1. Celiac Disease Case Study 12 Jackie Farrall KNH 411 Professor Matuszak
November 13, 2012

2. 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

3. 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

4. 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

5. Patients’ Symptoms Weight loss Foul smelling/fatty stool
Chronic diarrhea
Anemia
Fatigue

6. 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

7. Reasons for Abnormality
Chemistry
Melissa’s value
Normal 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/dL
Prealbumin
13 g/dL
16-35 g/dL
AGA antibodies +
Abnormal autoimmune response to gluten
EMA antibodies
HGB
9.5 g/dL
12-15 g/dL
Low absorption of iron
HCT
34 g/dL
37-47 g/dL
Vitamin B12
21.2 ng/dL
ng/dL
Folate
3 mm cubed
5-25 mm cubed
Ferritin
12 mg/mL
mg/mL

8. Nutrition Requirements
Requirements: 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 gr/day
Receiving:
598 kilocalories
9 gr of protein and fat

9. PES Statements
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.
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.

10. 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.

11. Flat Mucosa

12. Treatment MNT: Gluten-free diet Medication
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

13. 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.

14. References
American Association for Clinical Chemistry. (2009, May 16). Total protein and A/G ratio. Retrieved November 9, 2012, from 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 Celiac Sprue Association. (2008). Symptoms of celiac disease. Retrieved November 7, 2012, from 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 The University of Chicago Celiac Disease Center. (n.d.). The University of Chicago celiac disease center. Retrieved November 8, 2012, from