Coeliac (Celiac) Disease - Overview (signs and symptoms, pathophysiology, diagnosis, treatment)

hello in this video we're going to talk about celiac disease this is an overview and introduction celiac disease is an inflammatory disease a process which occurs in susceptible individuals in response to ingestion of wheat protein gluten specifically the protein Laden the clinical presentation of celiac disease include abdominal pain abdominal discomfort bloating diarrhea stinky stool steatorrhea which is essentially a fatty stool anemia weight loss failure to thrive specifically in children the young but select disease can also present a symptomatically in one-third of people who have it it's important to remember that if someone presents with diarrhea weight loss or anemia anemia can be iron deficiency or vitamin b12 to think of celiac disease some signs of celiac disease around the face include development of Aptus ulcers a trophic glossitis from the anemia as well as anorexia from the mountain owl now absorption there are tightest hepatic fullness is also another sign and this is also known as during this disease and it's a chronic blistering skin condition that is itchy and usually are on extensive surfaces such as your elbow ankles below the knees there are many differential diagnoses of celiac disease but we will not go into that if one presents with these clinical signs and symptoms it's important to order investigations investigations include a full blood count which will detect anemia or any possible infections electrolyte urea creatinine is important to check for any electrolyte arrangement as well as malabsorption l.f.t.s is also important to see to rule out differential diagnosis that can affect the liver of the biliary tree blood smear is also important to check for what type of anemia serology tests can also be you serology tests can also be ordered to test for the presence of auto antibodies seen in celiac disease specifically Auto antibodies to transglutaminase endo Meissen as well as glidin finally an endoscopy can be performed and it is gold standard for the diagnosis of celiac disease and this is essentially where camera is fed through the esophagus down to the small intestine where a tissue biopsy can be taken and using the tissue biopsy a diagnosis can be made however for proper diagnosis the person suspected of having celiac disease should not eat gluten containing foods initially then a biopsy will be taken this is followed by eating normal gluten containing food and then another tissue by obviously taken and this is in order to check for the differences in small intestine tissue architecture and the change is seen in active celiac disease include increase in lymphocytes in the area hypertrophy of the crypts as well as villous atrophy and this is the hallmark for the diagnosis of celiac disease management is ongoing and includes mainly a gluten-free diet a gluten-free diet means not in eating foods containing gluten and gluten containing foods can be remembered with the acronym brow so be as in Bali R as in rye o as in oats and W as in wheat so these four things contain a lot of gluten and therefore should be avoided further if malabsorption is an issue supplements such as calcium iron as well as other vitamin supplements can be offered during periods of exacerbations from celiac disease a ka cilia crisis quick treatment is important cilia crisis is a life-threatening condition and it is rare people who present usually have unexplained diarrhea with severe malabsorption and massive electrolyte imbalance treatment of cilia crisis include rehydration with electrolytes and also corticosteroids to reduce the inflammation and pain that is occurring now let us talk about the pathophysiology the mechanism of disease of celiac disease so here is the jejunum the duodenum and the stomach we are looking at the lumen of the jejunum and the cells here so here is a zoomed in view of the area here is the lumen where food will pass through or parts of the food the jejunum is made up of antara sites and below these in terror sites is the lamina propria which contains other types of cells on top of the entire site here in yellow is the mucus the small intestine forms crypt and villi the interior sites of the small intestine also have micro villi which are essentially small finger-like projections that increases the surface area to increase absorption essentially as mentioned here in yellow is the mucus which actually lines and protects the mucosal cells the intera sites and residing on top of the mucus we can find antibodies IgA dimeric antibodies and IgA antibodies are the antibodies of the mucosal immune system and help defend against infections within the lamina propria which is the level below the entire site you can find some other cells including antigen presenting cells which are important cells in the communication between the innate immune system and the adaptive immune system some people essentially have a predisposition to developing celiac disease and these are risk factors and these risk factors include having a family history of celiac disease and autoimmune thyroid disease having type 1 diabetes having IgA deficiency and inflammatory bowel disease the path of phase of celiac disease is a mystery but here and now I'm just going to draw about the current against theory so drawing it out I'm just drawing the same picture on the left here we have the lumen