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Coeliac Disease (Clinical Presentation (Nausea & vomiting, Angular…
Coeliac Disease
Clinical Presentation
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Osteomalacia - softening of bone due to impaired bone metabolism due to lack of phosphate, calcium and vitamin D leading to OSTEOPOROSIS
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Dermatitis hepetiformis - red raised patches, often with blisters that burst on scratching, commonly seen on elbows, knees and buttocks
Complications
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Increased risk of malignancy (gastric, oesophageal, bladder, breast and brain) due to increased cell turnover
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Key Facts
Prolamin's; gliadin in wheat, hardens in barley and secalins in rye
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T-cell mediated autoimmune disease of the small bowel in which PROLAMIN intolerance causes villous atrophy and malabsorption
SUSPECT in all with diarrhoea, weight loss or anaemia (especially if iron or B12 deficient)
Condition in where there is inflammation of the mucosa of the upper small bowel that improves when gluten is withdrawn from the diet and relapses when gluten is reintroduced
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Diagnosis
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Serum antibody testing
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The levels of these correlate with the severity of mucosal damage and can thus be used for dietary monitoring
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Treatment
Correction of vitamin and mineral deficiencies e.g. B12, folate, iron, calcium and vitamin D
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Pathophysiology
High glutamine and proline content in wheat means they are resistant to digestion, so remains in the intestinal lumen thereby triggering immune responses
The inflammatory cascade releases kinases and other mediators, which contribute to villous atrophy, crypt hyperplasia and intraepithelial lymphocytes
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