1. Celiac Disease Case Study
FSHN 450
Honor Pledge: "I have not given, received, or used any unauthorized
assistance."
Alysse Milano

2. Patient’s Value Normal Range Reason for variance
BMI: 18.6 18.5-24.9 Lower due to disease
Albumin 3.8 g/dL 3.5-5 g/dL Normal
Glucose 80 mg/dL 70-90 mg/dL Normal
Na+ 140 mEq/L 135-145 mEq/L Normal
K+ 3.8 mEq/L 3.5-5.0 mEq/L Normal
Cl- 102 mEq/L 96-106 mEq/L Normal
Creat 0.6 mg/dL 0.6-1.2 mg/dL Normal
GGT 18 U/L 0-51 U/L Normal
Total Billirubin 0.2
mg/dL
0.0-0.2 mg/dL Normal
BUN 10 mg/dL 7-20 mg/dL Normal
AST 10 U/L 8-48 U/L Normal
ALT 12 U/L 7-55 U/L Normal
Cholesterol 115
mg/dL
<200 mg/dL Normal
Hgb 10.8 g/dL <12 g/dL Normal
Hct 32.1% <36% Normal
MCV 101 fl 75-98 fl High
WBC 5 x 109 /L
RBC 4 x 1012 /L
3.8-11.0 x 109 /L
3.5-5.0 x106 mm
Normal
Normal
Ferritin 18 ng/ml 24-336 ng/mL
Transferrin 398
mg/dL
240-450 mg/dL

3. Needs Assessment:
Kcal w/ Harris Benedict (BEE): 655 + 4.35 (112 lbs) + 4.7 (65 inches) – 4.7 (22) = 1344
Protein: 1.2 (50.8 kg) = 61 g
Fluid: 35 mL/kg/day = 1778 mL
1. There are various etiologies of celiac disease. These include genetic susceptibility,
exposure to gluten, certain environmental triggers, or an autoimmune response. BR doesn’t
have any genetic history indicating a foodallergy. However, her blood tests indicated that
she was positive for IgA-tissue transglutaminase and IgA anti-endomesial antibodies,
indicating a food allergy linked to an autoimmune response.
2. The IgA-tissue transglutaminase antibodies are associated withtissue transglutaminase,
whichis an enzyme causing crosslinking in some proteins. IgA anti-endomesial antibodies
are associated with the endomysium, a tissue layer covering certain muscle fibers. In celiac
disease, these antibodies are usually released in response to gluten. This is obviously an
abnormal effectof the immune system.
3. The small intestinal biopsy was ordered in order to identify abnormalities in the
intestinal mucosa, whichcould be indicative of celiac disease.
4. Gluten causes the loss of intestinal foldsand villi in the intestine, which are replaced by
immature cryptcells.
5. The abdominal distention is related to celiac disease because the small intestine cannot
digest food very well,and thus results in inflammation. Since BR’s response to gluten is
caused by an autoimmune disorder, these responses can also cause allergic responses like
an itchy rash or joint pain.
6. In the patient’s 24-hour diet recall, gluten is apparent in each of her meals. For breakfast,
there is gluten in her corn flakes (unless they are specifically gluten-free). For lunch, her
toast (and potentially potato chips) contain gluten. The brownies and cookiesshe has for
dinner and a snack also probably contain gluten. Gluten-free foods are pretty easy to come
by nowadays.BR couldfind gluten-free bread, cookiesand brownies. For breakfast, she
could eat a cereal like Rice Chex. Besides diet, cross-contactwith gluten could occurwith
various cooking materials like a toaster or shared containers. Additionally, gluten could be
found in lip products or some herbal/nutritional supplements.
7. Anemia is prevalent in patients with celiac disease for probably tworeasons: a) lack of
nutrient (specifically,iron)absorption in the small intestine due to flattened villi from celiac
disease and b) poor eating habits, with lackof iron rich foods, because some foods aren’t
handled well digestively by patients with celiac disease. Both of the patient’s low ferritin
and transferrin levels are associated with anemia.
8. Why might this patient be lactose intolerant?
Lactose intolerance can occur withceliac disease due to the damage that has occurred to the
mucosal lining of the intestines. The enzymes that digest lactose are present on the villi, and

4. since the villi have been damaged and flattened from celiac disease, they also have difficult
digesting and absorbing lactose.
1. Nutrition Diagnosis (PES Statement): Predicted suboptimal nutrient intake of iron
related to Celiac disease as evidenced by low lab levels of ferritin and transferrin.
Evaluation: Achieve appropriate intake of iron (≥18mg/day) through diet and proper
nutrition while consistently eating a gluten-free diet.
Intervention: Encourage eating nutrient dense and iron rich foods. Give patient
examples of foods containing the appropriate amount of iron she needs daily, and a diet
plan that meets the needs of her gluten-free restriction.
2. Nutrition Diagnosis (PES Statement): Impaired nutrient utilization related to Celiac
disease as evidenced by symptoms of diarrhea, abdominal distention, itchy rash, and
unexplained weight loss.
Evaluation: The patient will adhere to a gluten-free diet in order to prevent issues of her
autoimmunity to gluten.
Intervention: Discuss with the patient what foods contain gluten and why she needs to
avoid them. Additionally, she should be aware that there are other ways in which she can
come into contact with gluten, and that these should be avoided as well.
3. Nutrition Diagnosis (PES Statement): Food and nutrition related knowledge deficit
related to recently diagnosed Celiac disease as evidenced by 24-hour diet history
containing gluten.
Evaluation: The patient requires education on gluten containing foods and additional
nutrient deficiencies that could be associated with her recent diagnosis.
Intervention: Discuss with the patient what foods contain gluten, specifically the ones
she is eating everyday, and why this should be avoided. She should also be informed
about how she can obtain specific nutrients from her diet in case of deficiency (i.e. iron).