CELIAC DISEASE

Celiac disease (CD), also called gluten-

sensitive enteropathy.
It is a disease of the small intestines
characterized by a permanent inability to
tolerate dietary gluten.
The ingestion of gluten produces an
immune response that damages the villi of
the small intestine, decreasing the surface
area, causing malabsorption.
CD occurs most frequently in Caucasians
and among females by 2:1 over males.
 Pathophysiology and Etiology
 The cause is unknown.
 Requires interaction between a number of
intrinsic factors (genetic susceptibility,
activation of the immune system) and
extrinsic factors (gluten and possibly other
environmental factors).
 The disease can be triggered by surgery,
pregnancy, viral infection, or severe
emotional stress. Immunoglobulin A (IgA)-
deficient children are 20 times more likely
to develop celiac disease.
• Characteristics of celiac disease
include:

Impaired intestinal absorption.

Histologic abnormalities of the small

intestine.

Clinical and histologic improvement with

wheat-, rye-, barley-, and possibly oat-free
diet.
 Clinical Manifestations
1. Ages 3 to 9 months:
 Irritability.
 Acutely ill; severe diarrhea and vomiting.
2. Ages 9 to 18 months {celiac appearance is
seen}
 Impaired growth
 Abnormal stools,more frequent, pale, soft, bulky, greasy
(steatorrhea) with offensive odor
 Abdominal distention
 Anorexia
 Hypotonia
 Mood changes,humor, irritability, temper tantrums, shyness
 Mild clubbing of fingers
 Vomiting;commonly occurring in evening
 Seizures
 Tooth discoloration or loss of enamel
 Pale sores on inside of mouth called aphthous ulcers ‌
 Painful skin rash called dermatitis herpetiformis
3. Older Children

Symptoms diminish or disappear in adolescence

and reappear in early adulthood.
 Manifestations Secondary to
Malabsorption
 Anemia, vitamin deficiency
 Edema
 Hypocalcemia, hypokalemia,
hypomagnesemia
 Hypoprothrombinemia resulting from
impaired vitamin K absorption
 Disaccharide intolerance with acid sugar-
containing stools [secondary to the altered
small-bowel mucosa]
 Low bone density, osteoporosis secondary
to decreased calcium absorption
 Diagnostic Evaluation
 Diagnosis is most commonly made by ages 6 to 24
months.
 History, Serologic testing
 Endoscopy with small bowel biopsy demonstrating
flattened villi.
 Biochemical changes include low serum albumin,
protein, and magnesium.
 Seventy-two-hour quantitative stool collection for
fecal fat shows increased fat due to malabsorption
 Skeletal X-rays may show demineralization and
retarded bone age.
 D-xylose absorption less than 20 to 25 mg/dL at 60
minutes.
 Sweat test and pancreatic function studies to rule out
cystic fibrosis.
 Management

 Lifelong gluten-free diet

 Adequate caloric intake
 Supplemental vitamins and minerals
 Reduction of fat intake.
 Nursing Assessment
 Obtain family dietary history as it relates
to onset of symptoms.
 Assess child's nutritional status .
 Check for signs of infection.
 Assess growth and developmental
parameters.
 Nursing Diagnoses
 Imbalanced Nutrition: Less Than Body
Requirements related to malabsorption of
nutrients, diarrhea, and vomiting.
 Risk for Infection related to
malnourishment and anemia.
 Impaired Parenting related to inability to
control behavioral problems.
 Nursing Interventions

1. Providing Adequate Nutrition and

Dietary Restrictions
 Make sure that the initial diet is high in
protein, relatively low in fat, low in
lactose, and free from gluten .
 Continue to restrict wheat, rye, and barley
from diet.
 Maintain NPO status during the initial
treatment of celiac crisis or during
diagnostic testing.
 Encourage small, frequent, appetizing
meals, but do not force eating if the child
has anorexia.
2. Preventing Infection

 Advise parents to avoid exposing the child

to anyone with an infection.
 Prevent upper respiratory infection by
position changes, good hygiene, and
clearance of secretions.
 Teach and practice good hand-washing
technique.
 Assess for fever, cough, irritability, or
other signs of infection.
 3. Promoting Effective Parenting

 Teach the parents to recognize changes,

and care for child accordingly.
 Explain that diet and eating have a direct
effect on behavior
 Advise the parents to allow the child to
express feelings freely.
 Provide emotional support for the child
and parents.
 :Prepared by
 Mohammad Abu Teilakh
 120051814