Gastroenterology

Question 1

What is coeliac and what conditions is it associated with?

Answer 1

Gluten exposurre causes auto-antibodies (Anti-ttG and Anti-EMA) to be produced.

These target epithelium in small intestine leading to jejunal inflammation and malabsorption.

Associations:
- Genetic (HLA-DQ2/8)
- T1DM
- Thyroid disease
- Down’s
- Autoimmune hepatitis

Question 2

Presentation of coeliac?

Answer 2

Usually under 3 + often asymptomatic

Failure to thrive
Diarrhoea
Fatigue
Weight loss
Abdo cramping/pain
Signs of anaemia
Dermatitis herpetiformis (itchy, blistering skin rash on abdomen)

Question 3

Investigations for coeliac?

Answer 3

Must ensure gluten has been in diet for 6 weeks prior to tests

Serology - total IgA and IgA ttG

Duodenal biopsy (Marsh clasiffication) - positive findings = crypt hypertrophy and villous atrophy

Question 4

Management and complications of coeliac?

Answer 4

Gluten-free diet and supplements
Annual follow-up

Complications:
- Anaemia
- Osteopenia/perosis
- Subfertility
- Vit deficiency
- Malignancy (lymphoma/adenocarcinoma)
- Mental health issues