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Celiac DiseaseCase Study 12Jackie FarrallKNH 411Professor Matuszak November 13, 2012

+Patient Description Melissa Gaines 36 years old female; 5’3” Currently 92 lbs UBW is 112 lbs Patient Hx:

Chief Complaint: “I have lost a tremendous amount of weight, and I have been having terrible diarrhea for awhile now. I don’t even have the energy to get off the couch”

GI issues on mothers side Has been relying on chicken noodle soup, crackers and sprite for the

past few days Has a college degree and works as a secretary for a hospital

administrator but just gave birth 3 months ago so on maternity leave

+Etiology

Auto-immune condition which affects an individual for life once there is an onset Usually inherited (associated with the AGA/EMA antibody production) Onset can occur at birth, after surgery, during pregnancy, after

infection or any serious trauma

Immune response to gluten, a wheat protein which causes damage to the intestinal villi Damaged villus will decrease the area of the intestines in which

nutrients are absorbed into the bloodstream

+Symptoms for Celiac Disease

Direct Abdominal bloating Chronic diarrhea Vomiting Constipation Foul smelling/fatty stool Weight loss

Indirect Anemia Fatigue Arthritis Skin rash Osteoporosis Infertility/miscarriage

+Patients’ Symptoms

Weight loss Foul smelling/fatty stool Chronic diarrhea Anemia Fatigue

+Assessment

36 year old female, thin, pale, experiencing fatigue, weakness and diarrhea

BMI: 16.3 UBW: 112 lbs Melissa is 82% of her UBW Actual body weight: 92 lbs Avoids eating due to nausea and diarrhea. Has resulted

to weight loss

+Chemistry Melissa’s

valueNormal values

Reasons for Abnormality

Albumin 2.9 g/dL 3.5-5 g/dL Weight loss, muscle wasting, inadequate protein intake

Total Protein 6-8 g/dL 5.5 g/dLPrealbumin 13 g/dL 16-35 g/dL

AGA antibodies

+ 0 Abnormal autoimmune response to glutenEMA

antibodies+ 0

HGB 9.5 g/dL 12-15 g/dL Low absorption of ironHCT 34 g/dL 37-47 g/dL

Vitamin B12 21.2 ng/dL 24.4-100 ng/dLFolate 3 mm cubed 5-25 mm

cubedFerritin 12 mg/mL 20-120 mg/mL

+Nutrition Requirements

Requirements: 1185-1400 kcals per day Increased the kcal by 500 kcal/day because we want

Melissa to gain weight

Protein: 1.0 g/kg body weight/day (1.0 x 41.8 kg)=42 g/day Which would increase the protein by 63-73 gr/day

Receiving: 598 kilocalories 9 gr of protein and fat

+PES Statements

1. Involuntary weight loss (NC 3.2) related to inadequate energy intake and untreated Celiac disease as evidence by recent weight loss of 30 lbs and BMI of 16.3 kg/m squared.

2. Altered gastrointestinal function related to secondary malabsorption of nutrients, vitamins and minerals as evidence by reported consumption of gluten containing foods, small bowel biopsy indicating flat mucosa with villous atrophy and hyperplastic crypts, having diarrhea on and off for most of her adult life, and recent weight loss over one month.

+Diagnosis Diagnostic Measures

24-hour stool collection 100-g fat diet x 3 days 72- hour fecal fat Sudan Black B fat stain Blood tests Collecting a sample of small intestine for testing CBC, WBC, ESR, CRP, CMP tests

Melissa's results revealed flat mucosa with villus atrophy and hyperplastic crypts. Fecal fat tests indicated steatorrhea and malabsorption. As seen in lab values patient was positive for AGA and EMA antigens.

+Flat Mucosa

+Treatment

MNT: Gluten-free diet Nothing containing wheat, rye or barley Words such as stabilizer, starch, flavoring, emulsifier, hydrolyser, plant

protein often mean wheat protein is involved Corn, potato, rice, soybean, tapioca, arrowroot, carob, buckwheat, millet,

amaranth and quinoa are allowed and good carbohydrate sources Cross contamination Alcohol

Medication Steroids and immune suppressants Vitamin supplements

Treatment for this condition is non-surgical

+Prognosis

Education will be important part of recovery With a gluten-free diet regeneration of new epithelial

cells in the gut will take place and within 2 years patients intestine will be healed

If patient does not stay on gluten-free diet- Increase chances of developing cancer of the intestine Osteoporosis Untreated pregnant women have higher than normal rates

of miscarriage and babies born with birth defects, especially neural tube defects, which arise from inadequate amounts of folic acid.

+ReferencesAmerican Association for Clinical Chemistry. (2009, May 16). Total protein and A/G

ratio. Retrieved November 9, 2012, from http://www.labtestsonline.org/understanding/analytes/tp/test.htm

American Dietetic Association. (2008). International dietetics and nutrition terminology (IDNT) reference manual: Standardized language for the nutrition care process (2nd ed.)

Celiac Disease Foundation. (2011). Celiac disease symptoms. Retrieved November 9, 2012, from http://www.celiac.org/

Celiac Sprue Association. (2008). Symptoms of celiac disease. Retrieved November 7, 2012, from http://www.csaceliacs.org/celiac_symptoms.php

Nelms, M. N., Roth, S. L., & Lacey, K. (2009). Medical nutrition therapy: A case study approach (2nd ed.). Belmont, CA: Wadsworth Cengage Learning.

USDA Center for Nutrition Policy and Promotion. (2010, September 28). MyPyramid tracker. Retrieved November 9, 2012, from http://www.mypyramid.gov/

The University of Chicago Celiac Disease Center. (n.d.). The University of Chicago celiac disease center. Retrieved November 8, 2012, from http://www.celiacdisease.net/