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Coeliac disease (Clinical
presentation (Diarrhoea
Steatorrhoea, Abdo…
Coeliac disease
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Pathophysiology
Immune reaction to prolamines gluten, gliadin
(wheat, barley, rye, some oats)
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Prolamines broken down by TTG in brush border,
increasing its immunogenicity
Deaminated gliadin presented on APCs,
B and T cells activated
Inflammation and bowel mucosa damage,
malabsorption of Fe, B12, bile acids
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Complications
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Malignancy
Oesophageal, CRC,
small bowel lymhpoma
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Diagnosis
Examination
Abdo - low BMI, pallor, kolinychia,
angular stomatitis, ulcers, glossitis
Investigations
Bloods
FBC (Fe-deficient anaemia)
Fe studies - low Fe, high TIBC
B12/folate (may be deficient)
U+Es, LFTs, TFTs
Coeliac - anti-TTG/anti-gliadin/
anti-endomysial +ve
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Biopsy
Macroscopic - villous atrophy
Microscopic - crypt hyperplasia, WCCs
History
PC - weight loss, bowel change
PMH - other autoimmune
FH - Coeliac, other bowel dis
SH - smoking, alcohol, diet
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