Coeliac Disease

Question 0

What is a hallmark of coeliac disease?

Answer 0

remission on a gluten free diet

Question 1

Where do you mainly find gluten?

Answer 1

wheat
barley
rye

Question 2

Coeliac disease definition?

Answer 2

immunologically mediated disease in genetically susceptible people driven by gluten antigen

Question 3

Prevalence of Coeliac disease?

Answer 3

1:100

Question 4

Coeliac disease has strong association with which genes?

Answer 4

HLA-DQ2

HLA-DQ8

Question 5

When does Coeliac disease manifest?

Answer 5

anytime from infancy to late adulthood

Question 6

what’s the treatment for Coeliac disease?

Answer 6

gluten-free diet only

Question 7

what mainly gets absorbed in the ileum?

Answer 7

Vitamin B12 and bile acids

Question 8

what are valves of Kerkring?

Answer 8

found in duodenum

circumferential rings to increase surface area

Question 9

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

Answer 9

1kg

Question 10

crypts produce how many cell per day?

Answer 10

200-300 cells and climb the villus

Question 11

how are chylomicrons absorbed?

Answer 11

via lymphatics

Question 12

what is the ratio for mature to crypt cells?

Answer 12

4:1

Question 13

what are Paneth cells for?

Answer 13

secrete natural defensins (antibiotics) to ward off pathogens

Question 14

What is IELs?

Answer 14

intraepethelial lymphocytes

Question 15

how does the small bowel keep bacteria undercontrol overall?

Answer 15

by being in a constant state of controlled mild inflammation

Question 16

normally how many CD3/CD8 cells per enterocytes?

Answer 16

<25/100

Question 17

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

Answer 17

total villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis

Question 18

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

Answer 18

2-3 per enterocyte! More plasma cells

Question 19

what do the microvilli in Coeliac disease look like?

Answer 19

distorted

stunted

Question 20

What do you find in Marsh Type I?

Answer 20

more than 30 IELs per 100 enterocyte

Question 21

What do you find in Marsh Type II?

Answer 21

elongation and branching of crypts

Question 22

What do you find in Marsh Type III?

Answer 22

villi shortened and blunted

villous to crypt ratio is less than 1:4

Question 23

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

Answer 23

CD8 and T-cells

Question 24

other causes of villous atrophy?

Answer 24

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

Question 25

Gastro clinical presentations of Coeliac disease?

Answer 25

``` fatty diarrhea bloating cramps flatulence malabsorption of nutrients ```

Question 26

nutrients affected by Coeliac disease?

Answer 26

anaemia | vitamin deficiencies

Question 27

bones and general disposition of Coeliac disease?

Answer 27

osteoporosis risk lethargic migraines

Question 28

people with Coeliac disease have increased prevalence of what else?

Answer 28

autoimmune diseases type I diabetes thyroiditis

Question 29

Coeliac disease in babies consequences?

Answer 29

failure to thrive

Question 30

does Coeliac disease have to be symptomatic?

Answer 30

could be asymptomatic

Question 31

age of many new Coeliac disease diagnosis?

Answer 31

0-9 | 30-59

Question 32

4 elements in pathogenesis of Coeliac disease?

Answer 32

genetics environment T-cells Gluten

Question 33

what % of people have this gene in Coeliac disease?

Answer 33

99.6% have the HLA-DQ2/DQ8

Question 34

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

Answer 34

20-30%

Question 35

what does HLA-DQ2/DQ8 do?

Answer 35

helps with antigen presentation to T-Cells

Question 36

infant environment for Coeliac disease is avoided how? 3 ways

Answer 36

breast feeding timing of gluten introduction prevention of infections

Question 37

Where are the CD4 cells that react to gluten?

Answer 37

in the small bowel mucosa

Question 38

how do CD4s cause damage in Coeliac disease?

Answer 38

IFN-y

Question 39

how is the innate immune response in Coeliac disease?

Answer 39

CD8+ and NK cells accumulate in epethelium

Question 40

What proteins from wheat are the culprits for Coeliac disease?

Answer 40

Gliadins (alcohol soluble) | Glutenins

Question 41

What does proline do to toxic gluten peptides?

Answer 41

proline resists digestion by proteases and increases toxicity

Question 42

so what? high glutamine and proline and resists digestion?

Answer 42

it allow to pass through intestinal epithelium intact

Question 43

what happens after intact peptides pass through intestinal epithelium?

Answer 43

convert glutamine to negatively charged glutamate

Question 44

what converts glutamine to negatively charged glutamate?

Answer 44

tTG | tissue transglutaminase

Question 45

so big deal, there's negatively charged glutamate?

Answer 45

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

Question 46

what happens after peptides bound to receptor on APCs??

Answer 46

bound to MHCII and start making cytokines

Question 47

what antibodies are made by plasma cells in Coeliac disease?

Answer 47

anti-tTG | anti AGA

Question 48

how do the enterocytes apoptose?

Answer 48

gliadin activated perforins are released

Question 49

can Coeliac disease give you cancer?

Answer 49

T-cell malignancy is possible | get autoreactive IEL

Question 50

Serological dx of Coeliac disease?

Answer 50

tTG antibody | deaminated gliadin peptide ( DGP-IgG)

Question 51

what is gold standard for dx of Coeliac disease?

Answer 51

small bowel biopsy during gluten exposure

Question 52

how soon to get the diagnosis of Coeliac disease?

Answer 52

the earlier the better | long term risks are bad

Question 53

long term risks of undiagnosed Coeliac disease?

Answer 53

osteoporosis autoimmune diseases cancer