Celiac Disease
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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.
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The cause is unknown, but genetic, environmental, and immunologic elements maybe involved.
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The disease is triggered by surgery, pregnancy, viral infection, or severe emotional distress.
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It is most common in young children ages 6 to 24 months but can occur at any age.
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Symptoms typically diminish or disappear in adolescence and reappear in early adulthood.
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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
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Acutely ill; severe diarrhea and vomiting
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Irritability
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Possible failure to thrive
Ages 9 to 18 months
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Slackening of weight followed by weight loss
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Abnormal stools
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Pale, soft, bulky
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Offensive odor
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Greasy (steatorrhea)
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May increase in number
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Abdominal distention
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Muscle wasting: most obvious in buttocks and proximal parts of extremities
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Hypotonia, seizures
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Mood changes: ill humor, irritability, temper tantrums, shyness
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Mild clubbing of fingers
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Vomiting: usually occurs in the evening
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Aphthous ulcers, dermatitis
Older Child and Adult
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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)
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Hypoproteinemia with edema
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Hypocalcemia, hypokalemia, hypomagnesemia
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Hypoprothrombinemia from vitamin K deficiency
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Disaccharide (sugar) intolerance
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Osteoporosis due to calcium deficiency
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Anorexia, fatigue, weight loss.
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May have colicky abdominal pain, distention, flatulence, constipation, and steatorrhea.
Diagnostic Evaluation:
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Small bowel biopsy, which demonstrates characteristic abnormal mucosa.
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Hemoglobin, folic acid, and Vitamin K levels may be reduced.
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Prothrombin time may be prolonged.
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Elevated immunoglobulin (Ig) A endomysium antibodies and IgA anti-tissue transglutaminase antibodies.
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Total protein and albumin may be decreased.
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72 hour stool collection for fecal fat is increased.
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D-xylose absorption test – decreased blood and urine levels.
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Sweat test and pancreatic function studies may be done to rule out cystic fibrosis in child.
Therapeutic Interventions:
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Dietary modifications includes a lifelong gluten-free diet, avoiding all foods containing wheat, rye, barley, and possibly, oats.
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In some cases, fats maybe reduced.
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Lactose and sucrose may be eliminated from diet for 6 to 8 weeks, based on reduced disaccharidase activity.
Nursing Interventions:
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Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status.
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Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as protein, fats, vitamins, and minerals.
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Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing.
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Provide parenteral nutrition as prescribed.
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Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown.
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Encourage small frequent meals, but do not force eating if the child has anorexia.
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Use meticulous hand washing technique and other procedures to prevent transmission of infection.
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Assess for fever, cough, irritability, or other signs of infection.
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Teach the parents to develop awareness of the child’s condition and behavior; recognize changes and care for child accordingly.
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Explain that the toddler may cling to infantile habits for security. Allow this behavior, it may disappear as physical condition improves.
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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.
Image by: National Science Foundation