Coeliac Disease Flashcards Preview

Jason's GI Block > Coeliac Disease > Flashcards

Flashcards in Coeliac Disease Deck (54):
0

Where do you mainly find gluten?

wheat
barley
rye

1

What is a hallmark of coeliac disease?

remission on a gluten free diet

2

Coeliac disease definition?

immunologically mediated disease in genetically susceptible people driven by gluten antigen

3

Prevalence of Coeliac disease?

1:100

4

Coeliac disease has strong association with which genes?

HLA-DQ2
HLA-DQ8

5

When does Coeliac disease manifest?

anytime from infancy to late adulthood

6

what's the treatment for Coeliac disease?

gluten-free diet only

7

what mainly gets absorbed in the ileum?

Vitamin B12 and bile acids

8

what are valves of Kerkring?

found in duodenum
circumferential rings to increase surface area

9

how many cells (kgs) do we lose every 2-3 days ?

1kg

10

crypts produce how many cell per day?

200-300 cells and climb the villus

11

how are chylomicrons absorbed?

via lymphatics

12

what is the ratio for mature to crypt cells?

4:1

13

what are Paneth cells for?

secrete natural defensins (antibiotics) to ward off pathogens

14

What is IELs?

intraepethelial lymphocytes

15

how does the small bowel keep bacteria undercontrol overall?

by being in a constant state of controlled mild inflammation

16

normally how many CD3/CD8 cells per enterocytes?

<25/100

17

what do you see in advanced Coeliac disease histologically? 3 things

total villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis

18

what is the ratio of IELs per enterocytes in Coeliac disease?

2-3 per enterocyte! More plasma cells

19

what do the microvilli in Coeliac disease look like?

distorted
stunted

20

What do you find in Marsh Type I?

more than 30 IELs per 100 enterocyte

21

What do you find in Marsh Type II?

elongation and branching of crypts

22

What do you find in Marsh Type III?

villi shortened and blunted
villous to crypt ratio is less than 1:4

23

In Marsh Type III what is there a marked increase in?

CD8 and T-cells

24

other causes of villous atrophy?

tropical sprue
other immunodeficiency
autoimmune enteropathy
drugs: mycophenolate mofetil (used in transplants)

25

Gastro clinical presentations of Coeliac disease?

fatty diarrhea
bloating
cramps
flatulence
malabsorption of nutrients

26

nutrients affected by Coeliac disease?

anaemia
vitamin deficiencies

27

bones and general disposition of Coeliac disease?

osteoporosis risk
lethargic
migraines

28

people with Coeliac disease have increased prevalence of what else?

autoimmune diseases
type I diabetes
thyroiditis

29

Coeliac disease in babies consequences?

failure to thrive

30

does Coeliac disease have to be symptomatic?

could be asymptomatic

31

age of many new Coeliac disease diagnosis?

0-9
30-59

32

4 elements in pathogenesis of Coeliac disease?

genetics
environment
T-cells
Gluten

33

what % of people have this gene in Coeliac disease?

99.6% have the HLA-DQ2/DQ8

34

how many people who have HLA-DQ2.DQ8 don't have Coeliac disease?

20-30%

35

what does HLA-DQ2/DQ8 do?

helps with antigen presentation to T-Cells

36

infant environment for Coeliac disease is avoided how? 3 ways

breast feeding
timing of gluten introduction
prevention of infections

37

Where are the CD4 cells that react to gluten?

in the small bowel mucosa

38

how do CD4s cause damage in Coeliac disease?

IFN-y

39

how is the innate immune response in Coeliac disease?

CD8+ and NK cells accumulate in epethelium

40

What proteins from wheat are the culprits for Coeliac disease?

Gliadins (alcohol soluble)
Glutenins

41

What does proline do to toxic gluten peptides?

proline resists digestion by proteases and increases toxicity

42

so what? high glutamine and proline and resists digestion?

it allow to pass through intestinal epithelium intact

43

what happens after intact peptides pass through intestinal epithelium?

convert glutamine to negatively charged glutamate

44

what converts glutamine to negatively charged glutamate?

tTG
tissue transglutaminase

45

so big deal, there's negatively charged glutamate?

they can bind to HLA-DQ2 T-cell receptor on an APC. effectively making the glutamate an antigen

46

what happens after peptides bound to receptor on APCs??

bound to MHCII and start making cytokines

47

what antibodies are made by plasma cells in Coeliac disease?

anti-tTG
anti AGA

48

how do the enterocytes apoptose?

gliadin activated perforins are released

49

can Coeliac disease give you cancer?

T-cell malignancy is possible
get autoreactive IEL

50

Serological dx of Coeliac disease?

tTG antibody
deaminated gliadin peptide ( DGP-IgG)

51

what is gold standard for dx of Coeliac disease?

small bowel biopsy during gluten exposure

52

how soon to get the diagnosis of Coeliac disease?

the earlier the better
long term risks are bad

53

long term risks of undiagnosed Coeliac disease?

osteoporosis
autoimmune diseases
cancer