Coeliac disease Flashcards Preview

Module 104: Theme 1 > Coeliac disease > Flashcards

Flashcards in Coeliac disease Deck (11)
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1
Q

Coeliac disease

A

Inflammatory bowel disease.

Occurs as a result of auto-immune mediated response in the small intestine- to gliadin in gluten.

Causes malabsorption.

2
Q

Genetic abnormalities of coeliac disease

A

Mutation in genes:

  • HLA-DQ2 [95%]
  • HLA-DQ8 {5%]

Strong hereditary predisposition

3
Q

Prevalence of coeliac disease

A

Western Europeans and Americans
- Especially Irish and Scandinavian descent

High prevalence in:

  • Down’s syndrome
  • TI diabetes mellitus
  • Autoimmune hepatitis (presents abnormal liver function tests)
  • Thyroid gland abnormalities.
4
Q

Pathophysiology of coeliac disease [5]

A
  1. Gliadin in wheat binds to tissue transglutaminase in small bowel mucosa.
  2. Transglutaminase deaminates gliadin to release a negatively charge protein.
  3. Triggers the release of IL-15
  4. Stimulates the recruitment of NK and intraepithelial T cells
  5. Inflammatory cells cause tissue destruction and villous atrophy.
5
Q

Pathological features of coeliac disease [4]

A

Villous atrophy
- Shortened and flattened out villi

Crypt hyperplasia
- Lengthened crypts to compensate for flattened villi.

Lymphocyte infiltration (chronic inflammation) in lamina propria

Increased transepithelial lymphocytes

6
Q

Presentation of coeliac disease

A

Abdominal distention

Failure to thrive and short stature in children.

Chronic diarrhea- steatorrhea

Weight loss + fatigue

Anaemia

Osteopenia and osteoporosis from Vit.D and calcium deficiency.

7
Q

Classification of coeliac disease

A

Classical:
- Shows malabsorption symptoms

Non-classical: symptoms outside GI tract

Sub-clinical:
- Detected with blood tests

8
Q

Symptoms outside GI from coeliac disease

A

Heartburn

Nausea

Recurrent miscarriage /infertility

Dermitis herpetiforms- skin rash

9
Q

Serological investigations for coeliac disease

A

Tissue transglutaminase antibodies (IgA) [TTGA]
- 98% sensitive, 96% specific

Endomysial IgA: detects autoantibody in endomysium

  • Most specific (100%)
  • Not as sensitive (90%)

Deaminated gliadin peptide- using IgA and IgG

10
Q

Investigations into coeliac disease

A

General: Full blood count, Liver function tests, renal function tests.

Duodenal biopsy

Genetic screening in children:
HLA-D2
HLA-D8

Serological tests

11
Q

Complications of coeliac disease

A

T-cell lymphoma

High risk of adenocarcinoma of small bowel and other organs

Dermatitis hepetiformis

Infertility and miscarraige