Inflammatory Bowel Disease/ Coeliac disease

Question 1

If you have a first degree relative with coeliac disease then what is the chance you have it?

Answer 1

In in 10

Question 2

What are the classical features of coeliac disease?

Answer 2

diarrhoea, weight loss, iron/ folate deficiency, abdominal bloating
malaise, lethargy
flatulence
mouth ulceration
alternating diarrhoea and constipation
pale and thin patient

Question 3

What are diagnostic features of coeliac disease?

Answer 3

• elevated faecal fat
• villous atrophy on duodenal biopsy
• IgA antigliadin antibodies (screening- limited)
• IgA anti-endomysial antibodies (>90% sensitivity and specificity)
• IgA transglutaminase antibodies (>90% sensitivity and specificity)

Question 4

What are some conditions that may be associated with coeliac disease?

Answer 4

iron deficiency anaemia
type 1 diabetes
pernicious anaemia
primary biliary cirrhosis
subfertility
malignancy especially lymphoma
dermatitis herpatiformis
IgA deficiency
Autoimmune thyroid disease
Osteoporosis
Neurological (eg seizures, ataxia, peripheral neuropathy)
Down Syndrome

Question 5

What is the management of coeliac disease?

Answer 5

Diet control- gluten free
treat specific vitamin and mineral deficiencies
give pneumococcal vaccination (increased risk of pneumococcal sepsis)

Question 6

What symptoms make you suspect inflammatory bowel disease?

Answer 6

bloody diarrhoea + mucus
colonic pain + fever
constitutional symptoms eg weight loss and malaise
extra-abdominal manifestations such as arthralgias

Question 7

What are the clinical features of ulcerative colitis?

Answer 7

mainly western
mainly young adults (15-40)
high risk: family history, previous attacks, low fibre diet
recurrent attacks of loose stool
blood and/ or mucus in stool
slight or absent abdominal pain
uncommon fever, malaise, weight loss
begins in rectum and continues proximally. Does not usually spread beyong ileovaecal valve
increased risk of carconoma after 7-10 years
main symptom bloody diarrheoa
recurrent attacks common

Question 8

What are the clinical features of Crohn disease?

Answer 8

recurrent diarrhoea in a young person (15-40 years)
blood and mucus in stools (less than U/C)
colicky abdominal pain
RIF pain
constitutional symptoms eg fever, weight loss, malaise, anorexia, nause
perianal disorders eg anal fissure, fistula, ischiorectal abscess
mouth ulcers
skip lesions