GI block i-Human cases Questions and
Answers Grade A+ 2023
Clues about the patient's stool for Ms. Schilling - -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 - -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 - -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 - -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 - -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 - -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 - -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 - -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.
Answers Grade A+ 2023
Clues about the patient's stool for Ms. Schilling - -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 - -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 - -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 - -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 - -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 - -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 - -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 - -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.
