GI block i-Human cases
/. Clues about the patient's stool for Ms. Schilling - Answer-If floating high fat content, if
watery the colon is not able to absorb water, urgency also indicates more water in stool
/.Role of the gallbladder for Ms. Schilling - Answer-Patient had gallstones, gallbladder is
responsible for making bile so could be recurrence of gallstones. Gallstones can be
stuck in gallbladder and often in the sphincter of Oddi area. This could be the reason for
her pain.
/.Differential diagnoses for Ms. Schilling - Answer-Gluten sensitivity, gallstones, irritable
bowel syndrome, pancreatitis maybe (but usually related to alcohol use), substance
abuse--possibly laxative abuse in this case, ulcerative colitis, anxiety/stress, cancer,
giardiasis (from contaminated water)
/.Significant findings for Ms. Schilling - Answer-Low albumin (protein) levels
(malabsorption), gall stones were present but no signs of inflammation, macrocytic
anemia due to low vitamin B12 (malabsorption), positive for glandin IgA and glandin IgG
antibodies (Celiac), positive endomysial Ab screen (Celiac)
/.Findings which support Ms. Schilling's diagnosis - Answer-Diarrhea (with fecal fat)
associated with abdominal pain worsened with wheat products, weight loss due to
malabsorption, positive antibodies for gliadin and endomysium, to confirm diagnosis
obtain biopsy of small intestine via endoscopy (will show flat mucosal villi surface with
plasmacytic infiltration of subepithelial region), coagulopathy (deficiencies)
/.5 complications specific to Celiac disease for Ms. Schilling - Answer-1. Malnutrition: if
left untreated, happens in spite of adequate diet, deficiency in vitamins/minerals, vitamin
D, folate, iron, anemia, weight loss 2. Loss of calcium and bone density: loss of fat in
stool causing calcium and vitamin D loss, may result in osteomalacia, osteoporosis 3.
Lactose intolerance: damage to small intestine from gluten can cause sensitivities to
other foods like dairy, may or may not resolve with gluten-free diet 4. Cancer: if gluten-
free diet not maintained greater chance of cancers including intestinal lymphoma and
bowel cancers 5. Neurological complications: Celiac disease associated with nervous
system disorders including seizures and peripheral neuropathy
/.Normal non-inflammatory response to foods Ms. Schilling case - Answer-M-cells
sample protein digests and present antigens to immune system so that we do not react
to these antigens in order to promote tolerance.
/.Celiac disease immune response Ms. Schilling case - Answer-Not able to fully break
down gluten, likely due to high proline content. If perforation in gut barrier then will
cause reaction. Antigen recognizing cells HLA-DQ2 HLA-DQ8 recognize gluten. Gluten
doesn't quite fit in receptor so TTG needs to change conformation in order to fit.
/. Clues about the patient's stool for Ms. Schilling - Answer-If floating high fat content, if
watery the colon is not able to absorb water, urgency also indicates more water in stool
/.Role of the gallbladder for Ms. Schilling - Answer-Patient had gallstones, gallbladder is
responsible for making bile so could be recurrence of gallstones. Gallstones can be
stuck in gallbladder and often in the sphincter of Oddi area. This could be the reason for
her pain.
/.Differential diagnoses for Ms. Schilling - Answer-Gluten sensitivity, gallstones, irritable
bowel syndrome, pancreatitis maybe (but usually related to alcohol use), substance
abuse--possibly laxative abuse in this case, ulcerative colitis, anxiety/stress, cancer,
giardiasis (from contaminated water)
/.Significant findings for Ms. Schilling - Answer-Low albumin (protein) levels
(malabsorption), gall stones were present but no signs of inflammation, macrocytic
anemia due to low vitamin B12 (malabsorption), positive for glandin IgA and glandin IgG
antibodies (Celiac), positive endomysial Ab screen (Celiac)
/.Findings which support Ms. Schilling's diagnosis - Answer-Diarrhea (with fecal fat)
associated with abdominal pain worsened with wheat products, weight loss due to
malabsorption, positive antibodies for gliadin and endomysium, to confirm diagnosis
obtain biopsy of small intestine via endoscopy (will show flat mucosal villi surface with
plasmacytic infiltration of subepithelial region), coagulopathy (deficiencies)
/.5 complications specific to Celiac disease for Ms. Schilling - Answer-1. Malnutrition: if
left untreated, happens in spite of adequate diet, deficiency in vitamins/minerals, vitamin
D, folate, iron, anemia, weight loss 2. Loss of calcium and bone density: loss of fat in
stool causing calcium and vitamin D loss, may result in osteomalacia, osteoporosis 3.
Lactose intolerance: damage to small intestine from gluten can cause sensitivities to
other foods like dairy, may or may not resolve with gluten-free diet 4. Cancer: if gluten-
free diet not maintained greater chance of cancers including intestinal lymphoma and
bowel cancers 5. Neurological complications: Celiac disease associated with nervous
system disorders including seizures and peripheral neuropathy
/.Normal non-inflammatory response to foods Ms. Schilling case - Answer-M-cells
sample protein digests and present antigens to immune system so that we do not react
to these antigens in order to promote tolerance.
/.Celiac disease immune response Ms. Schilling case - Answer-Not able to fully break
down gluten, likely due to high proline content. If perforation in gut barrier then will
cause reaction. Antigen recognizing cells HLA-DQ2 HLA-DQ8 recognize gluten. Gluten
doesn't quite fit in receptor so TTG needs to change conformation in order to fit.
