Celiac disease physical examination: Difference between revisions

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* [[Epistaxis]]
* [[Epistaxis]]


===Gastrointestinal===
===Abdomen===
The [[diarrhoea]] characteristic of coeliac disease is [[steatorrhoea|pale]], voluminous and malodorous. [[Abdominal pain]] and cramping, bloatedness with abdominal distention (thought to be due to fermentative production of bowel gas) and [[mouth ulcer]]s<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref> may be present. As the bowel becomes more damaged, a degree of [[lactose intolerance]] may develop. However, the variety of gastrointestinal symptoms that may be present in patients with coeliac disease is great, and some may have a normal bowel habit or even tend towards [[constipation]]. Frequently the symptoms are ascribed to [[irritable bowel syndrome]] (IBS), only later to be recognised as coeliac disease; a small proportion of patients with symptoms of IBS have underlying coeliac disease, and screening may be justified.<ref name=Spiegel>{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | year = 2004 | month = Jun | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref>
*[[steatorrhoea|Pale]], voluminous and malodorous [[diarrhoea]].  
 
*[[Abdominal pain]] and cramping  
Coeliac disease leads to an increased risk of both [[adenocarcinoma]] and [[lymphoma]] of the small bowel, which returns to baseline with diet. Longstanding disease may lead to other complications, such as ''ulcerative jejunitis'' (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring).<ref name=AGA>{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>
*Abdominal distention<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref> .
*Increased bowel sounds<ref name=Spiegel>{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | year = 2004 | month = Jun | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref><ref name=AGA>{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>


===Musculoskeletal===
===Musculoskeletal===

Revision as of 21:32, 12 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Common physical examination findings of celiac disease include [finding 1], [finding 2], and [finding 3].

Physical Examination

Appearance

The patient may appear pale and fatigued.

Skin/Mucous Membrane

HEENT

Abdomen

Musculoskeletal

Neurological

Malabsorption-related

The changes in the bowel make it less able to absorb nutrients, minerals and the fat-soluble vitamins A, D, E, and K.

Miscellaneous

Coeliac disease has been linked with a number of conditions. In many cases it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.

References

  1. Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.
  2. Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167. Unknown parameter |month= ignored (help)
  3. "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.
  4. Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.
  5. Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.
  6. Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.
  7. Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.
  8. Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.
  9. Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.
  10. Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.
  11. Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.
  12. Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.
  13. Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.

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