Malaborption and Coeliac

Question 1

What is coeliac

Answer 1

Autoimmune
Abnormal reaction to Gliadin present in gluten
Inflammation via tissue transglutaminae
Villus atrophy and malabsorption

Question 2

What should raise high suspicion of coeliac

Answer 2

Diarrhoea
Weight loss 
Anaemia - iron, b12, folate (normochromic)
- Always think 
Abdo pain

Question 3

What should you do if someone has these symptoms

Answer 3

Coeliac serology

Must be on gluten to do this

Question 4

What are other features

Answer 4

FTT in young children 
Steatorrhoea
Fatigue / low energy 
Lethargy 
Dyspepsia
Bloating
Indigestion
Constipation
N+V
Features of malabsorption

Question 5

What are associated symptoms

Answer 5

Anaemia due to malabsorption 
Dermatitis herpetiforms
Clubbing
Ataxia
Peripheral neuropathy - can present with this in adults so always think 
Apthous ulceration
Angular stomatitis
Osteomalacia
FTT
Hyposplenism

Question 6

What are RF for coeliac

Answer 6

HLA DQ2 / DQ8
Autoimmune thyroid - always test if Dx 
Autoimmune gastritis hepatitis
Type 1 DM - always test if Dx 
IgA deficinet
IBS
PBC
Down's syndrome 
FH

Question 7

What do you do if patient Dx with type 1 DM / thyroid

Answer 7

Coeliac serology

Question 8

How do you Dx coeliac

Answer 8

Serology

• TTG IgA
• IgG if IgA deficient as not accurate
• Endomysial Ab

Distal duodenal biopsy

Must be on gluten for 6 weeks to do test

Question 9

What does biopsy show

Answer 9

Villous atrophy
Crypt hyperplasia
Lymphocyte
Do in endoscopy if looks normal but symptoms / iron anaemia

Question 10

What other tests

Answer 10

HLA status
FBC - decreased Hb, B12, ferritin
U+E, LFT, CRP
Vit D / Ca 
Stool culture
Thyroid
Calprotectin

Question 11

How do you Dx in children

Answer 11

Genetics + Sx can be enough
Serology
HLA status

Question 12

How do you Rx

Answer 12

Withdraw gluten
Dietician
Rechallenge if Dx <2 
Pneumococcal vaccine due to hyposplenism
Fix B12 before folate

Question 13

What are complications

Answer 13

Refractory disease = steroid
Iron deficiency / B12 so typically normocytic 
Vitamin deficiency 
Hypospleism
Ulceration / apathos stomatitis 
Osteporosis
Subfertility
Delayed puberty
Neuropathy
Small bowel lymphoma / NHL

Question 14

What are the most common causes of malabsorption / Ddx

Answer 14

Coeliac
IBD
Chronic pancreatitis
Amyloid
PBS
Biliary obstruction

Question 15

What are infectious causes of malbasorption

Answer 15

Tropical spure 
HIV
Giardia lambila
Cryptospordium
Traveller's
Whipples

Question 16

What is tropical spure

Answer 16

Folate or b12 deficiency causing inflammation

Question 17

What is Whipple’s

Answer 17

Middle age men
Malabsorption - diarrhoea / weight loss
Arthralgia
Abdominal pain
LN
CNS - seizure / dementia / ataxia / opthalmoplegia
Skin brain joints heart

Question 18

How do you Dx

Answer 18

Biopsy

Trepheryma Whipelli

Question 19

How do you Rx

Answer 19

Co-trimoxaole

Tetracycline

Question 20

How do you treat tropical supra

Answer 20

Tetracycline

FOlic acid

Question 21

How do you treat Giardia lambila

Answer 21

Metronidazole

Question 22

What are motility causes of malabsorption

Answer 22

Systemic sclerosis
Scleroderma
DM = stasis
Pseudo-obstruction

Question 23

What are iatrogenic causes

Answer 23

Gastric surgery
Short gut
Radiation
Drugs
Alcohol

Question 24

Pancreatic causes

Answer 24

CF
Pancreaitits
Cancer

Question 25

What are symptoms of malabsorption

Answer 25

``` Weight loss Diarrhoea Steathorrhea Bloating Fatigue Abdo pain ANaemia Muscle wasting ```

Question 26

How do you Dx malabsorption

Answer 26

``` FBC, Ca, B12, folate, lipids INR as risk of clotting defieincy Coeliac Stool microscopy Biopsy + endoscopy Test for infection ```

Question 27

What does vit A deficiency cause

Answer 27

Night blindess | Teratogenic

Question 28

What does vitamin B deficiency (thiamine = B1) cause

Answer 28

Memory loss Dementia Korsokoff / Weirnecke

Question 29

What does vitamin C defineicy cause

Answer 29

``` Scurvy Bleeding gums / epistaxis Dental Malaise Poor wound healing Gingivitis Bruises Weakness Arthralgia ```

Question 30

What does vitamin D deficiency cause

Answer 30

Osteomalacia | Metabolic bone disease

Question 31

What does vitamin K cause

Answer 31

Clotting issues

Question 32

What does hypo calcium cause

Answer 32

``` Spasms Tetany Trosseuks - spasm of hand when BP cuff cuts of blood Chovstek - touching face = spasm Neuropathy Check vit D and PTH ```

Question 33

What are the fat soluble vitamins

Answer 33

ADEK

Question 34

What is folic acid and B12 needed for

Answer 34

DNA Synthesis | Always replace B12 first to avoid degernation of spinal cord

Question 35

When are you at increased risk of b12 deficiency / folic

Answer 35

Pregnanc Alcohol Phenytoin Methotrexate

Question 36

What is phosphate important for

Answer 36

ATP | Respiration

Question 37

When do you test for coeliac

Answer 37

``` DM at diagnosis Autoimmune thyroid at Dx 1st degree with coeliac IBS Sx in adults Unexplained iron, b12 or folate deficiency Weight loss Fatigue Faltering growht Abdo / GI Sx ```

Question 38

What does niacin (B3) deficiency cause

Answer 38

``` Pellagra syndrome Dermatitis Diarrhoea Dementia Death ```