week 3 Celiac Disease

Ashish Gupta
40 Male
Married with 2 children
Chief complain: Feeling tired (may be caused by iron deficiency anemia? Bleeding?)
Associated symptoms: Stomach cramps, bloating (bacteria releasing air?), flatulence (chronic)
Belief: irritable bowel syndrome
Past med history:
Past family history: mother- irritable bowel syndrome

Want to know:
· Change in Bowel habit?
· Malabsorption? (caused by parasite? History of intermittent fever?, pass worms
· Any Vitamin deficiency? A,D,E,K,B12 (symptoms of scurvy, alopecia, cracked lips, ulcer)

During abdominal examination, look for:
· Any mass
· Visible peristalsis
· Percussion-hyper resonant
· Clubbing
· Eye-anemia, jaundice
· Scratch marks (pluritus)
· Palpable lymph nodes (cancer?)

Additional Examination
· Vital signs
· Per rectal examination – palpable mass? Look at stool

Investigation
· Full blood count
· colonoscopy

Differential Diagnosis:
· Chronic Pancreatitis
· Celiac Disease
· Irritable bowel syndrome (stress-related?) – however, shouldn’t cause malabsorption
· Cancer (weight loss? Loss of appetite? Lethargic?

Learning issues
Celiac disease – gluten insensitivity
1. Definition and List of Gluten-free diet (bring food!) Tinyee and Li tatt
2. Definition and incidence, include histology of villi in Celiac disease - Alvin
3. Pathophysiology include inheritance- Chingmei and Haisherng
4. Causes and risk factors- Zhimei
5. Signs and symptoms include examination results- Thomas
6. Investigation (lab results)- Shuhaiba
7. Treatment and management, include food- Meena
8. Complication and prognosis- Akmez
9. Psychosocial impact- Irene