Liver & GIT
A 30 year old lady presents with features of malabsorption and iron deficiency anaemia. Duodenal biopsy shows complete villous atrophy. Which of the following antibodies is likely to be present: (AIIMS Nov 05, AIIMS May 07, May 06)
|B||Anti-goblet cell antibodies|
|C||Anti-saccharomyces cerevisae antibodies|
|D||Antineutrophil cytoplasmic antibodies|
It is T cell mediated autoimmune disorder in which prolamine (alcohol soluble protein in wheat and Barley) intolerance occur.
Also known as non tropical sprue, celiac disease and gluten-sensitive enteropathy.
Etiology –(Ref. H-18th edi, Pg 2469)
A. Environmental factor-Gliadin, which is a component of gluten that is present in wheat, barley, and oats.
B. Immunological factor- a. Anti endomysial antibody
b. Anti tissue transglutaminase antibodies.
c. Anti alpha gliadin antibody.
d. IgA anti reticulin antibody.
C. Genetic factors HLADQ2 is present in 95% cases. Other have HLA DQ8 10% first degree relatives.
Clinical Features – 2 age peaks (Infancy and 50 – 60 years) more common in females.
a. Symptoms may appear at any age, but more typically they appear with the introduction of cereals in an infant’s diet.
b. Usual clinical features are :
I. Diarrhea- Due to
i.Steatorrhea resulting from changes in jejunal mucosal function.
ii.Endogenous fluid secretion resulting from crypt hyperplasia
iii.Secondary lactose deficiency resulting from change in jejunal brush border enzymatic function.
iv.Bile acid malabsorption on-Due to involvement of ileum.
II. Anemia - Due to
(a) Iron deficiency
(b) Folate deficiency
(c) Vitamin B12 deficiency if ileum is involved.
III. Edema - Due to protein loss.