By: Leila Floresca Esteban BSNIII-B

CELIAC DESEASE
 Celiac Desease
 Celiac disease is a digestive disease that damages the
small intestine and interferes with absorption of
nutrients from food. People who have celiac disease
cannot tolerate a protein called gluten, which is found
in wheat, rye, and barley. When people with celiac
disease eat foods containing gluten, their immune
system responds by damaging the small intestine.
Specifically, tiny fingerlike protrusions, called villi, on
the lining of the small intestine are lost. Nutrients from
food are absorbed into the bloodstream through these
villi. Without villi, a person becomes malnourished--
regardless of the quantity of food eaten.
Sign and Symptoms of Celiac
Disease
 Can begin at any age
 Will persist for life
 Can involve and affect multiple organs
 May have varied symptoms or no symptoms
at all
 Will always disappear once the patient
follows a gluten-free diet
Digestive Symptoms

 Diarrhea
 Abdominal Pain
 Abdominal Bloating
 Pale stool
 Foul-smelling stool
 Flatulence
 Pallor
 Weakness
Behavioral Symptoms

 Depression
 Irritabilityparticularly in children
Inadequate Nutrition
Symptoms
 Weight Loss
 Delayed growth
 Failure to thrive
 Anemia
 Fatigue
 Missed Menstrual periods
Unclassified symptoms

 Gas
 Bone pain
 Joint pain
 Seizures
 Muscle Cramps
 No symptoms
 Ambiguous symptoms
 Ambiguous symptoms
 Tingling (in the legs from nerve damage)
 Numbness (in the legs from nerve damage)
 Mouth sores
 Skin Rash
 Dermatitis Herpetiformis
 Tooth discoloration and enamel loss
 Miscarriages
POSSIBLE COMPLICATION:
 Damage to the small intestines and the
resulting problems with nutrient absorption
put a person with celiac disease at risk for
several diseases and health problems.
 Lymphoma and adenocarcinoma are types
of cancer that can develop in the intestine.
 Osteoporosis is a condition in which the
bones become weak, brittle, and prone to
breaking. Poor calcium absorption is a
contributing factor to osteoporosis.
 Miscarriage and congenital malformation of the
baby, such as neural tube defects, are risks for
untreated pregnant women with celiac disease
because of malabsorption of nutrients.
 Short stature results when childhood celiac disease
prevents nutrient absorption during the years when
nutrition is critical to a child's normal growth and
development. Children who are diagnosed and
treated before their growth stops may have a catch-
up period.
 Seizures, or convulsions, result from inadequate
absorption of folic acid. Lack of folic acid causes
calcium deposits, called calcifications, to form in the
brain, which in turn cause seizures.
 
EXPECTED OUTCOME:
 Research is needed to obtain data for
recommendations on the age at which to begin
screening, and the frequency of repeat screening,
of asymptomatic at-risk individuals. Additional
research is required to determine whether
serologic tests in specific clinical settings are
sufficient to confirm the diagnosis of celiac disease
without the need for a biopsy. Most cases with
positive EMA and TG2 autoantibodies have celiac
disease with a manifest gluten-dependent
mucosal lesion, and are DQ2- or DQ8-positive.
 In future, a diagnosis of genetic gluten
intolerance may include patients with gluten-
dependent symptoms or signs of celiac disease,
a positive test for the autoantibodies, and the
correct celiac-type HLA DQ type, even though
they have an equivocal or normal small
intestinal mucosa on biopsy. A multicenter
study within the Federation of International
Societies for Pediatric Gastroenterology,
Hepatology and Nutrition.should determine the
natural history of celiac disease in such patients
who choose to remain untreated.
 This study could provide the experimental
basis for new diagnostic criteria that combine
autoantibody positivity with correct genetics
without the need for invasive small intestinal
biopsy. However, while it is important to
diagnose celiac disease correctly, it is equally
important to avoid a false-positive diagnosis
and unnecessary treatment with a gluten-free
diet.
NURSING RESPONSIBILITIES
 -Prepared the client for the diagnostic test
 -Explain the procedure of the diagnostic test
 -Assist the patient
Assesment and Diagnostic
Findings
 Blood tests for four different antibodies. The
antibodies are IgA endomysial antibodies (EMA),
IgA tissue tranglutaminase (tTG), IgG tissue
transglutaminase, and total IgA antibodies.

