Case Study # 10

1 to 10, 12, 13, 14, 17 to 19

1. Celiac disease a condition where a person’s immune system makes antibodies to gluten. It is
an inherited disease and many cases remain undiagnosed because symptoms mimic many
other gastrointestinal conditions. Only about three percent of people who have celiac disease
have been diagnosed. You can’t say that Mrs. Gaine’s is a typical person for this disease given
her history but some symptoms such as diarrhea, abdominal pain, anemia, and weight loss
show that she was going to have this disease. She also mentioned that some symptoms were in
her family history.

2. The tTG antibodies are associated with tissue transglutaminase which is an enzyme causing
crosslinking in some proteins. The 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 effect on the immune
system.

3.
 Nongastrointestinal symptoms:
- Dermatitis herpetiformis
- Infertility or fetal loss
- Anemia
- Dementia
- Folate or iron deficiency
- Spinocerebellar syndrome
- Neuropathy
- Tetany
- Osteoporosis
- Arthralgia
- Developmentally synchronous dental enamel defects
- Fatigue
- Osteomalacia
- Seizures
- Depression
- Glycemic control more difficult
 Gastrointestinal symptoms:
- Steatorrhea
- Duodenal obstruction
- Osmotic diarrhea
- Elevated transaminase concentrations
- Secretory diarrhea
- Recurrent pancreatitis
 - Weight loss
- Occult blood
- Constipation
- Enteropathy-associated T cell lymphoma
- Bloating/Gas
- Abdominal pain
- Failure to thrive
- Vomiting
- Dyspepsia

4. The biopsy of the small intestine is a procedure where the doctor inserts a long tube through
the patient’s mouth and all the way down until the tube reaches the small intestine. Once at
the small intestine, the doctor will surgically remove a small sample of tissue. The tube will then
be removed and the tissue sample will be examined under a microscope for any damage.

5. Celiac disease is an autoimmune disease where the body cannot tolerate Gluten, which is the
protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate these
food items because the body does not absorb gluten proteins; gliadin and glutenin and when it
comes in contact with the small intestine it causes an autoimmune response where the
intestine lining eventually atrophies and becomes dysfunctional.

6. Gluten is a special type of protein that is commonly found in rye, wheat and barley.
Therefore, it is found in most types of cereals and in many types of bread. Not all foods from
the grain family, however, contain gluten. Examples of grains that do not have gluten include
wild rice, corn, buckwheat, millet, amaranth, quinoa, teff , soybeans, and sunflower seeds.

7. Incorporating oats uncontaminated with wheat, barley or rye, into a gluten-free dietary
pattern for people with celiac disease is generally safe and improves compliance. However,
many studies report that the introduction of oats may result in gastrointestinal symptoms such
as diarrhea and abdominal discomfort.

8. Many people, especially celebrities, practice a gluten free diet because they think it will lead
to weightloss and more energy. They don’t know that this diet, which includes a decreased
amount of whole grain and oats, can lead to cardiovascular disease and other cardiovascular
related problems.

9. Patients can be temporarily lactose intolerant. Due to the damage of the villi, brush border
enzymes, like lactase, are decreased. Once the patient consumes a gluten free diet and their
villi repair, the lactose intolerance may go away.

10. This patient is at risk for anemia due to the perceived lack of consumption of nutrients, like
calcium and iron.
12. He has low albumin (2.9 g/dL), prealbumin and total protein which were all indicated in
depleted protein stores. He also has a low red blood cell count and ferritin which would
indicate anemia.

13. Yes because celiac causes malabsorption, in this case of iron and calcium. Because of this,
protein stores that the body holds can be depleted and anemia will occur due to the damaged
villi and the inability to completely absorb nutrients.

14. Anemia can cause pale skin, lack of energy or feeling tired often. This can be related to her
statement about not being able to get off the couch. Depleted protein and calories can also
Beich4 results in muscle wasting, which can make one feel weak as well

15.
Food and nutrition related knowledge deficit related to new diagnosis of celiac disease and no
prior education for a gluten free diet as evidenced by positive EMA and AGA and patients
recent diagnosis of celiac disease.

Altered GI function related to damage of villi in small intestine as evidenced by small intestine
biopsy, low albumin, prealbumin, total protein, and ferritin levels.

17. I would start on a low fat diet and increase as tolerated. I would also start on a lactose free
diet as the patient may be temporarily lactose intolerant and increase as tolerated. I would also
recommend a gluten free, low fat and lactose free diet.

18.

- Cornflakes: Gluten Free Corn Flakes

- Banana: This is fine
- Coffee: This is fine
- Half and half: try almond milk
- Hot dog bun: gluten free bread
- Hot dog: eat lean meat such roasted chicken.
- French fries: Substitute for something like kale chips
- Chicken nuggets: switch out for roasted chicken or make sure it is not breaded
- Chocolate milk: make sure this is gluten free or else switch out with water
- Soy sauce: check label that it doesn’t contain gluten- Alternative: ketchup 
- Pudding: check label to see if it states it is gluten free- Alternative: flavored shaved ice
- Try out kale chips for a snack instead of peanut crackers
- Cookie dough ice cream: alternative is shaved ice again

19. I would encourage the family to also support her during this big diet change. Maybe
allowing her to have a separate fridge, pantry place and kitchen utensils so that she doesn’t
have to be cautious around using the same amenities. The family should also adopt to some
changes to make her feel better (i.e having no gluten days). She should be careful of gluten in
certain medications.