Transcript Case Study #9: Celiac Disease

By:
Kaili Acosta
Joyce Moore
Elizabeth Olivares
Rosalinda Ruiz
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Celiac Disease and Pathophysiology
Nutrition Therapy
Nutrition Assessment
Intake Domain
Clinical Domain
Nutrition Diagnosis
Nutrition Intervention
Monitoring and Evaluation
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Directions
2 teams - panel style
First group to raise hand will be given 30
seconds to deliberate the answer and choose a
spokesperson for each question (rotating
spokesperson) (both groups will deliberate
answer and spokesperson in case of incorrect
answer made by other team)
If first team answers incorrectly question will fall
to other panel and answer immediately
One point per question
No minus points
Panel with highest points wins!!!
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Patient name:
DOB:
Age:
Sex:
Ethnicity:
Height:
Weight:
Melissa Gaines
3/14
36
female
Caucasian
5’3”
92#
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Referring MD:
Roger Smith, M.D.,
gastroenterologist
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Chief complaints: Weight loss, diarrhea, lack of
energy
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Delivered a healthy baby boy (5 lb. 2 oz.)
Gained weight during pregnancy (11 lbs.)
 Greatest pre-pregnancy weight: 112#
 Current weight: 92#
Diarrhea on and off for most of her adult life
◦ Mother and grandmother also had diarrhea
Abnormal immune response to the consumption of
gluten
Etiology and Immune response:
Gliadin component of gluten triggers inflammatory
response
Presence of antibodies – autoimmune response
IgA - anti-tissue transglutaminase
AGA – antiendomysial antibodies
EMA – antigliadin antibodies
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Endoscopy and Biopsy
◦ Flat mucosa with villus atrophy and hyperplastic
crypts –inflammatory infiltrate in lamina propria
◦ Antibodies: Positive AGA, EMA
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72-Hour Fecal Test
Results:
◦ Steatorrhea and malabsorption
◦ 11.5 g fat/24 hours
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BMI=16.3 kg/m2
UBW= 112 #
%UBW=82 %
IBW=115#
% IBW= 80 %
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% weight change = 18 % weight change in 2
months
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Nutritional risks
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Anthropometric measurements
◦ TSK=7.5 mm.
 She is under the 5th percentile of TSF below average.
◦ MAC= 180 mm
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AMA = [(18 cm/12.56) x (3.14 x 0.75 cm)]2
(1.43 x 2.35)2 = 3.362 = 11.4 cm2
◦ Interpretation
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AFA: 14.4 cm2.
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◦ She is between the 5th and 10th percentile
which classifies her as below average fat.
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Nutrient requirements:
Calculation: Mifflin-St. Jeor equation:
Activity Factor: (1.2)
Injury Factor: (1.2)
EEN = (10 x 52.3kg) + (6.25 x 160.0 cm) - (5 x
36) – 161 = 1182 x (1.2) = 1418 (1.2)=1843 =
1800 kcal /day
EPR: (IBW 1.2 g/kg)
52.3 kg x 1.2g/kg = 62.76 = 63 g/d
24-Hour Recall
Evaluation
Lab
Albumin
Total Protein
Prealbumin
MG Value
2.9 g/dL (L)
5.5g/dL (L)
13 mg/dL (L)
Normal
3.5 - 5g/dL
6 – 8 g/dL:
16 - 35mg/dL
Nutritional Significance
PEM
PEM
PEM
AGA antibodies
+
-
Celiac Disease
EMA antibodies
+
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Fecal Fat Test
11.5 g / 24 hr
less than 7g / 24 hrs
Celiac Disease
Altered GI function,
steatorrhea, Malabsorption
HGB
9.5mg/dL (L)
12 - 15
Iron Deficiency Anemia
HCT
34 mg/dL (L)
37 - 47
Iron Deficiency Anemia
MCHC
30 L
31.5 - 36
Iron Deficiency Anemia
Ferritin
12 L
20-120
Iron Deficiency Anemia
ZPP
85 H
30-80
Iron Deficiency
Folate
3L
5-25
Malabsorption
B12
21.2 L
24.4-100
Malabsorption
Which lab values are
related to
consequences of Celiac
disease?
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Breastfeeding difficulty (NC-1.3)
Altered GI function (NC-1.4)
Impaired nutrient utilization (NC-2.2)
Altered nutrition related lab values (NC-2.2)
Underweight (NC-3.1)
Involuntary weight loss (NC-3.2)
Patient meets criteria:
Moderate Protein Energy Malnutrition
(PEM)
Albumin 2.9 g/dL
 82 % of UBW
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Inadequate energy expenditure (NI-1.4)
Inadequate oral food/beverage intake (NI-2.1)
Inadequate fluid intake (NI-3.1)
Inadequate mineral intake (sulfate, iron, Ca)(NI5.10.1)
Inadequate vitamin intake (Folate)(NI-5.9.2)
Malnutrition (NI-5.2)
Inadequate protein energy intake (NI-5.3)
Inadequate fat intake (NI-5.6.1)
Inadequate protein intake (NI-5.7.1)
Inadequate carbohydrate intake (NI-5.8.1)
Inadequate fiber intake (NI-5.8.5)
Inadequate oral and beverage intake (NI-2.1) RT
altered GI function and food- and nutrition-related
knowledge deficit secondary to CD AEB 24-hour
recall reveals 440 kcals, consuming 24% EEN, BMI
16.3 kg/m2, 80 % IBW, 82 % UBW, 30# weight loss
and18% weight change past 2 months revealing
severe weight loss.
Altered GI function (NC-1.4) RT intolerance to
foods containing gluten AEB diarrhea, weight
loss (30#) altered lab values: ferritin:12 mg/mlL
(L), HGB: 9.5g/dL (L), HCT: 34% (L), Alb: 2.9 g/dL
(L), Total PRO: 5.5 g/dL (L), PAB: 13 mg/dL (L),
ZPP : 85 umol/mol(H), Folate:3 ug/dL(L),
B12:21.2 ng/dL (L) and positive AGA and EMA.
 Gluten-free
 What
diet
is gluten?
 Where
can it be found?
 Consumption
of oats?
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Other sources than food
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Food additives
Coloring agents
Modified food starch
Medications
Lactose intolerance
Damage to villi affects ability
to absorb lactose
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Diet to start out on:
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High-protein supplement recommended:
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Glutamine supplementation:
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Length of stay on diet
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Follow-up
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How can we modify Mrs. Gaines’ diet?
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Nelms, MN, Sucher, K, Long,S. Nutrition Therapy and Pathophysiology, 2nd ed. Belmont, CA: Wadsworth/Thomas
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