1 | P a g e [ G I T ] © Copyright www.plab1keys.com (Constantly updated for online subscribers)
Plab1keys.com
Strict Copyrights!
GIT
No Sharing or Copying
Allowed by any means
Compensations and Version 5.2
Penalties Worldwide
System is Active
Corrected, Updated, Lighter
PLAB 1 Keys is for PLAB-1 and UKMLA-AKT (Based on the New MLA Content-Map)
With the Most Recent Recalls and the UK Guidelines
ATTENTION: This file will be updated online on our website frequently!
(example: Version 2.1 is more recent than Version 2, and so on)
Key Celiac Disease
1
◘ Autoimmune, Malabsorption disease, results due to sensitivity to Gluten
(which is a protein).
◘ Eating gluten diet (e.g., Rye, Wheat, Barley) → Villous atrophy of the GIT
→ Malabsorption → Iron deficiency Anemia, Folic Acid and Vit. B12
Deficiency, malabsorption of fat.
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Manifestations
• Chronic or Intermittent Diarrhea.
• Steatorrhea (fatty stools due to malabsorption of fat).
• Stinking, bad-smell, stools
• Abdominal discomfort, Bloating, Nausea and Vomiting.
• Wight Loss. √
• Iron deficiency anemia (the most common), followed by Folate
deficiency then Vit B12 deficiency.
• Manifestations of anemia e.g., Fatigue.
Complications → Osteoporosis / T-cell lymphoma (rare).
o Association not to be forgotten → Dermatitis Herpetiformis.
Diagnosis
• Positive TTG and IgA. (First Line)
(TTG= Tissue TransGlutaminase Antibodies)
• Positive Endomysial Antibodies.
Important: If the serum tissue transglutaminase antibodies are negative but
the clinical presentation is still suggestive of celiac disease (eg, diarrhea,
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intermittent abdominal ache especially after consuming gluten diet eg,
wheat) and in the presence of serum IgA deficiency)
→ Perform serum tissue transglutaminase antibodies using an IgG-based
essay. After that, arrange for jejunal/ duodenal biopsy to confirm the
diagnosis.
If TTG is positive, we need to confirm the diagnosis of Celiac disease by
Biopsy → Jejunal or Duodenal Biopsy. It will show:
o Villous Atrophy.
o Crypt hyperplasia.
o ↑ inter-epithelial lymphocytes.
Important: for the biopsy to be accurate, the patient should re-
introduce the gluten in his diet for 6 weeks before the biopsy.
Treatment → Gluten-free diet.
Example scenario:
33 Y/O male, Non-smoker.
Presents with recurrent and chronic diarrhea for 6 months.
His clothing appears to be ill-fitting (indicative of weight loss).
Hb = 11 ▐ MCV = 105 (high)
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o The most likely Diagnosis → Celiac Disease.
o Endoscopy + Duodenal Biopsy will show → Villous Atrophy.
Asked Before:
Q) Why there is malabsorption in celiac disease patients (what is the
pathophysiological reason for steatorrhea, anemia in celiac disease)?
→ Villous atrophy in the small intestine
(ie, decreased surface area for absorption).
Key Crohn’s Disease VS Ulcerative Colitis
2
◙ Points towards Crohn’s disease
o It can affect any part of the GIT (from mouth to anus).
o Endoscopy → Skip lesions, Transmural (deep Ulcers), Cobblestone
appearance
o Histology → Granuloma, ↑ Goblet cells.
o Examination → Abdominal Pain or Mass on the RIGHT iliac fossa.
o Diarrhea “Usually Non-bloody but can be bloody”.
o Weight loss is more common.
o Fistulae, perianal fistulas, anal fissures.
Copyrights @ Plab1Keys.com
Plab1keys.com
Strict Copyrights!
