someone has a low probability of celiac what test should you run?

Answer 6

Serologic testing if suggestive GI symptoms or extraintestinal s/s of Celiac disease

No significant s/s of malabsorption, no FH of celiac disease, Chinese, Japanese descent

Question 7

If someone has a high probability of celiac what tests should you run?

Answer 7

Serologic testing and small bowel biopsy

If have classic presentation, and have risk factors such as 1st or 2nd degree relative with confirmed CD, type 1 DM, autoimmune thyroiditis, down syndrome, Turner syndrome.

Question 8

What is the preferred serological test for celiac?

Answer 8

Tissue transglutaminase - tTG-IgA antibody - 90-98% sensitivity.

Anti-endomysial (EMA-IgA) is also measured.

Question 9

What are reasons there could be a negative serological test?

Answer 9

IgA deficiency

Low gluten/gluten free diet

False negative is more common in mild disease.

Question 10

What are endoscopic findings in celiac disease?

Answer 10

Atrophic appearing mucosa with loss of folds,

visible fissures,

nodularity,

scalloping,

prominnet submucosal vascularity.

Question 11

Biopsy for celiac is done with at least ____ biopsies and is graded using the _______

Answer 11

At least 4 biopsies are recommended to confirm dx. -

increased intraepithelial lymphocytes, atrophic mucosa with villi loss, epithelial apoptosis, crypt hyperplasia.

Graded using Marsh-Oberhuber classification.

Question 12

Management of celiac disease?

Answer 12

Gluten free diet

Replete nutritional deficiencies

Evaluate for bone loss with DXA

Pneumococcal vaccination

Question 13

People with celiac disease have a higher risk of?

Answer 13

Increase in overall mortality - mostly due to CV disease and malignancy

Increased risk of malignancy - lymphoma most common, GI cancers also common.