Gastroenterology: Coeliac Disease Flashcards
Describe the blood results for a patient with Coeliac [4]
normocytic anaemia: causes malabsorption of iron, folate and B12 - compensates to make normocytic
Raised WCC and CRP
Positive for IgA-tTG
Positive for endomysial antibody (EMA): a more expensive alternative to IgA-tTG
Why can patients have false negatives on a celiac disease antibody test when investigating for coeliac?
May be suffering from IgA deficiency: so IgA-tTG may not be positive
IgA deficiency is significantly more common in people with coeliac disease than in the general population.
What is the seroligcal test of choice for a coeliac patient with IgA defiency? [1]
IgG DGP (deamidated gliadin peptide)
Explain why you would perfom a skin biopsy for a coeliac patient? [1]
Explain the pathophysiology of this disease [1]
test initially in any patient with skin lesions suggestive of dermatitis herpetiformis:
- caused by granular deposits of IgA at the dermal papillae of lesional and perilesional skin by direct immunofluorescence
How would small bowel endoscopy appear in some coeliac patients? [1]
atrophy and scalloping of mucosal folds; nodularity and mosaic pattern of mucosa
What three histoligcal findings would indicate coeliac?
presence of intra-epithelial lymphocytes
villous atrophy
crypt hyperplasia
There is a link between coelaic and which other autoimmune diseases? [2]
DMT1 and thyroid disease
TOM TIP: Remember for your exams that we test all new cases of type 1 diabetes and autoimmune thyroid disease for coeliac disease, even if they do not have symptoms.
Which three antibodies are related to coeliac? [3]
Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
Which HLAs is coliac particularly associated with? [2]
HLA-DQ2
HLA-DQ8
Name 5 symptoms of coeliac [6]
Often goes undiagnosed !
diarrhoea
bloating
abdominal pain/discomfort
anaemia
failure to thrive in children
Mouth ulcers
The first line blood test is for Anti-tissue transglutaminase antibodies (anti-TTG) and what else? [1]
Total immunoglobulin A levels (to exclude IgA deficiency)
Patients with a positive antibody test are referred to a gastroenterologist to confirm the diagnosis by [] and []
Patients with a positive antibody test are referred to a gastroenterologist to confirm the diagnosis by endoscopy and jejunal biopsy.
Coeliac disease can effect which organ? [1]
Why is this clinically significant? [3]
Causes hyposplenism: means that patients are at risk of:
- Pneumococcus
- Haemophilus influenzae
- meningococcus
Name [1] and explain [3] an MSK complication of coeliac.
Osteoporosis: Reduced bone mineral density is common in coeliac disease and often improves significantly within 1 year of gluten withdrawal.
Occurs due to:
* release of pro-inflammatory cytokines
* calcium malabsorption
* activation of osteoclasts
Describe the stool of untreated coeliac patients [1]
Often greasy due to fat malabsorption
Which cancer is associated iwth coeliac? [1]
Enteropathy associated T cell lymphoma of smal intestine
Why may coeliac disease lead to fat malabsorption? [2]
Decrease in absorptive surface area
Decrease in absorption of fat soluble vitamins: ADEK
Describe what is meant by refractory coeliac disease [1]
Describe the two classifcations [2]
Refractory coeliac disease: persistent or recurrent symptoms and signs of malabsorption despite adherence to a strict gluten-free diet for at least 12 months. Believed to be independent of gluten since the gluten-free diet is not effective in preventing the lymphocytes from increasing.
Type I:
- Have < 20% abnormal lymphocytes
Type II:
- Have >20% abnormal lymphocytes
State why and explain which type of refractory coeliac disease is more prone to cancers [2]
Type II:
- Type II have a greater than 50 percent chance of the abnormal lymphocytes spreading outside the gut
- Causes: developing enteropathy-associated T-cell lymphoma (EATL)
Which type of cancer in the GI tract do coelaic patients suffer a risk of developing? [1]
Small bowel adenocarcinoma
Describe two neuorogical complications of coeliac disease [2]
Anti-gluten antibodies created by the immune system of patients with celiac disease in response to gluten are thought to damage nerves
Peripheral neuropathy: Coeliac disease can be associated with peripheral neuropathy, presenting as numbness, tingling, or burning sensations in the extremities.
Gluten ataxia: This rare neurological complication is characterized by gait disturbances, dysarthria, and nystagmus. A gluten-free diet may improve symptoms in some cases.