GIT
No Sharing or Copying
Allowed by any means
Compensations and Version 5.2
Penalties Worldwide
System is Active
Corrected, Updated, Lighter
PLAB 1 Keys is for PLAB-1 and UKMLA-AKT (Based on the New MLA Content-Map)
With the Most Recent Recalls and the UK Guidelines
ATTENTION: This file will be updated online on our website frequently!
(example: Version 2.1 is more recent than Version 2, and so on)
Key Celiac Disease
1
◘ Autoimmune, Malabsorption disease, results due to sensitivity to Gluten
(which is a protein).
◘ Eating gluten diet (e.g., Rye, Wheat, Barley) → Villous atrophy of the GIT
→ Malabsorption → Iron deficiency Anemia, Folic Acid and Vit. B12
Deficiency, malabsorption of fat.
Copyrights @ Plab1Keys.com
,2 | P a g e [ G I T ] © Copyright www.plab1keys.com (Constantly updated for online subscribers)
Manifestations
• Chronic or Intermittent Diarrhea.
• Steatorrhea (fatty stools due to malabsorption of fat).
• Stinking, bad-smell, stools
• Abdominal discomfort, Bloating, Nausea and Vomiting.
• Wight Loss. √
• Iron deficiency anemia (the most common), followed by Folate
deficiency then Vit B12 deficiency.
• Manifestations of anemia e.g., Fatigue.
Complications → Osteoporosis / T-cell lymphoma (rare).
o Association not to be forgotten → Dermatitis Herpetiformis.
Diagnosis
• Positive TTG and IgA. (First Line)
(TTG= Tissue TransGlutaminase Antibodies)
• Positive Endomysial Antibodies.
Important: If the serum tissue transglutaminase antibodies are negative but
the clinical presentation is still suggestive of celiac disease (eg, diarrhea,
Copyrights @ Plab1Keys.com
,3 | P a g e [ G I T ] © Copyright www.plab1keys.com (Constantly updated for online subscribers)
intermittent abdominal ache especially after consuming gluten diet eg,
wheat) and in the presence of serum IgA deficiency)
→ Perform serum tissue transglutaminase antibodies using an IgG-based
essay. After that, arrange for jejunal/ duodenal biopsy to confirm the
diagnosis.
If TTG is positive, we need to confirm the diagnosis of Celiac disease by
Biopsy → Jejunal or Duodenal Biopsy. It will show:
o Villous Atrophy.
o Crypt hyperplasia.
o ↑ inter-epithelial lymphocytes.
Important: for the biopsy to be accurate, the patient should re-
introduce the gluten in his diet for 6 weeks before the biopsy.
Treatment → Gluten-free diet.
Example scenario:
33 Y/O male, Non-smoker.
Presents with recurrent and chronic diarrhea for 6 months.
His clothing appears to be ill-fitting (indicative of weight loss).
Hb = 11 ▐ MCV = 105 (high)
Copyrights @ Plab1Keys.com
, 4 | P a g e [ G I T ] © Copyright www.plab1keys.com (Constantly updated for online subscribers)
o The most likely Diagnosis → Celiac Disease.
o Endoscopy + Duodenal Biopsy will show → Villous Atrophy.
Asked Before:
Q) Why there is malabsorption in celiac disease patients (what is the
pathophysiological reason for steatorrhea, anemia in celiac disease)?
→ Villous atrophy in the small intestine
(ie, decreased surface area for absorption).
Key Crohn’s Disease VS Ulcerative Colitis
2
◙ Points towards Crohn’s disease
o It can affect any part of the GIT (from mouth to anus).
o Endoscopy → Skip lesions, Transmural (deep Ulcers), Cobblestone
appearance
o Histology → Granuloma, ↑ Goblet cells.
o Examination → Abdominal Pain or Mass on the RIGHT iliac fossa.
o Diarrhea “Usually Non-bloody but can be bloody”.
o Weight loss is more common.
o Fistulae, perianal fistulas, anal fissures.
Copyrights @ Plab1Keys.com
