Celiac disease


00:00 / 00:00



Celiac disease


Peritoneum and peritoneal cavity



Upper gastrointestinal tract disorders

Cleft lip and palate

Congenital diaphragmatic hernia

Esophageal web

Tracheoesophageal fistula

Pyloric stenosis



Oral candidiasis

Ludwig angina

Aphthous ulcers

Temporomandibular joint dysfunction

Dental abscess

Gingivitis and periodontitis

Dental caries disease

Oral cancer

Warthin tumor

Barrett esophagus


Plummer-Vinson syndrome

Mallory-Weiss syndrome

Boerhaave syndrome

Gastroesophageal reflux disease (GERD)

Zenker diverticulum

Diffuse esophageal spasm

Esophageal cancer

Eosinophilic esophagitis (NORD)


Gastric dumping syndrome

Peptic ulcer


Cyclic vomiting syndrome


Gastric cancer

Lower gastrointestinal tract disorders


Imperforate anus


Meckel diverticulum

Intestinal atresia

Hirschsprung disease

Intestinal malrotation

Necrotizing enterocolitis


Tropical sprue

Small bowel bacterial overgrowth syndrome

Celiac disease

Short bowel syndrome (NORD)

Lactose intolerance

Whipple's disease

Protein losing enteropathy

Microscopic colitis

Crohn disease

Ulcerative colitis

Bowel obstruction

Intestinal adhesions


Gallstone ileus

Abdominal hernias

Femoral hernia

Inguinal hernia

Small bowel ischemia and infarction

Ischemic colitis

Familial adenomatous polyposis

Peutz-Jeghers syndrome

Gardner syndrome

Juvenile polyposis syndrome

Colorectal polyps

Colorectal cancer

Carcinoid syndrome

Irritable bowel syndrome


Diverticulosis and diverticulitis


Anal fissure

Anal fistula


Rectal prolapse

Liver, gallbladder and pancreas disorders

Crigler-Najjar syndrome

Biliary atresia

Gilbert's syndrome

Dubin-Johnson syndrome

Rotor syndrome



Portal hypertension

Hepatic encephalopathy


Wilson disease

Budd-Chiari syndrome

Non-alcoholic fatty liver disease

Cholestatic liver disease

Hepatocellular adenoma

Autoimmune hepatitis

Alcohol-induced liver disease

Alpha 1-antitrypsin deficiency

Primary biliary cirrhosis

Primary sclerosing cholangitis


Neonatal hepatitis

Reye syndrome

Benign liver tumors

Hepatocellular carcinoma


Biliary colic

Acute cholecystitis

Ascending cholangitis

Chronic cholecystitis

Gallstone ileus

Gallbladder cancer


Acute pancreatitis

Pancreatic pseudocyst

Chronic pancreatitis

Pancreatic cancer

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Gastrointestinal system pathology review

Congenital gastrointestinal disorders: Pathology review

Esophageal disorders: Pathology review

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

Inflammatory bowel disease: Pathology review

Malabsorption syndromes: Pathology review

Diverticular disease: Pathology review

Appendicitis: Pathology review

Gastrointestinal bleeding: Pathology review

Colorectal polyps and cancer: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review

Pancreatitis: Pathology review

Gallbladder disorders: Pathology review

Jaundice: Pathology review

Viral hepatitis: Pathology review

Cirrhosis: Pathology review


Celiac disease


0 / 8 complete

USMLE® Step 1 questions

0 / 3 complete

High Yield Notes

7 pages


Celiac disease

of complete


USMLE® Step 1 style questions USMLE

of complete

A 19-year-old woman comes to the physician for evaluation of recurrent bloating and diarrhea. The symptoms began 2 months ago. During this time, she has had bulky and foul-smelling stools with no visible blood as well as an unintentional 9-lb weight loss. In addition, the patient has had a pruritic rash on her arms, which she attributes to “sensitive skin.” Past medical history is notable for vitiligo and hypothyroidism, which is well controlled with levothyroxine. Vital signs are within normal limits. Physical examination shows conjunctival pallor. Large patches of hypopigmentation are seen. There are multiple tense, grouped subepidermal blisters on the patient’s elbows and dorsal forearms bilaterally. Further evaluation of this patient’s gastrointestinal tract is likely to show which of the following findings?  

External References

First Aid








Celiac disease p. 390

antibodies in p. 721

autoantibody p. 113

biliary cirrhosis and p. 404

dermatitis herpetiformis p. 494

HLA genes and p. 98

IgA deficiency p. 114

Dermatitis herpetiformis p. 494

celiac disease and p. 390


Celiac disease p. 721

HLA genes

celiac disease and p. 390

IgA antibodies p. 103

in celiac disease p. 390


celiac disease and p. 390


fat-soluble vitamin deficiencies and p. 63

vitamin BNaN deficiency p. 67

Weight loss

celiac disease p. 721


Content Reviewers

Rishi Desai, MD, MPH


Tanner Marshall, MS

Alaina Mueller

Robyn Hughes, MScBMC

Jake Ryan

It’s becoming more and more common to see things like “gluten-free pizza” or “gluten-free buns” and other gluten-free items at restaurants, grocery stores, or other food-based businesses. This is partly because there’s this increasing recognition, awareness, and diagnosis of a disease called Celiac Disease, in the past called celiac sprue. As many as 1 in 100 people have Celiac disease although many remain undiagnosed.

Now, Celiac disease is currently understood as an immune system-mediated disorder, where the gluten in food triggers the body’s immune cells to attack the cells in the small intestine as well as produce auto-antibodies against tissue transglutaminase also found in the small intestine as well as other tissues like the heart or the liver.

Gluten’s found in common wheats and grains, including wheat, rye and barley. If we take a look at wheat, you’ve got your individual wheat kernels, and then inside each kernel there is the endosperm, which has a bunch of nutrients for the seed’s embryo, mostly protein and starch, and some vitamins. The type of protein here is gluten, the main culprit in celiac disease.

Well, really the main culprit behind celiac disease is gliadin, an umbrella term given to a group of gluten peptides that share a 33 amino-acid sequence which triggers an immune response. So, if somebody with celiac disease eats a wheat-based pizza, it’s broken down in the stomach into gluten peptides ...and a whole lot of other stuff.

That other stuff is no challenge for digestion - gluten peptides, like the gliadin in wheat, however, are high in proline and glutamine, two amino acids which make it a tough little bugger to digest.

So when the undigested gluten proteins, like gliadin, get to the small intestine, they meet the intestinal mucosa, which is lined with a layer of intestinal epithelial cells. Gluten proteins can then get across the gut epithelial cells, either between them, or through the cell, from the apical to the basolateral membrane, and get to the lamina propria, which is a thin layer that lines the gut wall.

Once there, an enzyme called tissue transglutaminase, or tTG, cuts off of an amide group from the protein. Deamidated gluten proteins are then eaten up by macrophages and served up on its MHC class II molecules.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Ulcerative colitis" The Lancet (2017)
  6. "ACG Clinical Guideline: Ulcerative Colitis in Adults" American Journal of Gastroenterology (2019)
  7. "Colonic Sulfide in Pathogenesis and Treatment of Ulcerative Colitis" Digestive Diseases and Sciences (1997)

Copyright © 2023 Elsevier, except certain content provided by third parties

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.