Celiac disease

Question 1

what is the definition of celiac disease?

Answer 1

Chronic small intestine immune mediated enteropathy that is precipitated by dietary gluten in genetically predisposed individuals

Question 2

characteristics of celiac disease ?

Answer 2

Villi atroph of small intestinal mucosa

Associated with malabsorption of nutreints

Prompt clinical and subsequent HISTOLOGIC IMPROVEMENT after strict adherence to a GLUTEN free diet

Clinical histologic Relapse when gluten is reintroduced

Question 3

what names of Celiac disease ?

Answer 3

Nontropical sprue

Idiopathic steatorrhea

Primary malabsorption

Celiac syndrome

Celiac sprue

Gluten sensitive enteropathy

Adult celiac disease

Question 4

Gluten related disorders?

Answer 4

Celiac disease

Wheat allergy

Gluten ataxia

Dermaitis herpetiformis

non celiac gluten sensitivity

Question 5

characteristics of LATENT CELIAC?

Answer 5

Genetic susceptibility Present ( its present in all ) ( 7ta some person are healthy and have this genetic susceptibility )

MAY have positive antibodies

No histological findings

NO SYMPTOMS

at risk of developing celiac disease in the future

Question 6

characteristics silent celiac?

Answer 6

Positive antibodies

Positive histological findings

NO SYMPTOMS YET ( SILENT )

complication like anemia can develop

Question 7

classic celiac disease ?

Answer 7

Positive antibodies

positive histological findings

HAS SYMPTOMSMSSS :

If classic celiac = GI symtpoms , diarrhea and weight loss and malabsorption

IF atypical celiac —> NO GI SYMPTOMS = anemia, osteoporosis , neurological issues

Question 8

spectrum of clinical presentation of celiac ?

Answer 8

Typical/classical celiac disease

Atypical celiac disease

Asymptomatic SILENT celiac disease

Potential / Latent celiac disease

Non responsive celiac disease –> Refractory celiac disease

Question 9

envirornmental factors that lead to problems in celiac disease ?

Answer 9

WHEAT PROTEINS :

Prolamines/Gliadins –> Soluble in ethanol

Glutenis –> Partially soluble in diluted acid or alkali solution

Globulin ( soluble in 10% NaCl)

Albumins ( Soluble in water)

Prolamins /Gliadins and GLUTENESIS -> GLUTEN

Gliadins have 4 majors fractions that range in molecular weight from 20 to 75kd

Question 10

what are the genetic mutations of Celiac disease ?

Answer 10

HLA-DQ2 Chromosome 6 —> MOST COOMON 90%

HLA-DQ8–> 10% of the patients , less common

Question 11

what are the cytokines proinflammatory in celiac disease ?

Answer 11

IFN Y

TNF Alpha

TGF B

IL-2

IL-6

Question 12

Marsh stages?

Answer 12

Stage 0 –> normal

Stage 1—> Increased intraepithelial lymphocytes followed by infiltration of lamina propria

Stage2–> CRYPT hyperplasia

Stage 3—> Villus atrophy

stage 4—> Total mucosal atrophy ( loss of villi, enhanced apoptosis )

Question 13

typical symptoms of CD?

Answer 13

sign and symptoms of malabsorption :

Diarrhea

Steatorrhea

weight loss

Nutritional deficiencies

Question 14

atypical symptoms of CD?

Answer 14

Anemia

Fatigue

Abdominal bloating and discomfort

osteoporosis

infertility

Question 15

childhood presentation of CD?

Answer 15

diarrhea

steatorrhea

Cramping abdominal

Abdominal distention

Apathy and irritability

Muscle wasting

Hypotonia

Failure to thrive and short stature

Nutriotnal deficiences

Anemia

Rickets

Question 16

first skin manifestation of CD?

Answer 16

Dermatitis Herpetiformis ( type 3 tTg autoimmunity )

small vesicles like red dots or rash

Question 17

what is the best test with highest sensitivity and specifity for CD?

Answer 17

Tissue transglutaminase igA antibody

but some patients have igA deficiency problem so sometimes CD patients show negative igA so here need to do DQ

Question 18

another alternative for tissue transglulataminase igA test?

Answer 18

Anti endomysium igA antibody

if not tissue transam then go for anti endomysium

Question 19

last hope?

Answer 19

Antigliadin igA antibody

low specificity but ya3ni last hope

Question 20

is HLADQ2 /8 routine practice ?

Answer 20

No

Expensive, requrie time, too many problems

genetics is expensive

we do serology, tissue transaminase , anti endomyious

Question 21

DQ and CD?

Answer 21

not all patient with DQ develop CD

ALL patients with CD have DQ

NO DQ= NO CD

Question 22

what are disease associated with CD?

Answer 22

if you see them you need to screen for celiac :

Dermatitis herpetiformis

DM type 1

Down syndrome

Autoimmune hypothyroidism or hyperthyroidism

ATAXIA

Immunoglobulin igA deficiency

Question 23

disease that is not associated with CD whatsoever?

Answer 23

DM type 2

in fact CD protect from DM TYPE 2

Question 24

Patients who need to be screened for celiacl?

Answer 24

GI malabsorption problems

Malaise –> long standing malaise and farigue ( Tired of all time )

Hematologic–> unexplained iron defic anemia

Metabolic bone diseaes-> Vitamind D deficiency, osteoporosis

Question 25

what are the treatment options for CD?

Answer 25

Gluten free diet --> only known treatment and its life long we can give steroids if gluten free diet is not enough we need to give them supplements cuz they are lacking on some nutrients cuz no gluten

Question 26

when do we diagnosis Refractory/non resposnive celiac diseae ?

Answer 26

Persistence of symptoms and signs and abnormalities DESPITE ADHERE TO DIET FOR 6-12 MONTH 10% of patients with CD are nonresposnive in this case u need to confirm that its celiac cuz it could be something else and adjust diet and monitor the progress

Question 27

CD and malignancies ?

Answer 27

T cell lymphomas non hodgking lymphoma