012115 gluten sensitivity Flashcards Preview

Gastrointes 3 > 012115 gluten sensitivity > Flashcards

Flashcards in 012115 gluten sensitivity Deck (22):
1

classic celiac disease-symptoms

diarrhea, bloating, abdominal pain, weight loss

2

can you have antibodies of celiac disease but no celiac sprue

yes

3

can you have DQ2 or DQ8 genetic susceptibility for celiac disease but not have celiac disease

yes

4

atypical celiac disease-symptoms

iron deficiency
osteoporosis
dermatitis herpetiformis
IBS
DM type I
elevated LFTs

5

celiac disease affects what area?

sm intes
most common is duodenum (think Ca, phosphorous, iron absorption)

6

non GI presentation of celiac disease

unexplained iron deficiency anemia
folic acid or vit B12 defic
reduced serum albumin
unexplained elevated LFTs
other autoimmune disorders
Down syndrome and Turner syndrome
selective IgA deficiency
neurologic problems
gynecologic and fertility problems

7

how does dermatitis herpetiformis present?

pruritic
papulovesicles
extensor surface of extremities and trunk
85% have celiac dis

8

most common non-GI presentation of celiac dis

osteopenia/osteoporosis

9

what are neurologic symptoms of celiac dis

ataxia
night blindness (vit A)
seizures
headaches
epilepsy
mood disturbances
peripheral neuropathies

due to fat and vitamin malabsorption

10

what kind of gynceologic and fertility problems can there be in CD pts?

amenorrhea in untreated
infertility in untreated
spontaneous abortions
intrauterine fetal growth retardation

11

mechanism of celiac dis

gluten in gut gets broken down to gliadin
gliadin is converted to deamidated gliadin by tissue transglutaminase (tTG)

deamidated gliadin is presented by APC with HLA DQ2 or DQ8. activates T cell. activates B cell to produce anti-gliadin, anti-endomysium, anti-tTG

12

how to diagnose CD

IgA endomysial antibody (EMA)
IgA tissue transglutaminase (tTG)
IgA and IgG DEAMIDATED gliadin antibodies

IgA level may be helpful in the case of IgA deficiency

if IgA is positive, do multiple sm intes biopsies

13

biopsy of CD

scalloping or notching of small bowel
villous atrophy, intraepithelial lymphocytosis, crypt hyperplasia

14

genetics of CD

HLA class II:
95% have DQ2 heterodimer
5% have DQ8 heterodimer

15

gluten free diet-what to avoid

wheat, rye, barley
malt
meds with gluten

16

why should you treat asymptomatic CD pt?

long term prognosis-four fold increase in all cause mortality (due to cardiovascular disease and malignancy)

17

malignant complications of CD

enteropathy associated T cell lymphoma

18

wheat allergy

classic food allergy that affects skin, GI tract. (sometimes respiratory tract)

IgE mediated

IgE mediated diseases associated w/ wheat allergy are baker's asthma, rhinitis, contact urticaria, wheat -dependent exercise induced anaphylaxis

19

what findings are normal in wheat allergy?

normal intestinal mucosa (as opposed to CD)
normal antibodies (as opposed to CD)

20

symptoms of celiac dis vs wheat allergy

in both, you see intestinal and extraintes symptoms

gastorintestinal symptoms are not distinguishable btwn the two

21

tropical sprue

syndrome of stunted growth and diarrhea (common in developing countries)

22

is atypical or classic celiac dis presentaiton more common?

atypical