Gastroenterology

Question 1

sx of coeliac disease?

Answer 1

Chronic or intermittent diarrhoea
Failure to thrive or faltering growth (in children)
Persistent or unexplained gastrointestinal symptoms including nausea and vomiting
Prolonged fatigue (‘tired all the time’)
Recurrent abdominal pain, cramping or distension
Sudden or unexpected weight loss
Unexplained iron-deficiency anaemia, or other unspecified anaemia
folic acid deficiency

Question 2

pathophysiology of coeliac disease?

Answer 2

sensitivty to the protein gluten
autoimmune condition
repeated exposure results in villious atrophy - which then leads to malabsorption

Question 3

what genes are associated with coeliac disease?

Answer 3

HLA-DQ2 (95% of patients) and HLA-DQ8 (80%)

Question 4

what conditions are associated with coeliac?

Answer 4

Autoimmune thyroid disease
Dermatitis herpetiformis
Irritable bowel syndrome
Type 1 diabetes
First-degree relatives (parents, siblings or children) with coeliac disease

Question 5

what are the complications of untreated coeliac disease?

Answer 5

anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)
hyposplenism
osteoporosis, osteomalacia
lactose intolerance
enteropathy-associated T-cell lymphoma of small intestine
subfertility, unfavourable pregnancy outcomes
rare: oesophageal cancer, other malignancies

Question 6

how to diagnose coeliac disease?

Answer 6

Ttg- If patients are already taking a gluten-free diet they should be asked, if possible, to reintroduce gluten for at least 6 weeks prior to testing.

if positive - refer for a endoscopic intestinal biopsy - will show villous atrophy, crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

Question 7

management of coeliac disease?

Answer 7

avoid gluten
yearly pneumococcal vaccination - as all pt have a degree of hyposplenism