Celiac Disease Case Study 12 Jackie Farrall KNH

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

+ Patient Description n Melissa Gaines n 36 years old female; 5’ 3” n Currently 92 lbs n UBW is 112 lbs n Patient Hx: n n 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 n n Auto-immune condition which affects an individual for life once there is an onset n Usually inherited (associated with the AGA/EMA antibody production) n 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 n Damaged villus will decrease the area of the intestines in which nutrients are absorbed into the bloodstream

+ Symptoms for Celiac Disease n Direct n n n Abdominal bloating Chronic diarrhea Vomiting Constipation Foul smelling/fatty stool Weight loss n Indirect n n n Anemia Fatigue Arthritis Skin rash Osteoporosis Infertility/miscarriage

+ Patients’ Symptoms n Weight loss n Foul smelling/fatty stool n Chronic diarrhea n Anemia n Fatigue

+ Assessment n 36 year old female, thin, pale, experiencing fatigue, weakness and diarrhea n BMI: 16. 3 n UBW: 112 lbs n Melissa is 82% of her UBW n Actual body weight: 92 lbs n Avoids eating due to nausea and diarrhea. Has resulted to weight loss

+ Chemistry Melissa’s value Normal values Reasons for Abnormality Albumin 2. 9 g/d. L 3. 5 -5 g/d. L Total Protein 6 -8 g/d. L 5. 5 g/d. L Prealbumin 13 g/d. L 16 -35 g/d. L Weight loss, muscle wasting, inadequate protein intake AGA antibodies + 0 EMA antibodies + 0 HGB 9. 5 g/d. L 12 -15 g/d. L HCT 34 g/d. L 37 -47 g/d. L Vitamin B 12 21. 2 ng/d. L 24. 4 -100 ng/d. L Folate 3 mm cubed 5 -25 mm cubed Ferritin 12 mg/m. L 20 -120 mg/m. L Abnormal autoimmune response to gluten Low absorption of iron

+ Nutrition Requirements: 1185 -1400 kcals per day n n Protein: 1. 0 g/kg body weight/day (1. 0 x 41. 8 kg)=42 g/day n n Increased the kcal by 500 kcal/day because we want Melissa to gain weight Which would increase the protein by 63 -73 gr/day Receiving: n n 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 n Diagnostic n n n n 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 n 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 n MNT: Gluten-free diet n n n Medication n 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 Steroids and immune suppressants Vitamin supplements Treatment for this condition is non-surgical

+ Prognosis n Education will be important part of recovery n 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 n If patient does not stay on gluten-free dietn Increase chances of developing cancer of the intestine n Osteoporosis n 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.

+ References American 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 (2 nd 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 (2 nd ed. ). Belmont, CA: Wadsworth Cengage Learning. USDA Center for Nutrition Policy and Promotion. (2010, September 28). My. Pyramid 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/