Megan Blackburn

Celiac Case Study

FSHN 450

CSU ID: 830130344

I have not given, received, or used any unauthorized assistance on this assignment

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I. Answer the following questions:1.What is the etiology of celiac disease? Is there anything in BR’s history that might indicate a food allergy?

Etiology: o Genetic susceptibilityo Exposure to gluteno Environmental triggero Autoimmune response

Indications of food allergy : o Diarrheao Abdominal distention (after eating certain foods)o Rasho Joint paino Unexplained weight loss

2.What are anti-endomesial and anti tissue transglutaminase antibodies? Why are they used for testing for celiac disease?These are autoantibodies against the transgluaminase protein. Autoantibodies are antibodies that are against the body’s own products, and they can cause autoimmune disease, such as celiac disease. They are used to test celiac disease because if these autoantibodies are found in the intestine then that can be an indicator of celiac disease.

3.Why was a small intestinal biopsy ordered? A small intestinal biopsy could prove that the patient has damage to the intestinal mucosa or flat gut syndrome. This could lead to determining whether or not the patient has celiac disease.

4. What effect does gluten have on the small intestinal mucosa?Gluten effects the small intestine mucosa by damaging the intestinal mucosa. This can lead to flat gut syndrome, loss of intestinal fluids, villi, and immature crypt cells replace.

5. Which symptoms beside the abdominal cramping, diarrhea and weight loss are related to celiac disease? Why?Itchy rash, joint pain, and unexplained weight loss are all related to celiac disease. This is due to the autoimmune part of the disease, which attacks the body, which then results to rashes and inflammation.

6. What sources of gluten do you see in the patients 24-hour diet recall? What might be some acceptable substitutes? What are some other potential sources of gluten exposure besides diet?

Sources: o White Toast

o Chocolate Brownies

o Chocolate Chip Cookies

Substitutes :o Corn Tortilla/Gluten

free breado Gluten Free

brownies/Chocolate Ice cream

o Gluten Free cookies/just eat the chocolate chips!

Other Potential Sources :o Cosmeticso Contaminants in Processed foodso Binders in medications/supplements

7. There is a high prevalence of anemia among patients with celiac disease. Why is this the case? Which of the patient’s laboratory values are associated with anemia?Anemia occurs in patients with celiac disease due to the fact that their brush border in their small intestine is unable to absorb nutrients, including iron, which then can cause anemia. The patients lab values that are associated with anemia are:

Low hematocrit Low hemoglobin High MCV High Transferrin

8. Why might this patient be lactose intolerant?Since this patient has celiac disease, the villi that make up the brush border has been broken down and therefore you do not have enough lactase enzymes to breakdown the lactose sugars, producing an intolerance to lactose.

II. List each laboratory value in table form:

Value Normal Range Patient Value Reason for DeviationHematocrit: 35-45% 32.1% Possibility of anemiaHemoglobin: 12.1-15.6 g/dl 10.8% Possibility of anemiaRBC: 3.9-5.5 mm^3 4 x 1012/LWBC: 3,200-10,600/uL 5 x 109/L Intestinal tissue injuryMCV: 78-98 (um^3) 101 (um3) Possibility of anemiaSerum albumin: 3.5-5.0 g/dl 3.8 g/dl N/AGlucose (fasting): 80 mg/dlCholesterol: 120-199 mg/dl 115 mg/dl MalabsorptionFerritin: 12-1250 mg/dl 18 mg/dl N/ATransferrin: 212-360 mg/dl 398 mg/dl Possibility of anemiaSodium: 136-144 mEg/L 140 mEg/L N/A

Potassium: 3.5-5.0 mEg/L 3.8 mEg/L N/AChloride: 98-107 mEg/L 102 mEg/L N/ABUN: 8-23 mg/dl 10 mg/dl N/ACreatinine: 0.4-1.2 mg/dl 0.6 mg/dl N/ATotal Billirubin: 1.0 mg/dl 0.2 mg/dl N/AGGT: 7-33 U/L 18 U/L N/AALT: 4-31 U/L 12 U/L N/AAST: 10-31 U/L 10 U/L N/A

III. Conduct a nutrition assessment of the patient and report in ADIME format. Don’t forget your assessed Kcal and protein needs. Include one PES statement in the clinical domain and one PES statement in the behavioral domain and one PES statement in the intake domain and an intervention and evaluation for each one.Kcal Equation: Unintended Wt. Loss: 25-35 Kcal/kg(50.8): 1,270-1,778 Kcal/dayProtein for BMI <30: Hospitalized Patients: 1.2-2 g/kg: 61-102 g/dayAssessment:

22 y/o Caucasian female Ht: 5’5’’ Wt: 112# Wt loss: 10# in past 6 months BMI: 18.6 Family History:

o Father: type 1 diabeteso Mother: asthmao No history of GI disorders in patient or family

Treatment plan: gluten-free diet/nutrition consult/small intentional biopsy ordered

o Diet shows: intake of white toast, cookies, and brownies. Also consumes milk and butter.

C/O diarrhea, abdominal distention, itchy rash, joint pain, unexplained weight loss.

Blood test: positive for IgA-tissue transglutaminase and IgA anti-endomesial antibodies.

Clinical Domain: PES Statement :

o Altered GI function R/T abdominal distention and diarrhea AEB low cholesterol levels/malabsorption.

Intervention : o Encourage 1 lb wt gain per week until normal weight is reached.o Educate patient about gluten and provide recommendations of gluten

free foods.o Encourage patient to document any discomfort post food intake.

Evaluation : Monitor that weight gain is a healthy amount, suggest new blood test to evaluate hemocrit, hemoglobin, and MCV.

Behavioral Domain: PES Statement: Food and nutrition-related knowledge deficit R/T intake of

gluten AEB C/O abdominal distention/rash/joint pain. Intervention:

o Encourage patient to consume a bland diet until symptoms diminisho Provide education to patient about what consuming gluten does to

your small intestine when you have celiac disease.o Provide recipes/foods to patients that do not contain gluten (or

lactose)o Encourage patient to keep a food diary, therefore she’s less likely to

eat gluten if she has to admit it. Evaluation : check in with patient to see if symptoms are persisting. Monitor

that weight has increased, and not decreased. Check food diary to monitor food intake.

Intake Domain: PES Statement:

o Malnutrition R/T malabsorption in small intestine AEB low cholesterol levels and 10# weight loss in last 6 months.

Intervention: o Encourage ~1 lb wt gain per week until normal weight is reachedo Encourage no intake of gluten or lactose in the dieto Provide education about healthy weight gain

Evalutaion: monitor patient’s cholesterol levels after ~3 weeks, monitor weight gain, monitor symptoms/discomforts that patient was feeling prior to visit