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Flashcards in Coeliac Disease Deck (5)
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What is Coeliac Disease

Coeliac disease is an Autoimmune T-cell response to gluten in the small bowel causing villous atrophy and malabsorption


What will you find on a history taking of Coeliac Disease

Abdominal Pain
Nausea and Vomiting
Weight Loss
Malnutrition – Anaemia, Bleeding problems (Fat soluble Vit K deficiency), Neurological symptoms like neuropathy (Vitamin B12 deficiency), Pica (Craving for non-food items due to severe Iron deficiency anaemia e.g. dirt)

Risk Factors:
Can present at any age, but most common in 20-40’s
Family History

Crohns Disease - Extra GI manifestations, Bloody Diarrhoea, Fever
Chronic Pancreatitis - Jaundice/Diabetes/Epigastric Pain radiating to back/Risk factors e.g. alcohol
Alcoholism - History of alcohol abuse


Whatwill you find on examination of someone with Coeliac Disease?

End of the bed:
Dermatitis Herpetiform – Blistering skin condition affecting symmetrical extensor surfaces
Bruises - Vitamin K deficiency
Confusion - Beta deficiency
Muscle wasting/weight loss if malnourished
Leukonychia - Hypalbuminaemia indicating protein Malnutrition
Koilonychia - Iron Deficiency Anaemia
Peripheral Neuropathy - B12 deficiency
Trousseau sign – Gripping of hand muscle when inflating cuff above systolic BP for 3 mins
Aphthous ulcers
Angular Stomatitis - Iron deficiency anaemia
Chvostek sign– Facial muscle spasm on tapping facial nerve at parotid (Seen In hypocalcaemia)
Ascites - Protein Malnutrition
Splenomegaly - Anaemia
Oedema - Protein Malnutrition
Restless Leg syndrome - Iron deficiency anaemia
Peripheral Neuropathy - B12 deficiency


What are the investigations used for Coeliac Disease

FBC – Looking for Anaemia, Microcytic (Iron Deficiency), Macrocytic (B12/Folate Deficiency)
B12 – Levels can be reduced in malnutrition and cause neuropathies or anaemia
Total Iron Binding Capacity/Ferritin -Looking for Iron deficiency
Clotting screen – Vitamin K deficiency can cause impaired clotting
LFT's – Looking for Hypalbuminaemia, Transaminase levels can be slightly raised, but this will return to normal on gluten free diet
Anti-transglutaminase antibody - First line investigation, if positive refer for duodenal biopsy
Serum Calcium – Can be low in chronic malnutrition

Special Tests:
Duodenal biopsy – Diagnostic test, done if Anti Tissue transglutaminase is positive or there is a very high level of suspicion. The patient needs to still be eating gluten to show changes (Sub Villous atrophy, increased intra epithelial WBC's and crypt hyperplasia)
DEXA scan – Long term malnutrition can cause reduced bone density due to low serum calcium


What are the treatments of Coeliac Disease

Lifelong Gluten free diet
Iron, folate and vitamin B12 supplements as required
Yearly review measuring height/weight and considering need for dietitian referral