NAME: Princess E.

Tumangday BSN2-F

CELIAC DISEASE

Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune

reaction to eating gluten, a protein found in wheat, barley, and rye.  is a serious autoimmune
disease that occurs in genetically predisposed people where the ingestion of gluten leads to
damage in the small intestine. It is estimated to affect 1 in 100 people worldwide, but only about
30% are properly diagnosed. Celiac disease is hereditary, meaning that it runs in families. People
with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of
developing celiac disease. Celiac disease can develop at any age after people start consuming
gluten. Left untreated, celiac disease can lead to additional serious health problems.

Description

 Also called Gluten-Sensitive Enteropathy.

 Is a disease of the small intestine marked by atrophy of the villi and microvilli
caused by an immune-mediated 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 may
be 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
 Pale, soft, bulky
 Offensive odor
 Greasy (steatorrhea)
 May increase in number
3. Abdominal distention
4. Anorexia, discoloration of teeth
5. Muscle wasting: most obvious in buttocks and proximal parts of extremities
6. Hypotonia, seizures
7. Mood changes: ill humor, irritability, temper tantrums, shyness
8. Mild clubbing of fingers
9. 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.
 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
2. Anorexia, fatigue, weight loss.
3. May have colicky abdominal pain, distention, flatulence, constipation, and
steatorrhea.
Diagnostic Evaluation

1. Small bowel biopsy, which demonstrates characteristic abnormal mucosa.

2. Hemoglobin, folic acid, and Vitamin K levels may be reduced.
3. Prothrombin time may be prolonged.
4. Elevated immunoglobulin (Ig) A endomysium antibodies and IgA anti-tissue
transglutaminase antibodies.
5. Total protein and albumin may be decreased.
6. 72-hour stool collection for fecal fat is increased.
7. D-xylose absorption test – decreased blood and urine levels.
8. Sweat test and pancreatic function studies may be done to rule out cystic fibrosis in
children.
 Therapeutic Intervention
1. Dietary modifications include a lifelong gluten-free diet, avoiding all foods
containing wheat, rye, barley, and possibly, oats.
2. In some cases, fats may be reduced.
3. Lactose and sucrose may be eliminated from the diet for 6 to 8 weeks, based on
reduced disaccharidase activity.
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet.
The following chart is based on the 2006 recommendations. This list is not complete, so people
with celiac disease should discuss gluten-free food choices with a dietitian or physician who
specializes in celiac disease. People with celiac disease should always read food ingredient lists
carefully to make sure the food does not contain gluten.

Allowed Foods

amaranth
arrowroot legumes seeds
buckwheat millet sorghum
cassava nuts soy
corn potatoes tapioca
flax quinoa teff
Indian rice grass rice wild rice
Job’s tears sago yucca

Foods To Avoid

wheat barley
 including einkorn, emmer, spelt, Kamut rye
 wheat starch, wheat bran, wheat germ, cracked wheat, triticale (a cross between wheat
hydrolyzed wheat protein and rye)

Other Wheat Products

bromated
flour graham
durum flour flour
enriched phosphate self-rising flour
flour flour semolina
farina plain flour white flour

Processed Foods that May Contain Wheat, Barley, or Rye*

bouillon French seasoned tortilla chips

cubes fries self-basting turkey
 brown rice
syrup
candy
chips/potato
chips
cold cuts, gravy
hot dogs, imitation
salami, fish
sausage matzo soups
communion rice mixes soy sauce
wafers sauces vegetables in sauce
 Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
*

Nursing Intervention

1. Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status.
2. Make sure that the diet is free from causative agent but inclusive of essential nutrients, such as
protein, fats, vitamins, and minerals.
3. Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing.
4. Provide parenteral nutrition as prescribed.
5. Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown.
6. Encourage small frequent meals, but do not force eating if the child has anorexia.
7. Use meticulous hand washing techniques and other procedures to prevent transmission of infection.
8. Assess for fever, cough, irritability, or other signs of infection.
9. Teach the parents to develop an awareness of the child’s condition and behavior; recognize changes
and care for the child accordingly.
10. Explain that the toddler may cling to infantile habits for security. Allow this behavior, it may
disappear as the 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.
 

REFERENCES:
Celiac Disease - RNpedia
Celiac Disease Nursing Diagnosis and Nursing Care Plan - NurseStudy.Net
Celiac Disease | Johns Hopkins Medicine
What is Celiac Disease? | Celiac Disease Foundation

PRINCESS E. TUMANGDAY BSN2-F

 REFLECTION/INSIGHTS:

PRINCESS E. TUMANGDAY

November 25, 2001

AGRICULA, SAN REMIGIO, ANTIQUE