Download - Celiac Disease
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Celiac DiseaseCase Study 12Jackie FarrallKNH 411Professor MatuszakNovember 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 34g/dL 37-47g/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/