GI block i-Human cases Questions & Answers
100% Correct!!
Clues about the patient's stool for Ms. Schilling - ANSWERIf 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 - ANSWERPatient 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 - ANSWERGluten 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 - ANSWERLow 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 - ANSWERDiarrhea (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 - ANSWER1. 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
100% Correct!!
Clues about the patient's stool for Ms. Schilling - ANSWERIf 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 - ANSWERPatient 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 - ANSWERGluten 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 - ANSWERLow 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 - ANSWERDiarrhea (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 - ANSWER1. 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
