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Clinical Case Scenario_ Celiac Disease


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									Clinical Case Scenario: Celiac
         Catherine E. Farkas
              KNH 406
             Patient: Melissa Gaines
•   Female
•   36 years of age
•   5’3”
•   Currently 92 lbs
•   UBW is 112 lbs
•   Complains that she has lost weight, has terrible foul smelling
    diarrhea on and off for most of adult life and is lethargic
•   Has a college degree and works at a secretary for a hospital
    administrator but just gave birth 3 months ago so on maternity
•   GI problems run on the maternal side of her family
•   Has been relying on chicken noodle soup, crackers and sprite for
    the past few days
•   Diagnosed by physician with celiac disease
                          Celiac Disease
• Auto-immune condition which affects an
  individual for life once there is an onset
  – Usually inherited (associated with the AGA/EMA antibody production)
  – Onset can occur at birth, after surgery, during pregnancy, after infection or any serious

• Immune response to gluten, a wheat protein which
  causes damage to the intestinal villi
  – Damaged villus will decrease the area of the intestines in which nutrients are absorbed
    into the bloodstream
  – Secondary complications may arise as a result of this immune response
• Direct
  –   Abdominal bloating
  –   Chronic diarrhea
  –   Vomiting
  –   Constipation
  –   Foul smelling/fatty stool
  –   Weight loss

• Secondary
  –   Anemia
  –   Fatigue
  –   Arthritis
  –   Seizures
  –   Infertility/miscarriage
  –   Certain cancers
• Celiac disease with secondary malabsorption and
• Diagnostic Measures
   –   24-hour stool analysis (100-g fat diet x 3 days)
   –   White blood cell count
   –   Sudan black B fat stain
   –   Parasite testing
   –   Electrolytes, osmolality, pH and alkalization testing
   –   Small bowel biopsy

• 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.
                 Patient Hx
Item             Normal       Patient
Albumin          3.5-5        2.9
Total Protein    6-8          5.5
Pre Albumin      16-35        13
Magnesium        1.8-3        1.6
Osmolality       285-295      275
Chol             120-199      119
AGA antibodies   -            +
EMA antibodies   -            +
Fecal Fat        >7           11.5
HGB              12-15        9.5
HCT              37-47        34
MCHC             31.5-36      30
Ferritin         20-120       12
Vitamin B12      24.4-100     21.2
Folate           5-25         3
• MNT: Gluten-free diet
  – 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
  – Foods such as meat patties processed on multiple use machines must be inspected for

• Medication
  – Steroids and immune suppressants used to control intestinal swelling and
    malabsorption in extreme cases

• Treatment for this condition is non-surgical
• Based on the patient’s 24-hour recall, almost
  every product ingested contains a gluten
• Education will be important part of recovery
• With a gluten-free diet regeneration of new
  epithelial cells in the gut will take place and
  within 3-6 months patient will be healthy

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