Term
| what is the prototype disease for malabsorption? |
|
Definition
|
|
Term
| what are the various names for celiac disease? |
|
Definition
| gluten sensitive enteropathy, non-tropical sprue, celiac sprue, and gluten-induces disease of the SI |
|
|
Term
| what are characteristics unique to celiac disease? |
|
Definition
| lymphocytic inflammation, distorted mucosal architecture/loss of surface area (important in any malabsorptive disease), and malabsorption of nutrients/vitamins |
|
|
Term
| what sources in our diet contain gluten (which becomes *gliadin)? |
|
Definition
| wheat, barley, rye, and oats |
|
|
Term
| what is a common genetic association with celiac disease? |
|
Definition
| HLA-DQ2 is found in 95% of pts w/celiac disease |
|
|
Term
| what are the antibodies detected in celiac pts via serology? |
|
Definition
| IgA anti-endomysial (*most impt*) and IgA/G antigliadin. (make sure pt is not IgA deficient) |
|
|
Term
| what characterizes pathology due to celiac disease? what is unique to this disease in terms of the mucosa? |
|
Definition
| loss of absorptive surface area, blunting of villi, metaplasia of columnar cells to cuboidal/squamoid, elongation of crypts, presence of intraepithelial lymphocytes. **in celiac: mucosal thickness does not change b/c even though villi are lost, the crypts elongate** |
|
|
Term
| what is the clinical presentation of pts with celiac disease? |
|
Definition
| diarrhea (bulky/foul-smelling/floating), wasting ,abnormal labs: anemic, low albumin, macrocytosis of rectal cells due to Fe/B12 deficiency - which lead to night blindness/bone abnormalities/prothrombin time/muscle cramps/tetany/paresthesias/increased LFTs. most of this is due to malabsorption. **sometimes anemia/abnormal LFTs may be the only presenation** |
|
|
Term
| what physical findings are associated with celiac disease? |
|
Definition
| in severe cases: nail changes, edema of the lower extremities/ascities, ecchymoses, pallor, and cheilosis/glossitis |
|
|
Term
| how is celiac disease diagnosed? |
|
Definition
| serologic studies (*IgA anti-endomysial), capsule endoscopy, anti-transglutaminase autoantibodies, 100% resolution of diarrhea w/gluten removal from diet, and loss of villi/microvilli+transformation of columnar cells+elongation of crypts proven on bx. the last two criteria listed are essential for a celiac dx. |
|
|
Term
| with capsule endoscopy, where would abnormalities most likely be seen in celiac pts? |
|
Definition
| mostly around the proximal duodenum |
|
|
Term
| what are complications associated with celiac disease? |
|
Definition
| malignancy, ulcerative jejunoileitis, refractory sprue (*main complication*), collagenous sprue, and neuropathy |
|
|
Term
| what malignancy is associated with celiac? |
|
Definition
| *lymphoma* also esophageal, oral, and pharyngeal CA |
|
|
Term
| what is refractory sprue? |
|
Definition
| if a pt removes 100% of gluten from their diet, diarrhea may return |
|
|
Term
| what is collagenous sprue? |
|
Definition
| if a pt removes 100% of gluten from their diet, diarrhea may return - possibly due to a layer of collagen developing right below the mucosa which interferes with absorptoin and leads to diarrhea |
|
|
Term
| what is on the ddx for celiac disease? |
|
Definition
| any malabsorptive disease, MAI (mycobacterium avium intracellulare), whipple's, com variable immunodeficiency syndrome (no plasma cells leading to malabsorption), tropical sprue, lymphoma, small intestine bacterial overgrowth, eosinophilic gastroenteritis, gastrinoma, giardia lambria |
|
|
Term
| what other diseases are associated with celiac? |
|
Definition
| dermatitis herpetiformis (symmetrical papulovesicular lesions), DM, selective IgA deficiency (10x more likely w/celiac), PBC (primary biliary cirrhosis), PSC (primary sclerosing cholangitis) |
|
|
Term
| what is therapy for celiac disease? |
|
Definition
| maintenance of gluten free diet - remove all oats, rye, wheat, barley. once diarrhea resolves, you can try re-introducing oats |
|
|
