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. Schi
...
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.
Antigen recognizing cells in Celiac disease Ms. Schilling case - ANSWER HLA-DQ2 HLA-DQ8
[Show More]
.png)
