1. Value Normalrange Patientvalue Reasonfor deviation
Hematocrit 41-51% 32.1% Anemia
Hemoglobin 14.6-17.5 g/dl 10.8% Anemia
RBC 3.9 – 5.5 million/mm3 4 X 10^12/L ?
WBC 3.2-10.6 X10^3/mm^3 5X 10^9/L ?
MCV 78-93 101 (um^3) Megoblasticanemia
SerumAlbumin 3.5-5.0 gm/dl 3.8/dl -
FastingGlucose 70-99 mg/dl 80 mg/dl -
Cholesterol 120-199mg/dl 115 mg/dl Malabsorption
Ferritin 30-320 ng/ml 18 mg/dl Anemia
Transferrin 212-360mg/dl 398 mg/dl Amemia
Sodium 136-144mEq/L 140 mEg/L -
Potassium 3.5-5.0 mEg/L 3.8 mEg/L -
Chloride 98-107 mEg/L 102 mEg/L -
BUN 8-23 mg/dl 10mg/dl -
Creatinine .4-1.2 mg/dl .6mg/dl -
Total Billirubin 1.0 mg/dl .2mg/dl Malabsorption
GGT 7-33 U/L 18 U/L -
ALT 4-40 U/L 12 U/L -
AST 10-37 U/L 10 U/L -
Questions:
1. Celiac disease is an autoimmunediseasethat is passeddown genetically to off spring. Itcan also
be caused by some environmentalfactorsand exposer to gluten. The disease causes chronic
inflammation when gluten is ingested due to certain peptides. The inflammationin the small
intestine damagesimportantabsorptionfactorssuchas microvilli andbrushboarder. BR has
presentsof IgA-tissuetransglutaminaseandIgAanti-endomesialantibodiesshowshe has a food
allergy.
2. IgA-tissuetransglutaminaseandIgA anti-endomesialantibodiesarethey body’simmune
responseto the peptidesin gluten. They are used for diagnosingCeliac disease because they are
present when the body is tryingto fight off non-selfcells such asgluten.
3. A small intestinebiopsy was ordered to diagnoseCeliac disease andexamine the extent of
damageit hashad onBR. A patientwith Celiac diseasewho does notfollow a gluten free diet
with have damageto their small intestine, their mucosaand a decrease in villi. Small intestine
biopsy is the gold standardtodiagnosingthisdisease.
4. When glutenin introducedto the small intestine and is brokendown intopeptides, receptors try
to take in the peptidesbut insteadelicit and immuneresponse. Inflammationoccursand over
time there is a destructionof mucosaand villi. This decreases the surface area of the small
intestine which in return decreases the amountof nutrientsthat can ab absorbedfromall kinds
of food.
5. Steatorrhea, anemia, hemorrhages, muscle cramping, andbone pain are also commonsymptoms
of celiac disease. The mainreason all these occur is because onthe lack of absorptionthepatient
is getting from their food, causingmany deficiencies throughouttheirbody.

2. 6. The sources of gluten she hasin her diet come from her bread, cookies, andbrownies. There are
gluten free substitutesfor all these foods. Many grocery storessell gluten free cookies, brownies,
andbread. They alsohave gluten free flower if she is interested in makingher ownfood. Some
other potentialsources of gluten can come from shampoo, conditioners, andmakeup.
7. This is the case becauseof the decrease in surface area in the small intestine. It is harder for the
intestine to absorbironfrom dietary sources, leaving the patient anemic. BR appears to be
anemic from her lab valuesfor hematocrit, hemoglobin, ferritin, transferrin, and MCV.
8. BR is also lactose intolerant because of the damageceliac hasdone to the small intestine. It can
no longer secrete the enzymesthat break downlactose. Italso does not have the receptors the
bring in the molecules from the small intestine in to the cells.
Assessment
 22 y/o female consideredto have celiac disease
 Height: 5’5”wt: 122 BMI:18.5
 Tx: gluten free diet anda nutritionconsult with a small intestinal
 Labs: positiveIgA- tissue transglutaminaseandIgA anti-endomesialantibodies. Notinnormal
range for hematocrit, hemoglobin, ferritin, transferrin, and MCV
 Estimatedenergy needs: 56.81kgX 25kcal=1420.25kcal/kg/day. 56.81kgX 30kcal=
1704.3kcal/kg/day. Sheneedsbetween1420.25–1704kcalper day.
 Proteinneeds: 56.81kgX .8=45.45g/day, 56.81X1=56.81g/day. Sheneedbetween 45.45g/dayto
56.81g/day
 Family history:father positivefor type 1 diabetes, motherhas asthma. Nohistory GI disorders in
patient or family.
 Diet containssourcesof gluten. Only two typesif vegetables and two typesof fruit.
 weight loss of 10 poundsin past6 months.
Diagnosis
 Unintendedweight lossrelated to malabsorptionoffoodAEB loss of 10 poundsinthe last6
months
 Undesirablefood choices related to the consumptionofgluten in diet AEB cramping two hours
after eating
 Inadequateironintake related tolow consumptionofiron rich foodsAEB lab reports for
hematocrit, hemoglobin, ferritin, transferrin, andMCV
Intervention
 BR is to eat between 1420.25 to1704 kcalper day and45.5 to56.8gof proteinper day. She
shouldhavea sourceof proteinwith every meal. She can also bring snack with her when she
leaves the houseto ensure she doesnot skipany meals/snacks
 BR is to cut outall sources of gluten from her diet and replace themwith gluten free alternatives.
This meansswitching out her white bread out for gluten free bread. For her sweet she could have
gluten free cookies andbrownies, or she could substitutefruit.
 BR needs to add2 sourcesof ironinto her daily intake. She can put spinachon her sandwich
insteadof lettuce or snack onapricots.

3. Monitoring and Evaluation
 Track weight to ensure BR is gaining healthy weight andnot losingany more weight.
 Monitorhow BR feels after eating a meal andif she no longer hasGI problems2 hoursafter
eating.
 FollowuponBR’s labresultsfor hematocrit,hemoglobin,ferritin,transferrin,andMCV