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