Human Anatomy at Colby

Calvin Robbins: My Celiac Disease Story

February 24th, 2015 · Comments Off on Calvin Robbins: My Celiac Disease Story

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Every year, the BI 265 Jan Plan class holds student run Grand Rounds presentations. A Grand Round presentation is usually done by a doctor and patient (or actor) in front of other doctors to educate them of a surprising finding or elusive diagnosis, thereby helping the doctors in attendance better diagnose the problem in the future. This year a group presented about a man who had Celiac disease but presented as a cardiac patient (check out Ari, Danielle, and Laurel’s Grand Rounds presentation on celiac disease). It inspired me to tell my own story of being diagnosed with Celiac disease.

When I was 10 years old, I started to notice that when I coughed, there were small specks of blood in the mucous. Originally this was dismissed as an issue with dry air, as it was winter at the time, but as time passed, it was recognized as a larger problem.

The obvious assumption was a respiratory issue, so I had X-rays done which showed a very mild case of pneumonia. Soon the Pneumonia was treated but the blood in the mucous remained. Next came a series of blood tests, consultations, more blood tests, MRIs, X-rays, and still more blood tests, of which the only result was slight anemia. Guesses ranged from Acute Interstitial Pneumonia to tuberculosis to cancer, to a stomach ulcer, but every test came back negative. Doctors wanted to do a lung biopsy to check for AIP but my parents elected to wait for the Celiac results as a lung biopsy is invasive, carries a high risk of infection and would have had a long recovery period for an active 10 year old.

Finally, after about 3 months into an attempted diagnosis, a blood test was performed to test for Celiac Disease. The test was positive. An endoscopy was performed to verify Celiac Disease, as blood tests are not 100% accurate. The doctors discovered an abnormality in the small intestine: the villi were heavily flattened. Given this new insight, and after about a month of a gluten free diet, the blood speckling disappeared.

Celiac Disease is a genetic disease in which the body has an immune reaction to the presence of gluten, a protein found in wheat, rye, and barley. After blood testing it was found that my father and sister, who was asymptomatic, both have Celiac Disease, while my mother does not. From my family you might guess that it is recessive, but the actual inheritance mechanism is still unknown. Worldwide, it is estimated that about 1% of people are diagnosed with Celiac disease while most people with Celiac Disease actually remained undiagnosed.

Sticking with the theme of Grand Rounds, my case was actually presented as a Grand Rounds discussion by Dr. Andrew Filderman once the diagnosis was reached. It is thought that these types of atypical situations go undiagnosed or are improperly diagnosed most of the time they are presented, so spreading information about Celiac Disease is an important step in providing better care to patients.

Tags: Human Health

Laurel Edington: Grand Rounds – Celiac Disease

February 23rd, 2015 · Comments Off on Laurel Edington: Grand Rounds – Celiac Disease

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During the last week of class, we presented our grand rounds talks that we’ve been working on all semester. This was a great experience because it allowed us to practice giving a grand rounds lecture, which is a common presentation in the medical community. Each group of three picked a topic, which could be a case study or an overview of a disease or medical treatment, and then presented as if they were doctors talking about an interesting patient, new procedure that they’re performing, etc.

This year, the weather didn’t exactly cooperate with us. We were supposed to have a practice session during class on Tuesday and then go to Augusta to present our talks along with Kents Hill students at Maine General. Because of the snow day and horrible driving conditions, neither of these events happened and we had to present our final product with little group practice. Thankfully, my group was able to practice together before the weather was too bad, but practicing during class and at Maine General would have been helpful.

My group decided to present a case study on a 42 year old man with chest and abdominal pain. We found this study through the New England Journal of Medicine and it was used as a hugely teaching moment instead of a typical grand rounds talk. In this case study, the man’s symptoms were textbook for celiac disease but physicians performed a number of tests, including an invasive and non-diagnostic procedure, before even thinking of the possibility of celiac disease. This case study was not used to teach medical students and medical professionals about a rare disease or an interesting case, it was used to enforce the fact that celiac disease is becoming increasingly common and physicians need to be aware of it and perform the simple diagnostic blood test for the disease when a patient comes in presenting characteristic symptoms.

