[Gastro] Enteropathy Flashcards
what is coeliac disease?
a condition of the small bowel resulting in villous atrophy from ingestion of gluten in the diet
what is coeliac disease associated with?
other autoimmune conditions: T1DM, autoimmune thyroiditis
when do you suspect coeliac disease?
- persistent unexplained sx
- fatigue
- unexpected wt loss
- unexplained iron, B12 / folate deficiency
- T1DM
what do you need to ensure does before serological testing?
ensure pt is eating gluten for 6 weeks before serological testing
what are the 1st line ix for coeliac disease?
IgA anti-TTG + serum immunoglobulins
what do you do if IgA TTG and serum IgA levels are positive?
endoscopy + duodenal biopsy
for definitive dx
what do you do if IgA negative?
consider IgG EMA, IgG TTG
what can you see on biopsy for coeliac disease?
- villous atrophy
- crypt hyperplasia
- increased intraepithelial lymphocytes
what is strongly associated with coeliac disease?
HLA DQ2/DQ8
what is irritable bowel syndrome?
functional GI disorder defined by Rome IV criteria
what is the Rome IV criteria for irritable bowel syndrome?
recurrent abdominal pain at least 1 day/week in last 3 months, associated with 2 or more of:
- related to defecation
- associated with change in frequency of stool
- associated with change in stool form (appearance)
what is the conservative mx for irritable bowel syndrome?
- advice / reassure
- FODMAP diet
- psychological interventions e.g. CBT if not responding to pharmacological mx in 12 months
what is the medical mx for irritable bowel syndrome?
- constipation: bulk-forming laxative
- pain: mebeverine / low-dose TCA
- diarrhoea: loperamide
chronic diarrhoea, bloating and PMH scleroderma. dx?
small bowel bacteria overgrowth
suspected bile-acid malabsorption. test?
SeHCAT test
