Coeliac disease — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a general paediatric clinic. A fourteen-year-old is referred with tiredness and pallor. Her full blood count shows a microcytic anaemia with a haemoglobin of ninety-two grams per litre that has not corrected despite three months of oral iron. She has fallen from the fiftieth to the ninth centile for height, has intermittent abdominal bloating, and her maternal aunt has coeliac disease. She eats a normal gluten-containing diet. The team asks you to establish the differential and the workup, to explain a diagnostic rule, to state whether a biopsy can be avoided, and then to proceed to the management and family counselling. You have twelve minutes with the team and five minutes for examiner discussion. ^[2]