IBD and coeliac Flashcards
what is coeliac disease?
- autoimmune condition where exposure to cgluten can cause inflamation of the small intestines
what is targeted by the autoantibodies in coeliac disease?
epithelial cells of the intestine- especiallyu the jejunum
leads to atrophy of the intestinal villli which are important for absorbing nuetrients
what are the antibodies involved in coeliac?
- anti-tissue transglutaminase (anti TT-G)
- anti endomysial (anti-EMA)
- deaminated gliadin peptides (anti DGP)
what is the presentation of coelaic disease?
Failure to thrive in young children Diarrhoea Fatigue Weight loss Mouth ulcers Anaemia secondary to iron, B12 or folate deficiency
Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen
what conditions is coeliac disease linked with?
T1DM- test all patients with a new diagnosis of diabetes
also. ..
- thyroid disease
- autoimmune hepatitis
- billiary scerosis
- psc
- downs syndrome
what investigations need to be carried out and what precautions need to be taken when testing for coeliac?
check for antibodies:
- anti-ttg- first choice
- antiendomysial
- check for total IGA first as some patients can have IGA deficiencey which can lead to false negative result
endoscopy:
- crypt hypertrophy
- villous atrophy
what are complications of untreated coeliac?
Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) of the intestine Non-Hodgkin lymphoma (NHL) Small bowel adenocarcinoma (rare)
what is the treatment for coeliac disease?
lifelong gluten free diet- curative
what is the mneunonic for crohns?
Crohn’s (crows NESTS)
N – No blood or mucus (these are less common in Crohns.)
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)
what is the mneumonic for UC?
Ulcerative Colitis (remember U – C – CLOSEUP)
C – Continuous inflammation L – Limited to colon and rectum O – Only superficial mucosa affected S – Smoking is protective E – Excrete blood and mucus U – Use aminosalicylates P – Primary sclerosing cholangitis
what tests are used for IBD?
Faecal calprotectin is released by the intestines when inflamed. It is a useful screening test and is more than 90% sensitive and specific for IBD in adults.
Endoscopy (OGD and colonoscopy) with biopsy is the gold standard investigation for diagnosis of IBD.
Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.
how is remission induced in crohns?
steroids are first line - oral prednisolone or IV hydrocortisone
how is remission maintained in crohns?
azothrioprine and mecaptopurine
how is remision induced in UC?
aminosalycicaltes (mesalazine) and steroids
how is remission maintained in UC?
aminosalicyclate (mesalaxine) and azothrioprine
