Celiac Disease

Malabsorption of Vitamin K leads to

Inadequate blood coagulation

Lifespan considerations

Lifetime condition Very difficult for adolescents Must do forever If diet not followed, increased lyphoma or GI cancer

DC instructions

Monitor School is more difficult to prevent eating processed foods School aged and adolescent often tempted to eat bad foods Financial resources Follow-up medical care

Malabsorption of Vitamin D and Calcium leads to

Ostemalacia and osteoporosis

Malabsorption of proteins and CHO leads to

Peripheral edema/malnutrition

Acute episode Celiac crisis S&S

Profuse, expolsive, watery diarrhea Vomiting Dehydration Electrolyte imbalance Hypotensive shock Wasted appearance

Nursing Implementation

Provide education Nutrition plan for child Resources (American Celiac Society, Celiac disease foundation, Gluten Intolerance Group)

Malabsorption of B12 fats leads to

Steatorrhea

Diagnosis

Stool analysis for fat. Intestinal biopsy (duodenal biopsy) IgA antibodies, IgA antitissue, IgG antibodies Serum iron Folic acid levels Vitamin B12 levels

Etiology

Unknown, but genetic pre-disposition

Risk factors

White and European children Same families Usually seen in children from 6 mos to 2 years

Pathophys

when exposed to gluten, the villi in the small bowel atrophy causing malabsorption.

Foods they CAN have

...

Late stages of disease

Absorption of the following becomes impaired: Protein Calcium Iron Folic Acid Vits D, K, B12

Malabsorption of Iron, folic acid, vitamins leads to

Anemia

Drugs that precipitate crisis

Anticholinergic Inform doctors and dentists

Foods they CANNOT have

Bread, cake, cookies, chocolate candy, malts Crackers, donuts, pies, some ice cream. Spaghetti, pizza Prepared soups, hot dogs Lunch meats, gravy Some prepared hamburgers

Foods to avoid

Cereals & baked goods Hydrolyzed vegetable proteins Grains used as fillers in processed food

Management of Celiac crisis

Considered a life-threatening event Correct dehydration Correct metabolic acidosis NGT IV fluids with K, Ca, Mg Albumin infusions to treat hypoproteinemia IV steroids

First stages of disease

Failure to gain weight Poor appetite Bout of diarrhea Steatorrhea Constipation Vomiting Abdominal pain Irritability

Early stages of Celiac

Fat absorption is effected, so there is large quantities of undigested fat in the stool (steatorrhea) STOOL: frothy, foul odor, excessive quantity

Celiac crisis precipitated by

GI Infections Prolonged fasting and fluid and electrolyte imbalance Eating gluten Emotional disturbances

Management

Gluten free diet (no wheat, rye, barley, oats) Substitute with corn, rice, potato, hominy. Vitamin and Iron supplements High calorie diet

Progression of the disease

If disease process is not stopped, growth failure results. Begin slow introductions of grains 3-6 mos. See signs of general wasting.

Nursing diagnosis

Imbalanced nutrition - less than Risk for delayed G&D Deficient knowledge r/t nutrition needs

Definition

Immunologic disorder characterized by intolerance for GLUTEN (a protein) which is found in wheat, barley, rye, and oats. A chronic malabsorption syndrome