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Flashcards in Celiac disease Deck (29):
1

Celiac disease is an ______ disease characterized by chronic intestinal inflammation and varying degrees of intestinal mucosal atrophy and malabsorption

autoimmune

2

Describe the classic presentation of celiac disease

weight loss, watery diarrhea, and steatorrhea with a tympanitic, doughy abdomen on exam

only 10% of patients

3

List non-classical or other signs of celiac

weight gain and obesity
gastroesophageal reflux disease
irritable bowel syndrome with abdominal pain and constipation,
pancreatitis
myocarditis,
aphthous ulcers of the oral mucosa
lymphocytic and collagenous colitis
hyposplenism
asymptomatic IgA nephropathy

4

What factors constitute "minimal disease" in celiac?

iron and folate deficiency
osteogenic bone disease- Ca and Vitamin D deficiency
Bloating and cramping only

5

List factors that constitute severe disease in celiac

Nutritional deficiencies
megaloblastic anemia
neurologic disease (B12)
profound diarrhea
infertility
weight loss

6

Celiac is an immunologic reaction to the gluten protein in wheat called _____ or structurally similar proteins in rye and barley

gliadin

7

The most severe involvement in celiac disease is in the ________ where fragments of indigestible peptides are at highest concentration

upper small bowel, beginning in duodenum

8

Celiac disease is driven by _________ in the small bowel, a population of intraepithelial lymphocytes

gamma delta T cells

9

Describe the pathologic molecular mimicry in celiac disease

Alpha-gliadin is similar to the E1b
protein of the human adenovirus serotype 12 (Ad12).
Ad12 is usually found in the human digestive tract. The E1b protein causes inflammation in celiac patients.

10

List the triad of factors that leads to celiac disease

environmental trigger- alpha gliadin similar to E1b of Ad12

genetic predisposition- DQ2, DQ8

leaky gut- zonuin increases intestinal permeability

11

How does genetic predisposition contribute to celiac pathophysiology?

Patients have genes for HLA-DQ2 or DQ8 on APCs
tTG binds to DQ2/DQ8 and presents to T cells which mount an immune response

12

How do patients with celiac disease develop a leaky gut?

The tight junctions of the small intestine’s epithelium can be made more permeable through the action of the protein zonulin, which is secreted by the epithelial lining

In normal circumstances, zonulin allows for trafficking of immune cells, fluid, and large proteins.
The zonulin protein is mimicked by proteins manufactured by certain bacteria

13

What is the function of zonulin in normal circumstances?

allows for trafficking of immune cells, fluid, and large proteins.

14

_____ is mimicked by proteins manufactured by some bacterial, so people with a genetic predisposition can develop celiac disease when exposed to environmental bacterial triggers

zonulin

15

List antibody markers associated with celiac disease

best: anti-tTG IgA
others: anti-gliadin IgG/IgA

16

___ deficiency is present in 2% of celiac patients and can make some diagnostic tests falsely negative

IgA

17

__________ are no considered not just an epiphenomenon but play a role in disease process

tTG antibodies

18

Describe the histologic findings of duodenal tissue biopsy in celiac disease

villus atrophy
crypt hyperplasia
mucosal inflammation
increased intraepithelial lymphocytes

19

False negative biopsy results will be obtained if a patient adopts __________ prior to biopsy

gluten free diet

20

List conditions on the differential diagnosis for celiac

infectious gastroenteritis or bacterial overgrowth
eosinophilic enteritis
HIV
lymphoma
Zollinger-Ellison syndrome
ischemic or radiation damage
starvation

21

The mainstay of treatment of celiac disease is:

gluten free diet
must avoid wheat, barely, rye

22

List complications of full blown celiac disease

osteoporosis, short stature, chronic anemia, microscopic colitis, pancreatic insufficiency, lactose intolerance

23

In celiac, selection for certain clones of immune cells may predispose for transformation to _______

lymphoma

24

_________ is a severe form of celiac that is not responsive to diet change and would be concerning for possibly progressing to or masking lymphoma

ulcerative jejunoileitis

25

_______ does not respond to gluten free diet and is treated with steroids or immunosuppressants

refractory sprue

26

The neurologic manifestations of celiac disease can have the same MRI appearance as ____

ALS

27

________ is a pruritic papulovesicular rash seen on the extensor surfaces of the extremities

dermatitis herpetiformis

28

Describe quantitatively the relationship between dermatitis herpetiformis and celiac disease

80% of patients with DH have celiac disease.
10% of celiac patients have DH.

29

______ is a topical agent that can be used to treat the lesions of dermatitis herpetiformis

dapsone