QuestionSBA
QuestionChoice
Diarrhoea, weight loss, and iron deficiency anaemia are all suggestive of a diagnosis of coeliac disease, due to malabsorption. This also explains the slightly low serum vitamin B12 level. While the IgA anti-TTG is the most specific blood marker for coeliac disease, it is unreliable in the case of IgA deficiency (as seen in this case). Measurement of IgG antibodies is necessary in this case. The gold standard diagnostic test for coeliac disease is a duodenal biopsy.
10028226
a
Coeliac disease
QuestionChoice
Irritable bowel syndrome is common and could account for the occasional diarrhoea, but not the iron/B12 deficiency or weight loss.
10028230
e
Irritable bowel syndrome
QuestionChoice
A change in bowel habit and iron deficiency anaemia does raise suspicions for colorectal carcinoma, however this is not the most likely diagnosis in an 18-year-old patient.
10028228
c
Colorectal carcinoma
QuestionChoice
Menorrhagia is a common cause of iron deficiency anaemia in the young female population, however a history of heavy periods has not been provided. Menorrhagia would also not account for the weight loss, diarrhoea, and B12 deficiency.
10028227
b
Menorrhagia
QuestionChoice
A change in bowel habit, weight loss, and iron and B12 deficiency do raise suspicions for inflammatory bowel disease and this should remain within the differential. However, this is not the most likely diagnosis given an equivocal test for coeliac disease and the absence of other symptoms (bloody stools, extra-intestinal manifestations, severe diarrhoea).
10028229
d
Inflammatory bowel disease
Concept
Chapter
2693
4236
Coeliac disease
Topic
136
Gastroenterology
18043
Coeliac disease can present with fatigue, diarrhoea, weight loss, and iron deficiency anaemia due to malabsorption.
A 18-year old woman visits her GP feeling 'tired all the time'. She has also had occasional diarrhoea and weight loss, but is not experiencing any other symptoms of note. Routine investigations show:


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|--------------|:-------:|---------------|
|Haemoglobin|101   g/L|(M) 130 - 170, (F) 115 - 155|
|Mean Cell Volume (MCV)|68.9 fL|80 - 96|
|Serum Vitamin B12|100 ng/L|160 - 925|
|Serum Folate|5.2 μg/L|(3 - 15|
|Ferritin|7 μg/L|12 - 200|
|Thyroid Stimulating Hormone|3.32 mU/L|0.3 - 4.2|
|Total IgA|0.23 g/L|0.8 - 4|


  * Serum IgA anti-tissue transglutaminase - NEGATIVE

What is the most likely diagnosis?
a