Give examples of different types of small bowel disease
Coeliac disease Pernicious anaemia Crohn’s disease Infections Tumours
What is coeliac disease
Sensitivity to a-gliaden component of gluten that causes a reactive change inside of the small intestine
Give examples of food containing gluten
Wheat Barley Spelt Rye Kaput Oats
Why do people often think they have coeliac disease when they don’t
Companies list vague symptoms relating to coeliac that are fake and actually apply to their own products trying to trick patients
Describe the aetiology of coeliac disease
Immune reaction to a-gliaden
This will create antibodies
T lymphocytes damage mucosal tissue causing villus atrophy
Describe villus atrophy
As inflammatory changes take place, the projections into the lumen are lost significantly reducing the surface area of the jejunum available for food absorption
What is a common sign of coeliac disease in children
Malabsorption will be obvious as the child will fail to grow properly
What is a common dental sign of coeliac disease in adults
Patients appear with oral ulceration
What are the symptoms of coeliac disease
Weight loss Lassitude Weakness Abdominal pain/swelling Diarrhoea Aphthous ulceration in mouth Tongue papillary loss Steatorrhoea Dysphagia from Plumber Vinson syndrome
What malabsorption issues are caused by coeliac disease
Iron
Folic acid
Vitamin B12
Fat
What investigations are first carried out for coeliac disease
Antibody tests Serum transglutaminase (TTG) - less expensive, delivers a large number of false positives but if negative, patient does not have coeliac Anti-gliadin/anti-endomyseal antibodies - more expensive and specific
What other investigations can be used for coeliac disease
Jejunal biopsy - capsule or endoscopic biopsy
Farcical fat - increased if malabsorption
Haematinics - B12, folate, ferritin
What are the advantages of a gluten free diet
Reversal of jejunal atrophy
Improved well-being
Reduced risk of lymphoma
What are the disadvantages to a gluten free diet
Social consequences eg - going to a restaurant - menu choices, cross contamination
What skin disease is associated with coeliac disease and describe this disease
Dermatitis herpetiformis
Forms little blisters on the skin filled with fluid due to an auto antibody forming against the skin
IgA deposition in the skin tissue
How can dermatitis herpetiformis be detected
Immunofluorescence shows antibody binding at the junctional epithelium between the connective tissue and the epithelial surface
The antibody causes there to be a loss of adhesion between the epithelium and connective tissue
What is pernicious anaemia
Disease caused by Vitamin B12 deficiency
For what reasons can vitamin B12 deficiency occur
Not present adequately in the diet
Seen commonly in vegans
How is pernicious anaemia diagnosed
Shilling test (old) - uses radioisotopes to determine whether there is an absorption problem Now - looking for antibodies against the parietal cells and intrinsic factor
What are the different causes of pernicious anaemia
Lack of Vitamin B12 in the diet
Disease of gastric parietal cells
Inflammatory bowel disease of terminal ileum - Crohn’s disease
Bowel cancer at the ileo-caecal junction
How can a vitamin B12 deficiency be treated
Have a diet with an adequate quantity of vitamin B12
Take B12 supplements - often contain animal product
Arrange IM injections of B12 every 3 months
