GI block i-Human cases
Clues about the patient's stool for Ms. Schilling - answers 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 - answers 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 - answers 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 - answers 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 - answers 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 - answers 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 - answers 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.
Clues about the patient's stool for Ms. Schilling - answers 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 - answers 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 - answers 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 - answers 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 - answers 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 - answers 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 - answers 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.
