PREPARED BY: TRIXIE MARIE S.

ABDULLA

BSN

Celiac Disease

Also called Gluten-Sensitive Enteropathy. Is a disease of the small intestine marked by atrophy of the villi and microvilli caused by an immunemediated inflammatory response to gluten, a protein found in common grains such as wheat, rye, oats, and barley. The cause is unknown, but genetic, environmental, and immunologic elements maybe involved. The disease is triggered by surgery, pregnancy, viral infection, or severe emotional distress. It is most common in young children ages 6 to 24 months but can occur at any age. Symptoms typically diminish or disappear in adolescence and reappear in early adulthood. Complications include impaired growth, inability to fight infections, electrolyte imbalance, clotting disturbance, and possible predisposition to malignant lymphoma of the small intestine.

Assessment Ages 3 to 9 months 1. Acutely ill; severe diarrhea and vomiting 2. Irritability 3. Possible failure to thrive

Ages 9 to 18 months 1. Slackening of weight followed by weight loss 2. Abnormal stools

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3. 4. 5. 6. 7. 8. 9.

Pale, soft, bulky Offensive odor Greasy (steatorrhea) May increase in number

Abdominal distention Anorexia, discoloration of teeth Muscle wasting: most obvious in buttocks and proximal parts of extremities Hypotonia, seizures Mood changes: ill humor, irritability, temper tantrums, shyness Mild clubbing of fingers Vomiting: usually occurs in the evening

10. Aphthous ulcers, dermatitis

Older Child and Adult 1. Signs and symptoms are commonly related to nutritional or secondary deficiencies resulting from disease.

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Anemia, vitamin deficiency (A, D, E, K) Hypoproteinemia with edema Hypocalcemia, hypokalemia, hypomagnesemia Hypoprothrombinemia from vitamin K deficiency Disaccharide (sugar) intolerance Osteoporosis due to calcium deficiency

Anorexia, fatigue, weight loss. May have colicky abdominal pain, distention, flatulence, constipation, and steatorrhea.

Diagnostic Evaluation 1. 2. 3. 4. Small bowel biopsy, which demonstrates characteristic abnormal mucosa. Hemoglobin, folic acid, and Vitamin K levels may be reduced. Prothrombin time may be prolonged. Elevated immunoglobulin (Ig) A endomysium antibodies and IgA anti-tissue transglutaminase antibodies. Total protein and albumin may be decreased. 72 hour stool collection for fecal fat is increased. D-xylose absorption test decreased blood and urine levels. Sweat test and pancreatic function studies may be done to rule out cystic fibrosis in child.

5. 6. 7. 8.

Therapeutic Intervention 1. 2. 3. Dietary modifications includes a lifelong gluten-free diet, avoiding all foods containing wheat, rye, barley, and possibly, oats. In some cases, fats maybe reduced. Lactose and sucrose may be eliminated from diet for 6 to 8 weeks, based on reduced disaccharidase activity. The Gluten-free Foods: Some Examples Fresh fruits Fresh beef, pork, chicken, turkey, fish, and seafood Fresh eggs Fresh, plain milk, butter, margarine, cream Plain beans Plain corn Plain white rice, brown rice, wild rice Plain nuts and seeds honey Spices and herbs * Plain = no additives

Nursing Intervention

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Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status. Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as protein, fats, vitamins, and minerals. Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing. Provide parenteral nutrition as prescribed. Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown. Encourage small frequent meals, but do not force eating if the child has anorexia. Use meticulous hand washing technique and other procedures to prevent transmission of infection. Assess for fever, cough, irritability, or other signs of infection. Teach the parents to develop awareness of the childs condition and behavior; recognize changes and care for child accordingly.

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10. Explain that the toddler may cling to infantile habits for security. Allow this behavior, it may disappear as physical condition improves. 11. Stress that the disorder is lifelong; however, changes in the mucosal lining of the intestine and in general clinical conditions are reversible when dietary gluten is avoided.