Through this presentation, we learned the difference between celiac disease and non-celiac gluten sensitivity. With celiac disease, there is damage to the intestines and an IgA tissue transglutaminase and IgA endomysial antibody tests can be performed to diagnose the condition, this is not the case with a gluten sensitivity. Both conditions, however, are treated with a strict gluten-free diet. This is becoming a popular new diet in people who don’t suffer from celiac disease or non-celiac gluten sensitivity. People who are using this fad diet and who don’t have celiac disease or a gluten intolerance are at risk for developing new gastrointestingal problems.

This project was a great way to expose us to this sort of presentation since the majority of the class is interested in the medical profession and grand rounds are a common occurrence. This was an especially interesting experience because we were able to present in front of nurses and doctors, which made the experience that much more real. It also reinforced the material we had learned throughout the class because we had to explain the disease based on the anatomy and physiology. I’ve been to multiple grand rounds during my summer internships and I never thought that I would be able to understand a case as well as those doctors, but this experience showed me that I am more than capable and therefore, was an awesome experience.

Tags: Grand Rounds

Danielle Levine: Grand Rounds

January 31st, 2015 · Comments Off on Danielle Levine: Grand Rounds

Danielle Levine (’15, Biology)

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One of the opportunities I had during this Jan Plan course was to participate in a Grand Rounds Presentation; Grand Rounds, in which physicians give lectures to their peers, including other physicians and medical students, on a medical topic is a common tradition in medical education. In groups of three students, we were able to pick any topic of interest for a fifteen minute oral presentation that we would present at the end of the semester. Given the vast array of medical topics that could be picked for a presentation, we looked to academic medical sources, including the New England Journal of Medicine, for possible past case studies that we could research and discuss. After scrolling through dozens of case studies, and clicking on articles with titles that seemed very interesting and then reading the articles’ summaries, we finally settled on an interesting case subject, one about celiac disease or gluten-induced enteropathy, that we considered particularly relevant given the current emphasis on the effects of gluten in the diet in popular culture.

In this case study, a 42-year old man presented to the emergency room with the chief complaint of chest and abdominal discomfort; given his additional history of unintentional weight loss and chronic diarrhea for ten years following coronary artery bypass grafting, an inflammatory disorder or a cancer of the chest or abdomen were differential diagnostic considerations. After multiple tests were performed, including an invasive exploratory laparotomy done after a CT scan showed enlarged jejunal lymph nodes, a small bowel biopsy revealed the diagnosis of celiac disease given the presence of flattened villi and intraepithelial lymphocytes. Today, celiac disease can be diagnosed via a simple blood test for IgA tissue transglutaminase and IgA endomysial antibodies. This case study demonstrates the importance for physicians, especially given the increasing incidence of celiac disease, to test for it non-invasively when a patient’s symptoms may be suggestive of it.

The diagnosis of celiac disease has been increasing in the developed world, at least in part due to the availability of new non-invasive tests to diagnose the autoimmune disorder. Also, there has been an increase in the diagnosis of non-celiac gluten sensitivity, which has been an even more significant factor in the increase in the number of people now adhering to a gluten free diet in the developed world. Unfortunately, some people do not have a true gluten-related disease or sensitivity, but are adopting a gluten free diet in a fad-like way. This is unfortunate because a gluten free diet can cause its own problems, such as nutritional (in particular, certain vitamins) deficiencies, and a lack of fiber in the diet leading to bowel-related issues.

Given the occurrence of a generalized increase in autoimmune disorders today, the hygiene hypothesis has been offered as a possible explanation, the basic tenet of which is that given increasingly prevalent strict hygienic practices, children today are exposed to fewer pathogens, and as a result can develop autoimmune disorders in which their own immune systems attack self antigens. Given the increasing numbers of people diagnosed with autoimmune disorders, it is hoped that research into celiac disease as well as other autoimmune disorders will lead to improved treatments of and ways to prevent them.

This Grand Rounds presentation was very informational as it allowed us to research a current topic of interest and, in so doing, learn the signs and symptoms that may exist at presentation of a certain disease (in this case, celiac disease), and how that disease may ultimately be diagnosed. As celiac disease is likely to continue to be a relatively common disease in the developed world, I believe this experience will be helpful to me, since I hope to become a physician someday. Being able to present our research to our peers as well as physicians and nurse practitioners, that is, to emulate something a real physician might engage in, was a wonderful experience. Furthermore, my mom, as a physician, talks about attending Grand Rounds Presentations every week at a hospital in New Jersey, and for me to be able to present a case study in the same manner was a fun and great opportunity.

 

 

Tags: Grand Rounds · Human Health