These tests are very specific and sensitive, which

means that there are few false .The advantage of
the blood tests is they are easy to use and
noninvasive. They are often done first to see if
there is a need for a a biopsy.
 Endoscopy and intestinal biopsy provide the
most definitive diagnosis, but it is more
complicated, takes more preparation and an
anesthetic, an is uncomfortable. Before the
procedure is done, the patient fasts for eight
hours. Then an IV is put in for sedation and a
local anesthetic spray is used to control the
gag reflux. The procedure takes 10 to 20
minutes. During the procedure the doctor
views the larynx, the esophagus, the stomach
and the duodenum and takes a biopsy of the
intestine.
 A positive biopsy is considered the gold
standart for diagnosing Celiac Disease. It is
more conclusive than a positive antibody test.
People worry about subjecting themselves or
their children to this invasive procedure, but it
results in a certain diagnosis.
 Other possible tests are gluten challenge,
stool studies, blood dot test, fecal test, saliva
test and breath test, but these are not as
conclusive as an antibody test and a biopsy.
Treatment:
 It is important to get a solid diagnosis
because treatment for people with
Celiac Disease is a strict diet of avoiding all
foods with gluten or gluten contamination for
the rest of their lives. People who are unsure
of their diagnosis will have a hard time
following such a stringent regimen. If there is
any question about the diagnosis and the diet
isn't maintained, Celiac Disease can lead to
serious health complications.
Nursing Management
 The nurse provides the patient and family
education regarding diet and the use of
nutritional supplements regarding. It is
important to monitor patients with diarrhea for
fluid and elecrolyte imbalances. The nurse
conducts ongoing assesments to determine
whether the clinical manifestations related to
the nutritional deficits have abated. Patient
education includes information about the risk of
osteoporosis related to malabsorption of
calcium.
 
Nursing Interventions
 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 parental 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 child’s
condition and behaviour; recognize changes and care
for child accordingly.
 Explain that the toddler may cling to infantile habits
for security. Allow this behaviour, it may disappear as
physical condition improves.
 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.
NCP PRIORITIZATION
NCP Diarrhea
 NURSING DISCHARGE PLAN
Name: XX Daignosis:Celiac Deseas
RECOMMENDATION AND
CONCLUSION:
 Celiac disease is an immune-mediated enteropathy
caused by a permanent sensitivity to gluten in genetically
susceptible individuals. It is recommended that children
and adolescents with symptoms of celiac disease or an
increased risk for celiac disease have a blood test for
antibody to tissue transglutaminase (TTG), that those
with an elevated TTG be referred to a pediatric
gastroenterologist for an intestinal biopsy and that those
with the characteristics of celiac disease on intestinal
histopathology be treated with a strict gluten-free diet.
The quality of your health depends upon many pieces
that not only include the health of your bodily systems,
but also include a healthy diet, exercise, and spirituality.
Dietary recommendations for
celiac disease:
 Because malabsorption is prevalent with celiac
disease, daily vitamin and mineral
supplementation is essential. Important
supplements for celiac disease include iron, B
vitamins, magnesium, calcium and vitamin D.
 Add organic extra virgin coconut oil to your
diet to benefit from healthy plant-based
saturated fat.
 Add foods rich in omega-3 essential fatty
acids to your diet in the form of
ground flax meal, wild-caught salmon,
minimal-mercury albacore tuna, walnuts, 
fish oil, and sprouted walnuts. 
 Eat plenty of vegetables and vegetable juices
(kelp, sprouts, green and black olives,
peppers, spinach, chard, celery, zucchini).
 Add nutrient-dense and unprocessed foods
such as sprouted nuts and seeds to your diet.
 Drink purified water throughout the day
Foods and other products to
AVOID include:
 All foods that contain gluten in the form of wheat, rye,
barley, and oats.
 All processed foods that contain gluten as an
ingredient. Read all processed food labels carefully for
hidden gluten. Foods that may contain gluten include
canned soups, salad dressings, ice cream, candy bars,
instant coffee, luncheon meats, ketchup, mustard,
processed and canned meats, yogurt, and sausages.
 All supplements that contain gluten. Wheat starch can
be used as a binding agent in tablets and capsules.
 Cosmetics. Gluten can be found in cosmetic
products such as lipstick.
 All grain alcohols such as beer and malted liquors.
 All dairy products, since those with celiac disease
also tend to suffer from lactose intolerance.
 All foods containing refined sugar or artificial
sugar-substitutes such as aspartame, Splenda®,
etc. Choose a natural sweetener like Xylosweet
instead.
 Excessive caffeine intake – While moderate
amounts of caffeine may be beneficial, excessive
consumption of caffeine can disrupt the body’s
systems, causing irregularity (constipation or
diarrhea)
 Sweetened fruit juices that spike blood sugar levels
too rapidly
 Carbonated soft drinks that alter pH levels, making
the blood more acidic
 Bottom crawlers, such as oysters, clams, and
lobster that may contain toxic level of mercury.
 Deep-sea fish such as tuna, mackerel, and
swordfish that may contain toxic levels of mercury.
Choose minimal-mercury albacore tuna instead.  
 Sodium nitrite found in processed foods such as
hot dogs, lunch meats, and bacon
 Monosodium glutamate (MSG) found in many
foods as a flavor enhancer
 Hydrogenated or partially hydrogenated oils
(trans fats) found in many processed foods,
deep-fried foods, fast food, and junk food.

 Products (such as soy milk and ice cream)

that contain carrageenan, a seaweed extract
that’s added to foods to retain their creamy
texture. For some people, carrageenan
irritates the stomach.
Other tips for Celiac
Disease:
 If you have “silver” dental fillings, get an
evaluation from a mercury-free dentist who
specializes in the safe removal of mercury
amalgam fillings. Heavy metal toxicity may
cause gastrointestinal symptoms.