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Flashcards in Tutorial Cases: Celiac Deck (22):
1

What are classic manifestations of celiac disease? (7)

Chronic/recurrent diarrhea
Abdominal distention
Anorexia/failure to thrive/loss of weight
Abdominal pain
Vomiting
Constipation
Irritability

2

What are non-GI manifestations of celiac disease?

Appear during older child to adultDerm: herpetiformis
Bone: dental enamel hypoplasia
osteopenia, short stature
Delayed puberty, Fe-deficient anemia, hepatitis, arthritis

3

What are disorders associated with celiac disease?

T1DM, thyroiditis, sjogren's, chronic active hepatitis, lactose intolerance, IgA deficiency

4

Which HLA type is strongly associated with celiac disease?

90-95% of patients have HLA-DQ2
This is present in about 20-30% of controls

5

What dietary factor is associated with celiac?

Modified gladden peptide-- leads to activation of CD4+ T cells in lamina propria and subsequent IFN-gamma secretion

6

What testing is used for celiac disease diagnosis?

Biopsy for presence of serum gladden or endomysial antibodies in small bowel of patient ingesting gluten

Remission while on gluten-free diet

7

Describe the histological findings for celiac disease (5)

Increased intraepithelial lymphocytes
Villous atrophy
Crypt hyperplasia
Enterocyte damage
Mixed inflammatory infiltrate

8

What are the important serological markers of celiac disease?

EMA (IgA): sensitive/specific
TTG (IgA): highly sensitive/specific

9

What is treatment for celiac disease?

A gluten-free diet

10

What changes in epidemiology of eosinophilic gastroenteropathies have been observed in past 20 years?

Food hypersensitivity reactions affect up to 8% children under 3 and 2.5% of general population

There has been a 3x increase in prevalence of allergies in past 20 years due to environment, food process, abx usage

11

What are three diseases on spectrum of eosinophilic gastroenteropathies?

Allergic proctocolitis
Eosinophilic gastroenteritis
Eosinophilic esophagitis

12

Eosinophilic esophagitis presents with symptoms similar to ______, but in what way is its treatment/resolution different?

EoE presents with symptoms similar to GERD, but it is unresponsive to acid blockade and instead responds to removal of food antigen

13

What are clinical findings of eosinophilic esophagitis? (3)

Allergic history (asthma, rhinitis, eczema)
Slightly elevated IgE
Responsive to corticosteroids

Uncommon to have peripheral eosinophilia

14

What are gross findings in Eosinophilic esophagitis?

White plaques, rings/trachealization, lateral furrows

15

Describe epidemiology of allergic proctocolitis: Prevalence, age, sex

2-6% children in developed countries
Patients typically

16

What are clinical symptoms of allergic prococolitis? (4)

Blood streaked stools
Diarrhea
Mild abdominal pain
Weight gain, well-appearing

17

What are laboratory features of allergic proctocolitis? (4)

Fecal leukocytes
Mild peripheral eosinophilia
Rarely, hypoalbuminemia/anemia
Pin prick/RAST testing negative

18

What are provocative antigens? (3)

Cow's milk protein or soy milk
50-60% are exclusively breast fed

19

Describe the treatment and symptom resolution in allergic prococolitis

After foods removed, clinical symptoms improve within 72hr while diarrhea/bleeding resolve in 1-3 weeks.

Reintroduce foods later on

20

Describe epidemiology of eosinophilic gastroenteritis

Rare, affects all ages
Unknown etiology

21

What is another major cause of eosinophilia in GI tract?

Infections by parasites

22

Describe the epidemiology of IBD

10-15% have established diagnosis before 15yo

Incidence increasing among pediatric patients