PBL1

Question 1

ferrograd

Answer 1

– this is an iron supplement that is used to prevent and treat iron deficiency anaemia and vitamin C deficiency when the two are present together, a brand name for ferrous sulphate 200mg

Question 2

mean corpuscular volume

Answer 2

this is the average volume of red blood cells, average is 80-100

Question 3

alkaline phosphatase

Answer 3

this is an enzyme found in several tissues throughout the body, it is highest in the cells that are made out of the bone and liver. This is best produced under alkaline pH environmetns and dephosphorylates compounds as it is a phosphate. It is widespread in the liver and skeleton therefore its concentration in the bloodstream can be used as a biomarker, dependent on factors such as age gender and blood type as well as whether the individual is pregnant or not

Question 4

folate

Answer 4

this is B12, a type of vitamin that is needed, when it is deficiency it can cause the body to produce abnormally large red blood cells that do not function properly

Question 5

ferritin

Answer 5

this is a protein that is produced by mammalian metabolism which is used to store iron in tissue

Question 6

IgA anti-tTG

Answer 6

anti tissue transglutaminase, Anti tTg is a newer and more sensitive test and is produced in people with coeliac disease, tTG is what normal people have

Question 7

antibodies

Answer 7

polypeptides that are produced by plasma cells that combat disease

Question 8

Formalin

Answer 8

this is used to supress oxidation and polymerisation, it is used to preserve biological species

Question 9

what makes up gluten

Answer 9

gliadin and glutenin

Question 10

what is gluten present in

Answer 10

wheat oat, barely and rye

Question 11

what genes cause coeliac disease

Answer 11

• Usually more likely to have the condition if you have HLA-DQ2 (95%)or HLA-DQ8(5%), having these genes does not necessarily mean that you will develop the disease

Question 12

describe coeliacs disease

Answer 12

• Caused by an intolerance of gluten
• Exposure to gluten can lead to damage of the proximal small bowel and in serious cases it can affect the whole bowel
• Causes malabsorption leading to conditions such as anaemia
• 1 in 100 people have the condition

Question 13

what part of the bowel is affected

Answer 13

proximal small bowel

- in serious cases it can affect the whole bowel

Question 14

what are the symptoms of coeliacs disease

Answer 14

• Diarrhoea
• Abdominal pain
• Bloating and flatulence
• Aches and pains in legs – osteomalacia (softening of the bones) this is due to calcium malabsorption
• Indigestion
• Constipation
• Fatigue - due to iron and folate malabsorption
• Unexpected weight loss – due to malabsorption of fuels such as carbohydrates and fats
• Itchy rash
• Problems getting pregnant
• Irritability – due to folate deficiency

Question 15

what are the causes of coeliacs disease

Answer 15

• Autoimmune condition
• Where the immune system attacks the villus and the healthy tissue this means that they cannot do there role in the small intestine leading to inflammation
• Damages surface of the small bowel
• Body cannot absorb nutrients
• Change in the composition of gut flora, for example due to infection, stress and hormones that can trigger the activation of genes for coeliac disease

Question 16

what is the treatment of coeliacs disease

Answer 16

• Gluten free diet
• Iron and folic given in 1st three months after diagnose
• Reassess 8-12 weeks for improvement in symptoms and growth parameter

Question 17

how does the immune response relate to the gut metabolism

Answer 17

There is an initial immune reaction to the gluten
- Proximal gut is more effected as this is where there is the highest concentration of gluten
- Eventually this reaction develops into an autoimmune reaction against the small intestinal mucosa
- Gluten is the molecules that is broken down into small molecules that are toxic, the main toxic peptide is alpha gliadin
There is an inappropriate T cell mediated response(Th2) against gliadin in genetically susceptible individuals, the initial response may be mediated by a viral infection-adenovirus 12
- There are 2 antibdoeis produced as a result of the immune response
- These are anti-gliadin and anti-endomysial – these can be used to test for the presence of the disease
- The enodmysial antibody attacks the tTG tissue
- The mucosa of the small bowel is more effected
- As you move towards the ileum the effect decreases

Question 18

how does the immune response relate to the gut metabolism simply

Answer 18

• Gliadin crosses epithelium into the lamina propria
• Deaminated by tTG which then presents to DQ2+ or DQ8+ cells antigen presenting cells to pathogenic CD4+ cells. DQ2/8 binds more strongly.
• Triggers immune response which results in inflammation
• Leads to villus atrophy

Question 19

describe the histology of the gut in coeliacs disease

Answer 19

• Villus atrophy
• Crypt hyperplasia (increase in number of cells) whereas hypertrophy is an increase in the size of the cells
• Intraepithelial lymphocytosis – this is the increase in the number of inflammatory cells in the lamina
• This causes a decrease in surface area which causes a decrease in absorption

Question 20

how do you diagnose coeliacs disease

Answer 20

Duodenal biopsy
- examined under post-absorptive state under mild sedation
- direct visual of the mucosa of the oesophagus, stomach,
duodenum

Immunology

• tissue transglutaminase (TTG) antibodies (IgA)
• endomyseal antibody (IgA)

Question 21

how do you understand the blood test results

Answer 21

• Haemoglobin is low due to iron deficiency
• Haematocrit is low due to iron deficiency
• Mean corpsular volume is low due to microcytic anaemia
• Ferratin is low due to iron deficiency
• Calcium is low due to osteomalacia
• Alkakine phosphate is high due to osteomalacia
• Folate is low due to poor absorption
• IgA anti-tTG is high due to reaction to gliadin

Question 22

What’s the microanatomy and the anatomy of coeliac disease

Answer 22

• Dudodenum – pancreatic enzyms and bile secreted as well as site of iron absorption
• Jejunum – main site of absorption, large surface area, plicae circulares (intestinal folds), villi and microvilli
• Ileum – terminal ileum is the site of vitamin B12 absorption

Question 23

How are carbohydrates absorbed

Answer 23

broken down by brush border enzymes into glucose, lactose and
galactose

Question 24

how are proteins absorbed

Answer 24

Broken down by pepsin and trypsin and other proteases

forms amino acids at the brush border

Question 25

How are fats absorbed

Answer 25

Emulsified by bile

Broken down by lipases

hydrolysis forms micelles of fatty acids and glycerol

Question 26

How is gluten absorbed

Answer 26

mixture of proteins (prolamins) found in cereals, wheats, barley and rye.

contains prolamins → resistant to digestion

remain in gut as peptides

Question 27

what is treatment of coealics disease

Answer 27

Life-long disorder
- Conservative- Dietary changes
- complete removal of gluten
- can eat pure oats, rice and corn/ maize
= Villous atrophy and immunology normally reverses on a
gluten-free diet.

Question 28

why was she not diagnosed before

Answer 28

amount of gluten she has had in her diet

Time for atrophy

Variety of strengths