Celiac Flashcards
(18 cards)
Diarrhea+ epilepsy+ occipital calcification
Celiac disease
ليه اسم تاني؟
Gluten sensitivity enteropathy
Diarrhea+pruritic rash on extensor surface of the arm(dermatitis herptiformis)
Celiac
Diarrhea+iron difeceny anemia+ibs like symptoms+low caroten
Celiac
Diarrhea+low caroten+iron difeceny anemia+ howell jolly bodies + villous atrophy
Celiac
Low caroten
يعني ايه
يعني malabsorption
Howell joly boies in peripheral smear
يعني ايه
يعني
Hypospleenism
- With respect to celiac disease which statement is false?
A. It is the most common non-surgical cause of asplenia
B. It can be associated with Down syndrome and idiopathic pericarditis
C. The biopsy reveals intraepithelial lymphocytosis
D. African-Americans are at increased risk if they are lactose intolerant
E. Up to 6% of patients with irritable bowel syndrome turn out to have celia
D
A 6 year old male develops a duodenal hematoma after routine endoscopy for evaluation of his
chronic diarrhea and failure to thrive. Biopsies shows subtotal villous atrophy, atrophic villi, enlarged
crypts with large amounts of inflammatory cells. The patient is diagnosed with celiac disease Marsh
3b. What vitamin deficiency contributed to the formation of the duodenal hematoma during the
endoscopy?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
D
Which of the following could distinguish celiac disease from autoimmune enteropathy on small
bowel biopsies?
A. The degree of villous blunting is far less in autoimmune enteropathy
B. An increased number of plasma cells in the lamina propria in autoimmune enteropathy
C. The lack of increased intraepithelial lymphocytes in autoimmune enteropathy
D. The patchy nature of scalloped and ulcerated mucosa seen in autoimmune enteropathy
E. The increased presence of submucosal eosinophils in autoimmune enteropathy
D
Celiac mnemonics
C..cell mediated immunity
E…european descent
L… lymphocytes in lamina propria, lymphoma as a complication
I.. Iron difeceny anemia.. intolerance to gluten
A… atrophy in velli of small intestine .. abnormal D xylose test
C… childhood in preparation
C/p
1- malabsorption syndrome
2-IDA…15%of IDA is celiac
3-unexplained elevated liver enzymes
4-unexplained hypospleenism
(Howell - jolley bodies in pripheral smear)
5-unexplained infertility
6- Dermatitis herptiformis
(Vesicular skin lesion+ itching in extensor surfaces of the arm)
Found in 25%of celiac…
Every Dermatitis herptiformis is celiac
7- othe autoimmune diseases as.. hypothyroidism,sojgern,aih
8- Oral aphtus ulcera
Diagnosis
Patient must be on gluten containing diet during diagnosis
1-serology
**Ttg iga , serum total iga
If there is iga enteropathy, ttg igg is asked
**HLA-DQ2 and HLA-DQ8 on chromosome 6.
95% of patient have the HLA-DQ2 , and the other 5%
the HLA-DQ8
Absence of both alleles rules out the diagnosis of celiac disease (i.e., negative predictive value is ~100%)
*Endomeseal abs…only for follow up and monitoring
Biopsies?
Small bowel biopsies should be obtained in all adult patients with suspicion of celiac disease to confirm
the diagnosis and allow for a baseline before starting gluten free diet.
Endoscopic findings in celiac disease: mucosal fissuring, scalloping, nodularity, and loss of villi.
These findings have low sensitivity (50-60%).
Always obtain mucosal biopsies, even if the duodenal mucosa appears normal.
o Take four biopsies from the distal second portion, and 1-2 biopsies from the bulb.
o Most patients with celiac disease have duodenal involvement +/- jejunal patchy enteropathy,
however, few patients (<5%) may have patchy jejunal enteropathy alone.
Marsh classification
1-March 0
Normal IELs
Normal crypts
Normal villi
2-Marsh 1 – Infiltrative lesion
*Increased intraepithelial lymphocytes (IELs) (>30 per 100 enterocytes in dudenum & 40per 100 enterocytes in jujenum)
Normal crypts.
Normal villi structure.
3-marsh 2
*Increased IELs
*Crypt hyperplasia (crypts are enlarged and more active)
*normal villi
3-Marsh 3
A
*Increased IELs
*Crypt hyperplasia
* Partial villous atrophy.
B
*Increased IELs
*Crypt hyperplasia
* Subtotal villous atrophy
C
*Increased IELs
*Crypt hyperplasia
* Total villous atrophy
Treatment
1-Refer to a dietician to start a gluten free diet (GFD).
Patients should avoid all wheat, barley, and rye.
o This food should not contain any ingredient that is any type of wheat قمح, rye , barley الشعير, or crossbreeds of
these grains. It should contain less than 20 parts per million of gluten.
2- Check for nutritional deficiencies (A, D, E, B12, folate, iron, copper, zinc) and supplement as
3- Larazotide acetate is a new oral peptide that modulates intestinal permeability through its effects on tight
junctions. This leads to decreased permeability and decreased passage of active gluten peptides.
4-Latiglutenase is a mixture of two gluten-specific recombinant proteases that degrades gluten proteins before reaching intestine
Refractory celiac
symptomatic severe villous atrophy despite a confirmed gluten free diet of at least 6 months.
*Refractory celiac disease is divided into two types:
Type 1 refractory celiac disease
o This is less severe than type 2
o Small intestinal biopsy shows normal (polyclonal) intraepithelial lymphocytes (IELs).
Type 2 refractory celiac disease
o This is a more severe
o Characterized by the presence of an abnormal clonal population of IELs. These can demonstrate loss
of normal CD3 or CD8 expression.
o This type can progress to enteropathy-associated T-cell lymphoma (EATL) ,
ulcerative jejunoileitis, or rarely to mesenteric lymph node cavitations.
o Evaluate for lymphoma using enteroscopy, capsule endoscopy, CT, MRI, or PET scan.
Treatment options include glucocorticoids (prednisone, budesonide) and thiopurines.
Complications
1-lymphoma
2-ulcerative jejunoileitis
A 17-yearold female presented with diarrhea for the last 4 years. She passes 4-5 large
volume stools daily, frothy, greasy, foul smelling and contain undigested food materials.
No mucous or blood in stool. She has post prandial bloating, generalized weakness and
easy fatigability. No fever or joint pain. She has amenorrhea since 3 years. Examination
showed underbuilt pale female. Hematological and biochemical investigations were
significant for low hemoglobin 8 gm/dL, and mild elevation of ALT and AST.
A-What is your provisional diagnosis and illustrate how to confirm this diagnosi
Celiac
