26753663
Description
Flashcards by Jenna Paterson, updated more than 1 year ago
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Created by Jenna Paterson
about 4 years ago
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| Question | Answer |
| What genetic finding is often seen in patients with Coeliac disease? Does this guarantee development of Coeliac? | HLA-DQ2 (95%) and HLA-DQ8, found on antigen presenting cells. Not everyone with these genotypes will develop coeliac |
| What food types should people with CD avoid? | Wheat, barley and rye. e.g. breads, pastas, cereals, soups, beer |
| What causes coeliac? | Loss of immune tolerance to peptide antigens derived from prolamins in wheat (gliadin), rye (secalin), barley (hordein). |
| What is the most toxic gluten protein? | α-gliadin |
| What are the 7 ways an adult may present with coeliac? | - Symptomatic - Chronic or recurrent IDA - Nutritional deficiency - Reduced fertility/amenorrhoea - OP - Unexplained raised AST/ALT - Neurological/psychiatric symptoms |
| What are common symptoms of coeliac disease in adults? | Diarrhoea Bloating Flatulence Abdo discomfort Weight loss (50% have no history of diarrhoea, may be constipated) |
| What skin features might be seen in CDa and how might it be diagnosed? | Dermatitis Herpetiformis - Itchy papules and vesicles on normal or reddened skin which are symmetrical. - Commonly over extensor surfaces of elbows and knees, as well as shoulders, buttocks and scalp - Very itchy and so vesicles rarely actually seen - may present with excoriations - Skin biopsy is usually necessary to confirm dermatitis herpetiformis. |
| What are characteristics of the diarrhoea seen in CD? | Diarrhoea is watery, high volume, rarely bloody and may be steatorrhea due to reduced fat absorption. |
| What is the gold standard diagnostic tool for CD? | Endoscopy with at least 4 duodenal biopsies. |
| What serology can be carried out to diagnose CD? | - Anti-tTG (Iga tTG): reflects degree of mucosal damage (those with low or normal levels and only minimal histological changes may still have coeliac disease). - Anti-EMA (endomysial) Ab: greater specificity, lower sensitivity. May be used if Iga-tTG is unavailable |
| What are the main histological findings in CD? | - Intraepithelial lymphocytosis - Crypt hyperplasia - Villous atrophy |
| What can be used to classify the histological changes in CD? What are the different types. | Modified Marsh Classification System -Type 0 - normal villi and normal number of IELS -Type 1 - normal villi and increased number of IELS -Type 2 - normal villi, increased number of IELS and crypt hyperplasia -Type 3a - partial villous atrophy, increased number of IELS and crypt hyperplasia -Type 3b - subtotal villous atrophy, increased number of IELS and crypt hyperplasia -Type 3c - total villous atrophy, increased number of IELS and crypt hyperplasia |
| What are complications of CD? | - Anaemia - Dermatitis herpetiformis - Malignancy (including intestinal and extra-intestinal lymphoma and carcinomas of upper GI tract) - Hyposplenism -Lactose intolerance - Osteoporosis/fractures |
| What vaccination should newly diagnosed CD patients receive and why? | Against pneumococcus, as hyposplenism may result in increased infection with encapsulated bacteria |
| What are the endoscopy findings in CD? | May be normal. - Atrophy and scalloping of mucosal folds. - Paucity of folds - Mosaic pattern - 'cracked mud' - Prominent submucosal blood vessels - Nodular pattern to mucosa. |
| What can cause false -ve CD serology results? | IgA deficiency |
| What are disorders associated with CD? | - T1DM - Thyrotoxicosis - Addison's disease - Dermatitis herpetiformis |
| What malignancies are people with CD at risk of? | - Enteropathy-associated T-cell lymphoma (EATL) - type of NHL - Small bowel adenocarcinoma -Oesophageal and colonic adenocarcinoma |
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