CELIAC DISEASE

What is Celiac Disease?• Permanent inability to tolerate

dietary gluten in the small intestines.

• Is a significant medical condition that can result in a number of serious consequences if not diagnosed and treated properly.

• It affects the small intestine.• The lining of the small intestine is

damaged by gluten.

Causes:

• Celiac disease is caused by an interaction between gluten (the protein portion of wheat) and the small bowel lining in people susceptible to the disease.

• This cause damage to the lining which results in a reduction in the surface area of the villi or finger-like projections of the bowel lining.

• Both genetic and environmental factors play important roles in celiac disease.

• 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.

Pathogenesis

Celiac disease

Gluten

NecessaryCauses

GenderInfant feedingInfections

Risk Factors

Pathogenesis

Genetics

Clinical manifestations

There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as:

• Intermittent diarrhea• Abdominal pain• BloatingThe most common symptoms can include: • Anaemia (low Iron folate)• flatulence • Fatigue, weakness and lethargy • Nausea and vomiting • Stomach cramps • Weight loss – although weight gain is possible.

• Osteomalacia- (metabolic Bone disease characterized by inadequate mineralization of bone.)

• Steatorrhea- (foul-smelling stools w/ a high fat content: results from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestine)

• Azotorrhea- (excess of nitrogenous matter in the feces or urine)

How is Celiac Disease Diagnosed?

The three major steps leading to diagnosis of celiac disease are:

1. Blood tests for gluten autoantibodies2. A small bowel biopsy to assess gut damage. For those

with suspected dermatitis herpetiformis, skin biopsies will be taken of the healthy skin near the lesion.

3. Implement the gluten-free diet

• Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with celiac disease.

1:  Examination

Health History

The following areas should be considered in the discussion: (The first three are applicable to adults and children. The last is specific to children.)

• What are the physical and emotional symptoms?• How long have they been present? How often do they occur?

Is there a pattern?• Is it consistent throughout the day? When and for how long do

the symptoms occur?• Do family members have any autoimmune diseases?• Is the child's physical and emotional health within the normal

range?

• Physical Examination

• Depending on the presentation of symptoms, the physician will perform tests to check for some of the following items:

• emaciation• pallor (due to anemia)• hypotension • edema (due to low levels of

protein, [albumin] in the blood)• dermatitis herpetiformis (skin

lesions)

• easy bruising (lack of vitamin K)• bone or skin

and mucosa membrane changes due to vitamin deficiencies

• protruding or distended abdomen (intestine dysmotility)

• loss of various sensations in extremities including vibration, position and light touch (vitamin deficiency)

• gluten ataxia• peripheral neuropathy• migraine headache

2:  BiopsyIntestinal Biopsy

• In the event that clinical signs and positive laboratory tests indicate probable malabsorption, a biopsy of the small intestine [jejunal] is scheduled to be performed by a gastroenterologist. In this test, a small flexible biopsy instrument is passed through:

• a tubedown the throat stomach upper end of the small intestine.

• The tube is removed and the tissue samples are examined under a microscope for signs of damage.

Intestinal Biopsy

Shuttle Device

3:  Diet • When gluten is removed from the diet, most of the

damage that was done to the small intestine (the jejunum) is repaired. It takes only three to six days for the intestinal lining (the mucosa) to show improvement. Within three to six months, most symptoms subside as the mucosa returns to its normal (or nearly normal) state.

• The only treatment is the avoidance of all gluten containing foods. This allows the bowel lining to recover. This strict attention to diet must be lifelong.

Foods that contain gluten include:• bread, cakes and pasta. • However, there is also a whole range of ingredients within

prepared and commercial foods that can come from a gluten source.

• It is essential that a person with celiac disease become ‘ingredient aware’.

Pay attention to processed foods that may contain gluten. Wheat flour is a common

ingredient in many processed foods. Examples of foods that may contain gluten

include:• Canned soups• Salad dressings• Ice cream• Candy bars• Instant coffee• Luncheon meats and processed or canned meats• Ketchup and mustard• Yogurt• Pasta

Gluten Diet After GFD for 10 weeks

Nursing diagnosis

• Altered nutrition, less than body requirement related to Intermittent diarrhea.

Interventions:

• Assess nutritional Identify factors contributed to nutritional intake

• Assess patient nutritional dietary pattern to plan the proper meals

• Assess weight changes• Assess lab values for (protein, creatinine iron)• Provide preference food

Acute Pain related to Abdominal rigidityGoal: pain is resolved or controlled

Intervention:

• Maintain bed rest in a comfortable position, do not support the knee.

• Assess the location, weight and type of pain• Assess effectiveness and monitor side effects analgesic; avoid

morphine• Provide a planned rest period.• Change positions frequently and give her back rubbing and skin care.• Give and recommend alternative pain relief measures.

Nursing Management:• Monitor dietary intake,MIO, weight, serum electrolytes, and

hydration status.• 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.• Use meticulous hand washing technique and other procedures to

prevent transmission of infection.• Assess for fever, cough, irritability, or other signs of infection.• 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.

Management

C Consultation with skilled dietitianE Education about diseaseL Lifelong adherence to gluten-free dietI Identification & Rx of nutritional

deficienciesA Access to an advocacy groupC Continuous long-term follow-up by

multidisciplinary team

Summary of points to remember

• People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.

• Untreated celiac disease damages the small intestine and interferes with nutrient absorption.

• Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.

• A person with celiac disease may or may not have symptoms.

• Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.

• No treatment can cure celiac disease. • There is no surgical treatment for celiac disease.• Since celiac disease is hereditary, family members of a

person with celiac disease may wish to be tested.• Celiac disease is treated by eliminating all gluten from

the diet. The gluten-free diet is a lifetime requirement.• A dietitian can teach a person with celiac disease about

food selection, label reading, and other strategies to help manage the disease.

• Thank you For Listening!