Project #1 for FSHN 426_HW

Digestion and Absorption

Group: Leucine
9/9/2014
Case Study: Crohns Disease
A 24-year-old woman has a 7-week history of frequent diarrhea, right lower quadrant
abdominal pain (especially after eating), 20-lb weight loss, fatigue, occasional fever and
joint pain. She admits to having smoked approximately 1 pack of cigarettes every day
for the past 5 years. Results from her stool tests are negative for enteric pathogens
while results from her blood work reflect mild anemia (hemoglobin at 11.2 g/dL) with
elevated white blood cell count. The test also shows a normal metabolic panel as well
as normal thyroid-stimulating hormone levels. Total protein levels from lab results are
lower than normal at 5.5 g/dL and Vitamin D is also low at 22.7ng/mL, however, creactive protein levels from her results are higher than normal at 2.8mg/dL. An MRI and
a biopsy indicates inflammation and shows evidence of bleeding in the lower end of the
small intestine, the upper end of the large intestine, and the colon. A hydrogen breath
test reveals an elevated concentration of hydrogen. The woman is diagnosed with
Crohns disease.
Question #1: Discuss what the lab results imply about the absorption of certain
nutrients in the patient.
Key answer: Low hemoglobin levels and low total protein levels from the lab
workup suggest malabsorption of iron and protein, respectively. The recent
weight loss of the patient also suggests that other macronutrients are not being
effectively absorbed. Such malabsorption is most likely due to the inflammation
of the intestinal villi. When the intestinal villi are inflamed, nutrients are limited in
their ability to be transported into the enterocyte. This causes nutritional
deficiencies as seen in the lab results.
Question #2: What do the results of the hydrogen breath test suggest about the ability
of the patient to absorb fructose?
Key answer: An elevated concentration of hydrogen in the breath is indicative of
malabsorption of fructose. Malabsorption of fructose is due to deficient GLUT5
transporters in the small intestine. GLUT5 transporters are the proteins
responsible for shuttling fructose from the lumen into the enterocyte via facilitated
diffusion. When fructose is not fully absorbed in the small intestine, it passes to
the colon where the resident bacteria digest it and produce hydrogen. This leads
to an increased concentration of hydrogen when the patient takes the breath test.
Question #3: What are the key indicators that the patient is in fact suffering from
Crohns disease? Are there any additional diagnoses that can be made based on the
information provided?
Key answer: Key indicators of Crohns disease include inflammation and
bleeding evidenced in the small intestine, large intestine and colon. High c-

reactive protein levels also indicate inflammation characteristic of Crohns

disease. The patients numerous other issues including fever, abdominal pain
and joint pain all point to the same diagnosis. Since the patient was not tested for
gluten intolerance, however, the patient could actually have celiac disease. The
symptoms and diagnostic processes are actually very similar for the two
diseases.
Contribution of Each Group Member
Nicolette DeAngelis: Development of Crohns disease patient case study, input of lab
results commonly seen with Crohns disease
Erin Harman: Researched Crohns and similar diseases, contributed to the case study
synopsis and the questions, proof-read and submitted the project
Nol Konken: Verified references used to be credible. Contributed to case study
question #2 and proof-read entire document.
Joanna Manero: Proofread, and verified accuracy of information.
Melissa Raney: Identified and helped to input key answers to case study questions.
Created one case study question.
Leila Shinn: Development of Crohns disease patient case study, provided information
in key answer to question #3.