Coeliac disease

Question 1

When does coeliac disease usually present in kids

Answer 1

may occur at any age

-usually noticed at 6-9 months when child is weaning (introduction of gluten)

Question 2

presenatino of coeliac disease in children 7

Answer 2

1. stools- normal to pale and bulky
2. abdo distened
3. buttocks wasted
4. failure to thrive
5. mouth ulcers
6. anaemia seocndary to iron, B12 or folate deifcicey
7. dermatitis herptiformis -ithcy blisteing skin rah typically on abdomen

*-rarely- neurosyx
-peripehral neuropathy
cerebellar ataxia
epilepsy

Question 3

what shoudl always be tested in conjuction with coeliac disease

Answer 3

if a patient presents with new type 1 diabetes
-test for coeliac disease
-conditions are often linked

Question 4

autoantibodies found in coeliac disease 2

Answer 4

1. anti-TTG
2. anti-EMA

Question 5

where in the bowel does coeliac disease typically afect 1
-what does it cause 1

Answer 5

jejunum
-atrophy of intestinal villi

Question 6

genetic associations to coeliac disease 2

Answer 6

HLA-DQ2
HLA-DQ8

Question 7

what type of Ig are anti-ttg and anti-ema
-why is this imporatnt to remeber during testing

Answer 7

IgA
-important to test for total Immunoglobulin A levels because if total IgA is low the coeliac test will be negative even when they have the condition. In this circumstance you can test for the IgG version of the anti-TTG or anti-EMA antibodies or do an endoscopy with biopsies.

Question 8

important point about carrying out investiagtions in patients with coeliac disease

Answer 8

must remain on diet containing gluten otherwise may not be possible to detec antiboides or inflam in the bowel

Question 9

what must be checked before testing specific autoantiboides in coeliac disease

Answer 9

total immunoglobulin A levels to exclude IgA deficiency

Question 10

what will endoscopy and intestinal biopsy in coeliac disease show 4

Answer 10

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

Question 11

investigations for coeliac disease

Answer 11

TTG-IgA- highly sensitive and speicic
-if >10n TTG diagnoiss can be made with repated bloods and a trained dietician

moderaltely elevated TTG- duodenal mucosal biospy is necessary

Question 12

what histological changes are seen on duodenal mucosal biopsy in coeliac disease3

Answer 12

1. villous atrophy
2. crypt hyperplasia
   inreased intraepithelial lymphocytosis

Question 13

What conditions are coeliac disease associated with 6

Answer 13

1. Type 1 diabetes
2. Thyroid disease
3. Autoimmune hepatitis
4. Primary biliary cirrhosis
5. Primary sclerosing cholangitis
6. Down’s syndrome

Question 14

complications of untreated coeliac disease 7

Answer 14

1. Vitamin deficiency
2. Anaemia
3. Osteoporosis
4. Ulcerative jejunitis
5. Enteropathy-associated T-cell lymphoma (EATL) of the intestine
6. non-Hodgkin lymphoma (NHL)
7. Small bowel adenocarcinoma (rare)

Question 15

coeliac disease management 1

Answer 15

life long gluten free diet