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Year Two - Gastroenterology System > Coeliac Disease > Flashcards

Coeliac Disease Flashcards

1
Q

What is coeliac disease?

A

It is defined as an autoimmune condition characterised by gluten sensitivity, in which exposure to gluten causes inflammation of the jejunum

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2
Q

Describe the pathophysiology of coeliac disease

A

In coeliac disease, gliadin contained within gluten, is not broken down fully and passes through the gastrointestinal tract

In the jejunum, gliadin binds to HLA DQ2 and/or HLA DQ8 genes, activating T-cells in the intestinal mucosa and triggering the immune system

The immune system produces two auto-antibodies, anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA)

These antibodies target the epithelial cells of the jejunum, resulting in chronic inflammation

This leads to villous atrophy and thus malabsorption

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3
Q

What are the seven risk factors of coeliac disease?

A

Young Age, 8 Months Old - 3 Years Old

Middle Age, 40 – 50 Years Old

Female Gender

Family History

Autoimmune Conditions

Genetic Syndromes

IgA Deficiency

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4
Q

What seven autoimmune conditions are associated with coeliac disease?

A

Type 1 Diabetes Mellitus

Thyroid Disease

Autoimmune Hepatitis

Primary biliary cirrhosis

Primary sclerosing cholangitis

Dermatitis herpetiformis

Irritable bowel syndrome

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5
Q

What two genetic conditions are associated with coeliac disease?

A

Down’s Syndrome

Turner’s Syndrome

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6
Q

What pneumonic can be used to remember the conditions associated with coeliac disease?

A

I Don’t Take Apples, I Take Oranges

IgA deficiency
Down’s syndrome
Turner’s syndrome
Autoimmune hepatitis

IgA nephropathy
Type 1 diabetes mellitus
Other autoimmune conditions

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7
Q

What are the ten clinical features of coeliac disease?

A

Failure To Thrive

Chronic Diarrhoea

Chronic Fatigue

Abdominal Pain

Abdominal Distension

Anaemia Features

Dermatitis Herpetiformis

Mouth Ulceration

Nausea & Vomiting

Weight Loss

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8
Q

How is anaemia a clinical feature of coeliac disease?

A

It is secondary to malabsorption

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9
Q

What is dermatitis herpetiformis?

A

It is an itchy, blistering skin rash that is commonly located on the extensor surfaces - elbows, knees and buttocks

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10
Q

What is the cause of dermatitis herpetiformis?

A

The deposit of IgA in the skin

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11
Q

What gene allele is most commonly associated with coeliac disease?

A

HLA DQ2

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12
Q

What four investigations are used to diagnose coeliac disease?

A

Blood Tests

Blood Culture

Genotyping

Endoscopy + Biopsy

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13
Q

What are the six blood test results indicative of coeliac disease?

A

Decreased Total IgA Levels

Increased Anti-TGG Levels

Increased Anti-EMA Levels

Decreased RBC Levels

Decreased Ferritin Levels

Decreased Vitamin B12 Levels

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14
Q

Why is it essential to check the total IgA levels in suspected coeliac disease?

A

This is due to the fact that anti-TTG and anti-EMA antibodies are IgA

Therefore, in cases where individuals have decreased total IgA levels, the antibodies will present negatively – even when they have coeliac disease

In this circumstance, we test for the IgG version of anti-TTG or anti-EMA antibodies or conduct an endoscopy + biopsy

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15
Q

What is the first line investigation for coeliac disease?

A

Anti-TTG blood test

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16
Q

What anti-TTG level is indicative of coeliac disease?

A

x 10 of the upper limit

17
Q

When should anti-EMA levels be conducted?

A

It should only be performed if anti-TTG levels are unavailable

This is due to the fact that anti-EMA testing is a more expensive alternative to anti-TTG

18
Q

Why are decreased RBC, ferritin and vitamin B12 levels indicative of coeliac disease?

A

This is due to anaemia development secondary to malabsorption

19
Q

What five blood culture results indicate coeliac disease? Why?

A

Target Cells

Howell-Jolly Bodies

Pappenheimer Bodies

Siderotic Granules

Acanthocytes

These are features of hyposplenism, a complication of coeliac disease

20
Q

How is genotyping used to diagnose coeliac disease?

A

It is used to determine the presence of HLA DQ2 and HLA DQ8 genes within the genome

21
Q

Does genotyping provide a definitive diagnosis of coeliac disease? Why?

A

No

This is due to the fact that individuals can be HLA DQ2 and HLA DQ8 positive with no coeliac disease

Instead, it is used to exclude coeliac disease

22
Q

What is the gold standard investigation used to diagnose coeliac disease?

A

Endoscopy with biopsy

23
Q

In which section of the small intestine, do we conduct a biopsy in?

A

Duodenum

24
Q

When is endoscopy, with biopsy, used to investigate coeliac disease?

A

When serology markers are positive

25
Q

In children when is endoscopy with biopsy, not required for a diagnosis?

A

When TTG, EMA and genetic testing is positive

26
Q

What are the four histological features of coeliac disease?

A

Villous Atrophy

Crypt Cell Hyperplasia

Intraepithelial Cell Lymphocytosis

Inflammatory Cell Infiltration of Lamina Propria

27
Q

What is the main histological feature of coeliac disease?

A

Villous atrophy

28
Q

Should investigations be conducted whilst the patient is on a gluten free diet? Why? What should be done if individuals have already introduced a gluten-free diet?

A

No

This is due to the fact that this allows detection of antibodies and inflammation in the bowel

They they should reintroduce gluten for at least 6 weeks prior to testing

29
Q

What are the two management options for coeliac disease?

A

Lifelong Gluten-Free Diet

Immunisation

30
Q

What four gluten-containing foods should coeliac disease patients avoid?

A

Rye

Wheat

Barley

Oats

31
Q

What are three notable gluten free foods?

A

Rice

Potatoes

Corn

32
Q

How can we check for compliance with a gluten free diet?

A

Anti-TGG levels

33
Q

Why do we administer additional immunisations to coeliac disease patients?

A

This is due to their development of functional hyposplenism, resulting in a defective immune response

34
Q

What additional immunisations do coeliac disease patients receive?

A

Pneumococcal Vaccine Every 5 Years

Annual Influenza Vaccine

35
Q

What are the nine complications of coeliac disease?

A

Iron Deficiency Anaemia

Vitamin B12 Deficiency

Folate Deficiency

Hyposplenism

Osteoporosis

Osteomalacia

Lactose Intolerance

Enteropathy-Associated T-Cell Lymphoma (EATL)

Subfertility

Year Two - Gastroenterology System (33 decks)

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