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Gastrointestinal > Malabsorption & Coeliac Disease > Flashcards

Malabsorption & Coeliac Disease Flashcards

1
Q

What is Coeliac Disease?

A

An autoimmune condition where the immune system recognises gluten as something foreign

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2
Q

Is Coeliac common?

A

Yes, 1 in 100 people in European derived populations

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3
Q

What causes Coeliac to develop?

A

Genetics: links have been found with Coeliac and certain HLA IIs

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4
Q

What part of gluten is the body intolerant to?

A

Alpha-gliadin is the toxic bit of gluten

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5
Q

What’s the pathogenesis of Coeliac?

A

Epithelium is damaged by infection for example

Gliadin moves from the lumen through the epithelium

APC’s recognise gliadin as foreign, and presents it to T cell

T cells stimulate plasma cells to make antibodies against gliadin

T cells release cytokines that damage epithelial cells

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6
Q

What age does Coeliac usually present?

A

Infancy
Second peak around age 40-50

But can present at any age

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7
Q

Clinical features of Coeliac disease.

A

Diarrhoea + steatorrhoea

Stools with offensive smell

Abdominal pain + distension

Nausea + vomiting

Weight loss, fatigue, failure to thrive

Anaemia + nutritional deficiency

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8
Q

Investigations for Coeliac disease.

A

Serum antibodies: anti-gliadin
(they need to keep eating gluten until you do this test!)

Low Hb, ferritin + folate

Endoscopy: look for damage

Jejunal biopsy: villous atrophy + crypt hyperplasia

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9
Q

Why do Coeliac patients get anaemia?

A

They can’t absorb iron from their food as well as they should

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10
Q

Where in the body does Coeliac affect?

A

Mainly small intestine

Skin: dermatitis herpeteformis

Cerebellar dysfunction (rarely)

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11
Q

What does dermatitis herpeteformis look like?

A

Red, raised patches with blisters that burst with scratching

Severe itching and stinging

Elbows, knees, buttocks

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12
Q

What happens to the enterocytes in Coeliac?

A

Villous atrophy

Crypt hyperplasia

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13
Q

Why does Coeliac cause malabsorption?

A

Loss of villi and damage to enterocytes mean they can’t absorb nutrients from the gut as effectively

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14
Q

Management of Coeliac?

A

Gluten-free diet for life

Symptoms will disappear if gluten is removed completely

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15
Q

What cancers are Coeliac patients more at risk of?

A

T cell lymphomas

Gastric, oesophageal, bladder many more

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16
Q

What is malabsorption?

A

Problems with absorption of food nutrients across the gastrointestinal tract

17
Q

What are the clinical features of malabsorption?

A

Weight loss despite eating normally

Diarrhoea + steatorrhoea

Anaemia

General malnutrition

18
Q

When faced with a patient you suspect of malnutrition what should you first rule out?

A

Whether they are eating enough, think of things like anorexia

19
Q

What are the 5 different types of causes of malabsorption?

A
  1. Defective intraluminal digestion
  2. Insufficient absorptive area
  3. Lack of digestive enzymes
  4. Defective epithelial transport
  5. Lymphatic obstruction
20
Q

What could cause defective intraluminal digestion in the small bowel?

A

Intraluminal digestion = occurs in the lumen, before absorption

  1. Pancreatic insufficiency: lack of enzyme production
  2. Cystic fibrosis: enzymes can’t get from pancreas to lumen due to excess mucus
  3. Defective bile secretion: would lead to lack of fat solubilisation
  4. Bacterial overgrowth
21
Q

What could cause insufficient absorptive area in the small bowel?

A

Coeliac disease: villous atrophy

Crohn’s: scarring + fibrosis

Giardia Lamblia: parasites absorb nutrients before the gut can

22
Q

What is an example of lack of digestive enzymes that could cause malabsorption?

A

Lactose intolerance: lack of lactase

23
Q

What is another name for Coeliac disease?

A

Gluten sensitive enteropathy

24
Q

What could cause defective epithelial transport in the small bowel?

A

Primary bile acid malabsorption: mutations in bile acid transporter protein

Abetalipoproteinaemia: rare genetic problem with absorption of fat and fat soluble vitamins

25
Q

What could cause lymphatic obstruction?

A

Lymphoma

TB

26
Q

Investigations for malabsorption?

A

FBC: low iron, B12, folate

Stool: look for excess fat, infection

Endoscopy: look for Crohn’s, Coeliac

Biopsy

27
Q

What is tropical sprue?

A

A disease that causes abnormal flattening of the villi and inflammation of the lining of the small intestine

Occurs in far and middle east and Caribbean

Unknown cause, thought to be due to a persistent infection

28
Q

What are the symptoms of tropical sprue?

A

Same as Coeliac

Vitamin deficiency if left untreated

29
Q

Treatment of tropical sprue?

A

Antibiotics: tetracycline

Gastrointestinal (20 decks)

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