of the small intestine the intera sites and above the intera sites is the mucous in yellow below the intera sites is the lamina propria where we can find some cells including the antigen presenting cells in some parts of the small intestine there are also things called peyer's patches and also nearby there are mesenteric lymph nodes which are really important lymphoid tissues which help activate an immune response in these tissues we can find what's called naive t-cells which are basically T cells and immune cell which is not activated now above the mucosa back here again as mentioned earlier there are antibodies IgE antibodies IgA is the antibody of the mucosal immune system and it is dimeric here so the pathogenesis theory goes something like this gluten containing food is broken down and a part of gluten a specific part called Glide is absorbed Laden through the enzyme tissue glutamine A's or ttg gets converted to deaminated flight and peptides the deaminated glide and peptides gets picked up by these antigen presenting cells within the area the antigen presenting cell will then present this peptide onto a specific class of molecule called the HLA D q2 or HLA dq8 and so this antigen presenting cell will bring this deaminated Glade and to nearby lymphoid tissues such as the pages patches or the mesenteric lymph nodes and here the antigen presenting cell will present this blade and peptide to the naive t-cells this contact will actually activate the naive t-cells to become either cd8 T killer cells or cd4 T helper cells depending on the cytokine chemical produced and all these other stuff but just remember that the naive T cells become either a T killer or a T helper cell and these cells are now primed against the deaminated glide and peptide or the flight and protein to make it easy the cd8 T killer cell as the name suggests kills things they are a grow and will promote inflammation when in contact with bladed so every time we eat gluten which contains gliadin inflammation will occur the cd4 T cells as the name suggests they help they actually help another cell called b-cells what they do is they help activate b-cells and the activation of b-cells means that these b-cells can mature and become plasma cells and plasma cells are the cells that produce our antibodies so in this scenario this plasma cell will produce antibodies against gladen because it was the protein that was presented in this whole scenario interestingly the plasma cells activated in patients with celiac disease can actually produce other antibodies so we mentioned anti-gliadin but there also anti endo Meissen or endomysium or endomysium as well as anti tissue transglutaminase regardless when these antibodies are in contact with gliadin endomysium or our functional tissue transglutaminase they will promote inflammation and so every time we eat foods containing light and information will occur around the area inflammation around the small intestine will cause abdominal pain abdominal discomfort diarrhea as well as bloating not only that but inflammation damages the lining of the small intestine making the crypt look or funny and also damaging the micro villi the small finger like projections in the area so what does this mean well it means that things can't be absorbed properly so when there's damage to the mucosa this area things such as iron and vitamin b12 cannot be absorbed properly nutrients such as protein carbohydrates cannot be absorbed properly iron and vitamin b12 that can't be absorbed leads to anemia other nutrients not being absorbed efficiently leads to weight loss as well as failure to thrive in children lipids fats that are not being absorbed means that the lipids will still stay in the bowels and will come out in poo and this will cause the stool to be stinky and you get diarrhea which is basically fatty stool and these things again are not absorbed properly because of the damaged yukos aligning thanks to the inflammation let's now take a closer look and focus on the pathological changes seen in the small intestine of people who have celiac disease and therefore changes that is important here the first is that we can see villous atrophy we can see hyperplasia of intestinal crypts we can see increase in lymphocytes in the lamina propria and run this area and finally we see cell death around the area or just destruction in general complications of select disease can be minor or life-threatening complications include anemia that increased I guess risk of developing certain tumors a GI T t-cell lymphomas it can get hypo spleen ism osteoporosis neuropathies and dermatitis herpetiformis differential diagnosis of celiac disease include cow milk sensitivity food sensitive and trophies Crohn's disease colitis GI T lymphoma Whipple's disease Giardia lamblia infection and irritable bowel syndrome you

Channel: Armando Hasudungan

Views: 150,911

Keywords: Coeliac Disease, Celiac Disease, Irritable bowel syndrome, stomach pain, diarrhoea, diarrhea, malnutrition, celiac disease pathogenesis, mechanism of disease, gluten free, gliadin, gluten sensitivity, autoimmune disease, gastroenterology, bowel disease, chronic diarrhea, celiac crisus, medicine, treatment, paediatrics, pediatrics, undernutrition, failure to thrive, endomysium, gluten allergy, tutorial, lecture, celiac disease pathophysiology, Medicine (Field Of Study)

Id: Hxd0msD954I

Length: 14min 20sec (860 seconds)

Published: Mon Jun 05 2017