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Marissa Uhlhorn
Case Study Two
Celiac Disease
FSHN 450
Due Date: 10/2/15
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1.What is the etiology of celiac disease? Is there anything in BR’s history that might indicate a food allergy?
Etiology:
Genetic susceptibility
Environmental trigger- inflammation or illness
Exposure to gluten
Autoimmune Response
Indications of a food allergy:
Diarrhea
Abdominal pain (after eating certain foods)
Itchy rash
Unexplained weight loss (malabsorption)
Cramping (after eating certain foods)
2.What are anti-endomesial and anti-tissue transglutaminase antibodies? Why are they used for testing for celiac disease?
These antibodies are non-specific and sense the presence of the protein, gluten to cause an autoimmune response.
They are the most sensitive and specific blood test for celiac disease.
3.Why was a small intestinal biopsy ordered?
The biopsy was ordered to determine if it certain the patient has celiac disease. The small bioposy could show if the patient has flat gut syndrome or damage to the intestinal mucosa. This would show the possible loss of intestinal folds and villi.
4. What effect does gluten have on the small intestinal mucosa?
Gluten could cause flat gut syndrome in a patient with celiac disease, damaging the intestinal folds and villi. This could decrease the surface area of nutrients being absorbed, and could result in malnutrition.
5. Which symptoms beside the abdominal cramping diarrhea and weight loss are related to celiac disease? Why?
BR has two other symptoms that are related to celiac disease. These include: an itchy rash (dermatitis) and occasional joint pain (possible arthritis)
Celiac disease is an autoimmune disease, attacking other parts of the body, resulting in these symptoms including pain 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 of gluten: White toast, chocolate brownies, and chocolate chip cookies
Substitutes: Gluten free bread, corn/almond/soy/potato/brown rice flour, or gluten free multi-purpose flour to replace regular all purpose flour (containing gluten) in the chocolate brownies and cookies (or gluten free brownies and cookies- pre packaged)
Other exposures: Cosmetics, contaminants in processed foods, and 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?
A type of anemia called anemia of chronic inflammation is seen in patients with inflammatory diseases. The immune system’s response to inflammation can interfere with the body’s production of red blood cells, resulting in anemia. Due to the flat gut syndrome and damage to the intestinal mucosa, iron may not be absorbed well in the intestine.
8. Why might this patient be lactose intolerant?
When a patient has celiac disease, the villi on the intestinal mucosa are damaged or even flattened. These villi also make up the “brush border” which contains enzymes that help digest the sugars found in lactose. The lack of these enzymes would result in possible lactose intolerance.
II. List each laboratory value in table form:
|Value |Normal Range |Patient Value |Reason for Deviation |
|Hematocrit |34-45% |32.1% |Possible anemia |
|Hemoglobin |12.1-15.6 g/dl |10.8 g/dl |Possible anemia |
|RBC |3.9-5.5 million/mm3 |4 x 1012/L | |
|WBC |3200-10,600/microL |5 x 109/ L |Tissue injury (intestinal) |
|MCV |78-93 mm3/RBC |101 (um3) |Possible anemia |
|Serum Albumin |3.5-5.0 gm/dl |3.8 g/dl |No deviation |
|Cholesterol |120-199 mg/dL |115 mg/dl |Malabsorption |
|Ferritin |12-150 mg/dl |18 mg/dl |No deviation |
|Transferrin |212-360 |398 mg/dl |Possible anemia |
|Sodium |136-144 mEq/L |140 mEq/L |No deviation |
|Potassium |3.5-5.0 mEq/L |3.8 mEq/L |No deviation |
|Chloride |98-107 mEq/L |102 mEq/L |No deviation |
|BUN |8-23 mg/dl |10 mg/dl |No deviation |
|Creatinine |0.4-1.2 mg/dl |0.6 mg/dl |No deviation |
|Total Billirubin |1.0 mg/dl |0.2 mg/dl |No deviation |
|GGT |7-33 U/L |18 U/L |No deviation |
|ALT |4-31 U/L |12 U/L |No deviation |
|AST |10-31 U/L |10 U/L |No deviation |
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.
Assessment:
Anthropometrics:
22 y/o Caucasian female
Ht: 5’ 5”
Wt 112 lbs (51 kg)
BMI: 18.6 (lower end of normal)
Weight loss (10 lbs in past 6 months)
Nutrition consult and intestinal biopsy ordered
Biochemical Data-Labs: Hematocrit 32.1% (low), Hemoglobin 10.8 g/dl (low), WBC 5x 109/L (high), MCV 101 um3 (high), cholesterol 115 mg/dl (low), Transferrin 398 mg/dl (high)
All other lab values are normal
Positive IgA-tissue transglutaminase and IgA anti-endomesial antibodies
Family history: father with type 1 diabetes, mother with asthma
Physical findings: Itchy rash, 10 pounds of weight loss in past 6 months
Diet history: Consumption of gluten (bread, brownies, cookies), consumption of dairy (possible lactose intolerance associated with celiac disease)
Kcal Needs: For patients ................
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