Small Bowel Disease Flashcards
Celiac Disease (CD) is what?
an immune disorder that is triggered by an environmental agent (the gliadin component in gluten) in genetically predisposed individuals
Describe the pathway for wheat digestion
Serologic studies are used to follow the course of the disease: 2
- IgA antibodies to gliadin
- IgA antibodies to endomysium
WHat are IgA antibodies to endomysium?
A structure of the smooth muscle connective tissue
-Its presence is nearly pathognomonic for CD
Gliadin receptors on intestinal epithelial cells may mediate what?
transport of gliadin peptides into the lamina propria where T cell activation occurs—this may someday lead to drug therapy for CD
Which is a normal small intestine and which as celiac?
Describe the PP of Celiac Disease
CD Classic Clinical manifestations
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- Diarrhea w/ bulking, foul-smelling, floating stools due to steatorrhea (malabsorption)
- Weight loss
- Vitamin deficiencies—B vitamins, iron, copper, zinc, vitamins A, D, E, & magnesium
- On small bowel biopsy—villlous atrophy
Atypical Manifestations of CD?4
- Minor GI symptoms
- Can have anemia, osteoporosis, arthritis
- Increased LFTs, neurological symptoms, or infertility
- Most show severe mucosal damage & possess the CD antibody pattern
- Silent CD is recognized how?
- Often have changes in what?
- How do they usually present?
- Recognized incidentally based upon screening for antibodies
- Often have some changes in mucosa of the small bowel
- They DO NOT show clinical symptoms but may complain of fatigue
Several studies have shown that patients with CD have a slight increased of malignancies: such as? 6
(but what is there a decrease in?)
- Non-Hodgkin’s lymphoma
- Small intestinal adenocarcinoma
- Hepatocellular carcinoma
- GI cancer
- Lymphoproliferative disease
- Hodgkin lymphoma
Studies also showed a DECREASED risk of breast cancer!
Associated Conditions with CD?
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- Dermatitia herpetiformis (autoimmune rash)
- Type I DM
- Down syndrome
- Liver disease
- Autoimmune thyroid disease
- GERD
- Inflammatory bowel disease
- Menstrual and reproductive issues in women
- Infertility in men
What is this a picture of?
Dermatitis herpitiformis
Baseline Serology–Diagnosis
- What should we begin with?
- What are these?
- Used in what ages?
- Begin w/ IgA anti-tissue transglutaminase (TTG):
- Auto-antibodies against the bodies on tranglutiminases***
- Used for anyone over the age of 2
Single preferred test for detection of CD!
If High probability of disease & if IgA based serology is negative: What tests should we do? 2
- Test Total IgA or
- IgG-deaminated gliadin peptides (DGP)