Coeliac disease and inflammatory bowel disease Flashcards
What is Coeliac Disease?
An auto-immune disease of the small intestine triggered by the ingestion of gluten
How does Gluten cause Coeliac disease?
When Gluten comes in contact with small bowel mucosa, it stimulates tissue transglutaminase which deamidates glutamine in gliadin, leads to a negatively charged protein that activates IL-15 that stimulates NKC and lymphocytes that destroy tissue = villous atrophy
What are the 3 types of presentations with coeliac disease
Asymptomatic, classical and atypical.
State some classical symptoms of coeliac disease
Diarrhoea, Flatulence, weight loss, weakness and fatigue, severe abdominal pain and IBS like symptoms
State some atypical symptoms of coeliac disease
Anaemia, osteoporosis, muscle weakness, itchy skin conditions, lack of periods, fertility problems and bleeding disorders from Vit K deficiency
What are the investigations for coeliac disease
FBC, LFT’s (General), duodenal biopsies, TTGA IgA sensitive test. deamidated gliadin peptide.
What are the microscopic features of coeliac disease and how many biopsies should be sampled
VA, Crypt hyperplasia, increase in intraepithelial lymphocytes. At least 4 biopsies are needed.
What are the complications of coeliac disease
Enteropathy associated T-cell lymphoma, infertility and miscarriage, a gluten-free diet may reduce the risk of complications.
what is Crohn’s disease (CD)
idiopathic, chronic inflammatory bowel disease often by fibrosis, can affect any part of the GIT from mouth to anus.
What causes CD
the exact cause is unknown, genetics, infectious, immunologic, environmental and psychological factors are all possible causes.
What are the clinical features of CD
abdominal pain, relieved by opening bowels, prolonged diarrhoea, loss of weight and low-grade fever
What are the complications of CD
Intra-abdominal abscesses, deep ulcers lead to fistula e.g. colo-vesical fistula leads to pneumaturia.
What is UC and what causes it?
UC is a chronic inflammatory bowel disease which only affects the large bowel, from the rectum to caecum. causes are unknown but genetic, environmental factors such as cessation of smoking as smoking is protective of UC.
What are the complications of UC
Toxic megacolon ( abdominal distentions, very ill, bloody diarrhoea etc. refractory bleeding, dysplasia or adenocarcinoma.
What are investigations in CD & UC?
FBC, LFT’s, inflammatory markers (CRP), endoscopy and biopsies, MRI, CT scan etc
