CELIAC DISEASE PATIENT PROFILE Melissa Gaines 46 y

CELIAC DISEASE

PATIENT PROFILE Melissa Gaines, 46 y. o. white female Married, 2 sons No religious affiliation Other History: uses tobacco, takes vitamins, father had CAD

PATIENT HISTORY/SYMPTOMS Medical History: 3 pregnancies/2 live births Other History: uses tobacco, takes vitamins, father had CAD Symptoms: neuropathy; mouth sores; blistering, itchy skin rash over elbows, knees and buttocks; muscle cramps; and depression Physical: Pale skin; dermatitis on torso, scalp, and buttocks

ANTHROPOMETRICS Height: 63” Weight: Current=125 lbs, Past=150 lbs BMI=22 % Weight Loss=17%

ENERGY-PROTEIN NEEDS Mifflin St. Jeor: (9. 99 x 56. 81)+(6. 25 x 160. 02)- (4. 92 x 46)-161 PA=1. 1 (sedentary) IF (stress factor)=1. 4 1820 kcal Protein needs: 0. 8 g/kg=45 grams/day Fluid needs: 1 m. L/kcal=1800 m. L/day

NUTRITION HISTORY No problems w/food or appetite. No diarrhea or N/V 24 -hr recall: AM Toast (2 slices) w/butter and w/hot tea w/sugar Lunch Chicken noodle soup, pb/j sandwich, applesauce, Sprite Dinner Pasta, sauce, green beans, garlic bread, sherbet Super. Tracker data: 1600 kcal out of estimated need of 1820 kcal.

DX Rule out Celiac disease & anemia

DISEASE FACTS Celiac disease: is a genetically-based autoimmune disease characterized by chronic inflammation of the small intestinal mucosa. Reaction to specific sequences of amino acids found in gluten Gluten: A protein (a-gliadin and other protein components) found in wheat, rye, barley, and in small amounts oats Affects 1% of the population 2. 5 million Americans are undiagnosed

DISEASE FACTS Symptoms Children: Bloating, diarrhea, vomiting, fatty/foul stool, delayed growth, etc. Adults: Iron-def. anemia, joint/bone pain, depression, rashes, canker sores, missed periods, infertility or miscarriage, etc. Other intolerances

DERMATITIS HERPETIFORMIS (DH) Dermatitis Herpetiformis (DH): CD skin manifestation. Bilateral, symmetric rash or eruptions on pressure points of the skin that turn into blisters. On elbows, knees, buttocks, back, neck, etc. http: //siklusair. com/dermatitis-herpetiformis-face

ETIOLOGY Runs in the family, 10% chance. Stress, injury, childbirth, surgery, etc. can “turn on” your celiac disease (or methyl groups)? Small intestine exposed to components of gluten, WBC into the mucosa. Triggers inflammatory response, increase of Ig. A and other antibodies.

ETIOLOGY Inflammatory and innate immune response damage villi. Reduced surface area for nutrient absorption. Accompanied with other autoimmune disorders and food intolerances.

DIAGNOSING CELIAC Screening: t. TG-Ig. A is most common. Screen for antibodies. Diagnosis: Endoscopic biopsy – Gluten-free diet Gluten Sensitivity: Test negative, symptoms w/o intestinal damage

MRS. GAINES’ MEDICAL TX PLAN 1. Serum antibody tests for: anti-t. TG, EMA, and AGA 2. Chem 24 3. Hematology w/differential-% of WBC, helps reveal abnormal blood cell count 4. Dapsone: antibacterial for dermatitis herpetiformis 5. Gluten-free diet 6. Nutrition consult

LAB RESULTS AGA antibody capacity Iron saturation EMA antibody Vitamin B 12 t. TG Ig. A anitbody Hemoglobin/Hematocrit Folate Magnesium Transferrin Ferritin Iron Total iron binding

PES STATEMENT Impaired nutrient utilization related GI distress secondary to inflammation of the small intestine as evidenced by abnormal lab values presenting gluten antibodies and indicative of iron deficiency anemia.

MNT FOR MRS. GAINES Gluten-free diet – lifelong Lactose-free diet (until villi have had a chance to heal)

MNT FOR MRS Nutrition education to help patient be able to maintain a life-long diet and lifestyle change. Educate about foods that should be avoided (including foods that may be cross-contaminated) Help find supportive social network for patient Work with patient likes and dislikes to create diet Perform anthropometric and laboratory check-up to assess anthropometrics and nutrient levels

FOODS TO AVOID Wheat: Bulgur, cereal extract, cracked wheat, durum flour, emmer, einkorn, farina, farro, flours made from wheat Grains: Breads, other baked goods (brownies, cakes, cookies, muffins, etc. ), cereals, cous, pancakes, pasta, tortillas (made from flour) Vegetables/Fruits: look at packaging to see if prepared w/wheat products Fats & oils: Sauces, gravies, salad dressings prepared/thickened with flour Other: Soy sauce, licorice

SAMPLE MENU Breakfast: 1 cup oatmeal, 1 small banana, 1 hard- boiled egg, 1 cup milk Snack: 2 ounces cheese, 1 ounce wheat-free crackers Lunch: 1 large mixed green salad, 1 Tbsp olive oil and vinegar dressing, 3 ounces turkey, 2 slices wheat-free bread, 2 tsp mayonnaise Snack: Carrot and celery sticks Dinner: 1 cup barley soup (made from allowed ingredients), 4 ounces baked fish with herbs, 1 sweet potato, ½ cup stir-fried vegetables, 1 wheat-free roll, 2 tsp margarine Snack: ½ cup applesauce, Hot tea

SOURCES Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013 May; 108(5): 656 -76. [264 references] Pub. Med Nelms, M. N. , & Roth, S. L. (2014). Medical nutrition therapy: A case study approach. Stamford, CT: Cengage Learning. Nelms, M. , Sucher, K. , Lacey, K. , Roth, S. L. (2011). Nutrition therapy and pathophysiology. Stamford, CT: Cengage Learning. Academy of Nutrition & Dietetics Evidence Analysis Library. (2009). Celiac Disease Evidence Analysis Project. Retrieved from http: //andevidencelibrary. com/topic. cfm? cat=2826 Online Nutrition Care Manual. http: //www. nutritioncaremanual. org/vault/2440/web/files/Wheat. Allergy Menu. pdf