Flashcards
Coeliac Disease
Cards in this deck (18)
- 1What genetic finding is often seen in patients with Coeliac disease? Does this guarantee development of Coeliac?HLA-DQ2 (95%) and HLA-DQ8, found on antigen presenting cells.
Not everyone with these genotypes will develop coeliac - 2What food types should people with CD avoid?Wheat, barley and rye.
e.g. breads, pastas, cereals, soups, beer - 3What causes coeliac?Loss of immune tolerance to peptide antigens derived from prolamins in wheat (gliadin), rye (secalin), barley (hordein).
- 4What is the most toxic gluten protein?α-gliadin
- 5What are the 7 ways an adult may present with coeliac?- Symptomatic
- Chronic or recurrent IDA
- Nutritional deficiency
- Reduced fertility/amenorrhoea
- OP
- Unexplained raised AST/ALT
- Neurological/psychiatric symptoms - 6What are common symptoms of coeliac disease in adults?Diarrhoea
Bloating
Flatulence
Abdo discomfort
Weight loss
(50% have no history of diarrhoea, may be constipated) - 7What skin features might be seen in CDa and how might it be diagnosed?Dermatitis Herpetiformis
- Itchy papules and vesicles on normal or reddened skin which are symmetrical.
- Commonly over extensor surfaces of elbows and knees, as well as shoulders, buttocks and scalp
- Very itchy and so vesicles rarely actually seen - may present with excoriations
- Skin biopsy is usually necessary to confirm dermatitis herpetiformis. - 8What are characteristics of the diarrhoea seen in CD?Diarrhoea is watery, high volume, rarely bloody and may be steatorrhea due to reduced fat absorption.
- 9What is the gold standard diagnostic tool for CD?Endoscopy with at least 4 duodenal biopsies.
- 10What serology can be carried out to diagnose CD?- Anti-tTG (Iga tTG): reflects degree of mucosal damage (those with low or normal levels and only minimal histological changes may still have coeliac disease).
- Anti-EMA (endomysial) Ab: greater specificity, lower sensitivity. May be used if Iga-tTG is unavailable - 11What are the main histological findings in CD?- Intraepithelial lymphocytosis
- Crypt hyperplasia
- Villous atrophy - 12What can be used to classify the histological changes in CD? What are the different types.Modified Marsh Classification System
-Type 0 - normal villi and normal number of IELS
-Type 1 - normal villi and increased number of IELS
-Type 2 - normal villi, increased number of IELS and crypt hyperplasia
-Type 3a - partial villous atrophy, increased number of IELS and crypt hyperplasia
-Type 3b - subtotal villous atrophy, increased number of IELS and crypt hyperplasia
-Type 3c - total villous atrophy, increased number of IELS and crypt hyperplasia - 13What are complications of CD?- Anaemia
- Dermatitis herpetiformis
- Malignancy (including intestinal and extra-intestinal lymphoma and carcinomas of upper GI tract)
- Hyposplenism
-Lactose intolerance
- Osteoporosis/fractures - 14What vaccination should newly diagnosed CD patients receive and why?Against pneumococcus, as hyposplenism may result in increased infection with encapsulated bacteria
- 15What are the endoscopy findings in CD?May be normal.
- Atrophy and scalloping of mucosal folds.
- Paucity of folds
- Mosaic pattern - 'cracked mud'
- Prominent submucosal blood vessels
- Nodular pattern to mucosa. - 16What can cause false -ve CD serology results?IgA deficiency
- 17What are disorders associated with CD?- T1DM
- Thyrotoxicosis
- Addison's disease
- Dermatitis herpetiformis - 18What malignancies are people with CD at risk of?- Enteropathy-associated T-cell lymphoma (EATL) - type of NHL
- Small bowel adenocarcinoma
-Oesophageal and colonic adenocarcinoma
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- Gastroenterology Flashcards on Coeliac Disease, created by Jenna Paterson on 20/10/2020.
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- Jenna Paterson
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