AAAAA
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46 year-old white female presented with hypothyroidsm, depression and anemia. She complained of increasing tired, no energy. Past medical history indicated iron deiciency anemia and also folate deficiency. Laboratory resulted showed low calcium, low phosphate and increased alkaline phosphate. She denied any bloody dirrhea but has unintentional weight loss of 10 pounds over last three months. PE deep tendon reflex is normal. No constipation
What is the diagnosis ?
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A. Hypothyroidism
B. Crohn's Disease
C. Celiac Sprue
D. Osteomalacia
E. Colon cancer
Sorry for the last question
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| AAAAA
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What is the screening test ?____________________________________
What is the diagnostic confirmatoy test?__________________________________
remember, the screening test is NOT the same as confirmatory test !
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| achilles
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c-celiac sprue
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| achilles
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screening-snti endomysial and antigliadin antibodies ?
diagnostic-small bowel biopsy and response to gluten free diet
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| frontal
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I'm at a loss.
Wouldn't a patient with celiac sprue have diarrhea?
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| AAAAA
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Excellent, Dr. Archilles
you are right. Most Celiac Sprue patients would have diarrhea. But if they are not on a gluten diet, they will NOT have diarrhea.
Celiac sprue disease is the only one to cause iron, folate and calcium deficiency.
This points to malabsorption and then Celiac Sprue, Gluten-eneteropathy, or some kind of auto-immune disease !
Well done !!!!!!!! Great wonderful
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| AAAAA
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Because gluten is so common among the diet we eat, wheat, cereal, any kind of prepared food has gluten, so you automatically associated diarrhea with Celiac Sprue,
Celiac Sprue disease does not present with diarrhea if the patient eats fresh fruits and cook her meal and eat a gluten-free diet !!!!!!!!!!!!!!!
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| AAAAA
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| achilles
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thanks for the generous compliments AAAAA.
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| AAAAA
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In celiac sprue, ONLY if you eat gluten food, then you have diarrhea !
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| AAAAA
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Even many bread we eat has gluten. so you can understand why we all think Celiac Sprue patients have diarrhea.
If the patient can adhere to a strict frest vegetable, small amount of meat, and absolutely no gluten bread, cereal, wheat, then she is NOT going to have any diarrhea at all.
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| frontal
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That is true doctor. Thank you for explaining.
Good job achilles. You're studying hard. Keep at it and you'll make it. Good luck.
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| Jinx
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i have a question
if the treatment is to keep of gluten containing foods
and we assume shes not eating them coz no diarrhea--why does she have the other symt of malabsorption?--i mean if the diet does not have gluten--there shd not be antibodies to damage the villi rt?
do clarify im confused
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| AAAAA
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The real answer in real medicine for Celiac disease is
Antitissue tranglutamine antibodies
and IgA.
You can't get this from Harrison or Kaplan.
This comes from then GI guy I just saw.
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| AAAAA
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You must take a high 2 week gluten diet before the test !
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| AAAAA
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Diarrhea, wt loss, iron deficiency without bleeding in a young white female with osteomalacia is Celiac Sprue.
The correct screening test is antitissue transglutamine antibody !!!!!
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