Transcript Celiac Disease Presentation - Clinical Manual

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Celiac Disease
Case Study 12
Jackie Farrall
KNH 411
Professor Matuszak
November 13, 2012
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Patient Description
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Melissa Gaines
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36 years old female; 5’3”
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Currently 92 lbs
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UBW is 112 lbs
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Patient Hx:
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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
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Etiology
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Auto-immune condition which affects an individual for life
once there is an onset
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Usually inherited (associated with the AGA/EMA antibody production)
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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
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Damaged villus will decrease the area of the intestines in which nutrients
are absorbed into the bloodstream
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Symptoms for Celiac Disease
 Direct
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Abdominal bloating
Chronic diarrhea
Vomiting
Constipation
Foul smelling/fatty stool
Weight loss
 Indirect
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Anemia
Fatigue
Arthritis
Skin rash
Osteoporosis
Infertility/miscarriage
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Patients’ Symptoms
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Weight loss
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Foul smelling/fatty stool
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Chronic diarrhea
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Anemia
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Fatigue
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Assessment
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36 year old female, thin, pale, experiencing fatigue,
weakness and diarrhea
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BMI: 16.3
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UBW: 112 lbs
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Melissa is 82% of her UBW
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Actual body weight: 92 lbs
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Avoids eating due to nausea and diarrhea. Has resulted to
weight loss
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Chemistry
Melissa’s
value
Normal values
Reasons for
Abnormality
Albumin
2.9 g/dL
3.5-5 g/dL
Total Protein
6-8 g/dL
5.5 g/dL
Prealbumin
13 g/dL
16-35 g/dL
Weight loss,
muscle
wasting,
inadequate
protein intake
AGA
antibodies
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0
EMA
antibodies
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0
HGB
9.5 g/dL
12-15 g/dL
HCT
34 g/dL
37-47 g/dL
Vitamin B12
21.2 ng/dL
24.4-100 ng/dL
Folate
3 mm cubed
5-25 mm cubed
Ferritin
12 mg/mL
20-120 mg/mL
Abnormal
autoimmune
response to
gluten
Low
absorption of
iron
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Nutrition Requirements
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Requirements: 1185-1400 kcals per day
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Protein: 1.0 g/kg body weight/day (1.0 x 41.8 kg)=42 g/day
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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:
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598 kilocalories
9 gr of protein and fat
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PES Statements
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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.
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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.
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Diagnosis
 Diagnostic
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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.
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Flat Mucosa
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Treatment
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MNT: Gluten-free diet
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Medication
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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
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Prognosis
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Education will be important part of recovery
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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
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If patient does not stay on gluten-free diet
Increase chances of developing cancer of the intestine
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Osteoporosis
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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.
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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 (2nd 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
(2nd ed.). Belmont, CA: Wadsworth Cengage Learning.
USDA Center for Nutrition Policy and Promotion. (2010, September 28). MyPyramid 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/