1. Etiologyof celiacdisease includes geneticsusceptibility,exposure togluten,environmental trigger,
autoimmune response.
BR’s historythatmightindicate afood allergydue todiarrhea,skinrash,abdominal pain.
Anti-endomysial andanti-tissue transglutaminase antibodies; whythey are used fortestingforceliac
disease –Anti-endomysials are antoantibodies thatare producedbyyour immune systemagainstthe
individualsowntransglutaminase protein.Anti-tissue transglutaminaseantibodyattacks tissue
transglutaminase whichisanenzyme thatfixesdamage inyourbody. tTG isusedto testfor celiac
disease tocheckan individual’slevelsof antibodiesinthe bloodandcanhelpevaluate the effectiveness
of treatment.
A small intestinal biopsy wasorderedbecause BRhasexperiencedunexplainedweightlossand
abdominal distentionwhichcanimplymalabsorptionandotherdysfunctionsinthe small intestine.
The effectof gluten onthe small intestinal mucosaisinflammation,irritationandswellingandcancause
malabsorptionbydamagingvilli.
The symptomsbesidesthe abdominal crampingdiarrheaandweightlossrelatedtoceliacdisease are
jointpainsbecause of inflammation,itchyrashesbecause of glutensensitivityasafoodallergen, and
lowbone marrow because of breakdownof cartilage.
The sourcesof gluten inthe patients24-hourdietrecall are cookies,brownies,cornflakes,toast.
Some acceptable substitutesmightbe fruitsandveggiesinsteadof browniesandcookies,yogurtinstead
of corn flakes,mushroomsorlettuce insteadof bread.
Some otherpotential sources of glutenexposure besidesdietinclude the use of play-dough,some
vitaminsandminerals,nutritional supplements,religiousactssuchas takingcommunionwithwafersor
crackers,bodyproducts includinglipstick,lipglossandlipbalm andotherbeautysupplies.
There isa highprevalence of anemiaamongpatientswithceliacdiseasebecause of impropereating
habitsand ultimate damage tothe small intestine.Eating glutenwithceliacdisease causesdamage to
the villi inthe SIwhichisresponsibleforthe absorptionof nutrientswhichthengetspassedintothe
circulation. Thiscancause the malabsorptionof ironwhichthenleadstoanemia.
The patient’slaboratory values associatedwithanemiaare the lowerFerritinlevels,low hemoglobin
and belownormal percentageof hematocrit.
Thispatientbe lactose intolerantbecauseshe isexperiencingabdominal distentionandcramping2
hoursaftereatingcertainfoods.Alsodiarrheaandgas as well asbloatingare commonsymptomsfor
lactose intolerantindividuals.
II.List eachlaboratoryvalue intable form:
Value Normal Range PatientValue ReasonforDeviation
Sodium 136-144m 140 mEq/L Normal

2. Hemoglobin 12.1-15.6g/dL 10.8 % Low,SI damage
Potassium 3.5-5.0 mEq/L 3.8 mEq/L Normal
RBC 3.9-5.5 million/mm3
4 x 1012
/L Iron malabsorption
Chloride 98-107 mEq/L 102 mEq/L Normal
WBC 3200-10,600 5 x 109
/L Anemia
BUN 8-23 mg/dL 10 mg/dl Normal
MCV 78-93 (um3)
101 (um3)
Highlevels, iron
malabsorption
Creatinine 0.4-1.2 mg/dL 0.6 mg/dl Nomal
SerumAlbumin 3.5-5.0 gm/dL 3.8g/dl Normal
Total Billirubin 0.1-1.0mg/dL 0.2 mg/dl Normal
Cholesterol 120-199 mg/dL 115 mg/dl Malabsorption, damage
to SI,anemia
GGT 7-33 U/L 18 U/L Normal
ALT 4-31 U/L 12 U/L Normal
Glucose (fasting) 70-99mg/dl 80 mg/dl Normal
Ferritin 12-150ng 18 mg/dl Normal
AST 10-31 U/L 10 U/L Normal
Assessment:22 yofemale.Dx:Celiacdisease
Wt: 112lbs, Ht: 5’5”. Wt hx:unexplainedweightloss.
Meds: none.
Labs: Hemoglobin(low),RBC(low),WBC(low),MVC(low),cholesterol (low).
Diagnosis:Malabsorption –relatedtoceliacdisease andpotentiallactose intolerance.
Clinical:
AlteredGIfunctiondue toceliacdisease, impairednutrientutilizationdue toimpairedSI,unintended
weightlossdue toinsufficientabsorption.
Behavioral:
Poornutritionqualityof life due toceliacdisease,intake of unsafe foodsdue topotential lactose
intolerance.
Intake:
Inadequate energyintake due toGItract unable toabsorbnutrients,limitedfoodacceptance because of
celiacand potential lactose intolerance,malabsorptionwhichcanleadtomalnutrition.
Intervention:

3. 1. Long-termadherence toastrict glutenfree diet due topositivebloodtestsforIgA-tissue
transglutaminase andIgA anti-endomysial antibodies.
2. Take vitaminandmineral supplementsforIrondeficiencyandtohelpinthe replicationof cells
due to damage inthe Small Intestine.
3. Eliminate dairyfromdietdue tosymptomsof lactose intolerance.
Monitoring/Evaluation:
Continue tosee patientforlabtestsandto monitorpatient’sweight.
Followuponlactose intolerance symptomstosee if eliminationof dairyprovidedpatientwithrelief.
Helppatientwithdietplanstomake iteasierforBR to reduce the symptomsof Celiac’sdisease.