Weight Loss

Question 1

What are the differentials for unintentional weight loss?

Answer 1

stomach cancer, colorectal cancer, pancreatic cancer, lung cancer, lymphoma, leukaemia, prostate/ breast cancer, Crohn’s, ulcerative colitis, coeliac disease, pancreatic insufficiency, depression, bipolar disease, dementia, hyperthyroidism, anorexia

Question 2

What are the symptoms of coeliac disease?

Answer 2

diarrhoea, bloating, abdominal pain/discomfort, fatigue

Question 3

What are the signs of coeliac disease?

Answer 3

pallor, dermatitis herpetiformis

Question 4

What first line investigations would you do in coeliac diseases?

Answer 4

IgA-tissue transglutaminase (tTG) level: elevated titre

IgG-deamidated gliadin peptide (DGP) level: elevated titre

Question 5

What other investigations would you consider in coeliac disease?

Answer 5

total IgA level: may be low

endoscopy with small bowel biopsy: villous atrophy, increased lymphocytes