Celiac Disease - Meghan R. Zook

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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=150lbs
BMI=22
% Weight Loss=17%
ENERGY-PROTEIN NEEDS
Mifflin St. Jeor: (9.99x56.81)+(6.25x160.02)-
(4.92x46)-161
 PA=1.1 (sedentary)
 IF (stress factor)=1.4
 1820 kcal
Protein needs: 0.8g/kg=45 grams/day
Fluid needs: 1mL/kcal=1800mL/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
 SuperTracker 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 IgA 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: tTG-IgA 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.
2.
3.
4.
5.
6.
Serum antibody tests for: anti-tTG, EMA, and AGA
Chem 24
Hematology w/differential-% of WBC, helps reveal
abnormal blood cell count
Dapsone: antibacterial for dermatitis herpetiformis
Gluten-free diet
Nutrition consult
LAB RESULTS
 AGA antibody
 Iron saturation
 EMA antibody
 Vitamin B12
 tTG IgA anitbody
 Folate
 Hemoglobin/Hematocrit
 Magnesium
 Transferrin
 Ferritin
 Iron
 Total iron binding capacity
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, couscous, 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 stirfried 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] PubMed
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/WheatAllergyMen
u.pdf
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