Celiac Disease Presentation

8/8/2019 Celiac Disease Presentation

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CELIAC DESEASEBy: Leila Floresca Esteban BSNIII-B


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Celiac DeseaseC eliac disease is a digestive disease thatdamages the small intestine and interfereswith absorption of nutrients from food. Peoplewho have celiac disease cannot tolerate a

protein called gluten, which is found in wheat,rye, and barley. When people with celiacdisease eat foods containing gluten, theirimmune system responds by damaging thesmall intestine. Specifically, tiny fingerlikeprotrusions, called villi, on the lining of thesmall intestine are lost. Nutrients from foodare absorbed into the bloodstream throughthese villi. Without villi, a person becomesmalnourished--regardless of the quantity of


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Sign and Symptoms of CeliacDisease

C an begin at any ageWill persist for lifeC an involve and affect multiple organsMay have varied symptoms or no symptomsat all

Will always disappear once the patientfollows a gluten-free diet


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Digestive Symptoms

D iarrheaAbdominal Pain

Abdominal BloatingPale stoolFoul-smelling stool

FlatulencePallorWeakness


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Behavioral Symptoms

D epressionIrritabilityparticularly in children


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Inadequate NutritionSymptoms

Weight LossD elayed growth

Failure to thriveAnemiaFatigue

Missed Menstrual periods


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Unclassified symptoms

G asBone pain

Joint painSeizuresMuscle C ramps

No symptomsAmbiguous symptoms


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Ambiguous symptomsTingling (in the legs from nerve damage)Numbness (in the legs from nerve damage)

Mouth soresSkin RashD ermatitis HerpetiformisTooth discoloration and enamel lossMiscarriages


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PO SSI BLE C OMP LICATI ON:D

amage to the small intestines and theresulting problems with nutrient absorptionput a person with celiac disease at risk forseveral diseases and health problems.

Lymphoma and adenocarcinoma are typesof cancer that can develop in the intestine.Ost eoporo s is is a condition in which the

bones become weak, brittle, and prone tobreaking. Poor calcium absorption is acontributing factor to osteoporosis.


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M is carriage and congeni t al malforma t ion of the baby, such as neural tube defects, are risks

for untreated pregnant women with celiacdisease because of malabsorption of nutrients.S hor t st a tu re results when childhood celiacdisease prevents nutrient absorption during the

years when nutrition is critical to a child's normalgrowth and development. C hildren who arediagnosed and treated before their growth stopsmay have a catch-up period.S

eizu

res, or convulsions, result from inadequateabsorption of folic acid. Lack of folic acid causes

calcium deposits, called calcifications, to form inthe brain, which in turn cause seizures.


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EXP ECTED OU TCOME:Research is needed to obtain data forrecommendations on the age at which to beginscreening, and the frequency of repeatscreening, of asymptomatic at-risk individuals.Additional research is required to determinewhether serologic tests in specific clinicalsettings 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 amanifest gluten-dependent mucosal lesion, andare DQ2 - or DQ8 -positive.


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In future, a diagnosis of genetic glutenintolerance may include patients with gluten-dependent symptoms or signs of celiac disease,a positive test for the autoantibodies, and thecorrect celiac-type HLA DQ type, even thoughthey have an equivocal or normal smallintestinal mucosa on biopsy. A multicenterstudy within the Federation of InternationalSocieties for Pediatric G astroenterology,

Hepatology and Nutrition.should determine thenatural history of celiac disease in such patientswho choose to remain untreated.


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This study could provide the experimentalbasis for new diagnostic criteria that combineautoantibody positivity with correct geneticswithout the need for invasive small intestinal

biopsy. However, while it is important todiagnose celiac disease correctly, it is equallyimportant to avoid a false-positive diagnosisand unnecessary treatment with a gluten-freediet.


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NUR SING RESPO NSI BILITIES-Prepared the client for the diagnostic test-Explain the procedure of the diagnostic test-Assist the patient


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Assesment and Diagnostic

FindingsBlood tests for four different antibodies. Theantibodies are IgA endomysial antibodies (EMA),IgA tissue tranglutaminase (tT G ), IgG tissuetransglutaminase, 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 andnoninvasive. They are often done first to see if there is a need for a a biopsy.


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Endoscopy and intestinal biopsy provide the

most definitive diagnosis, but it is morecomplicated, takes more preparation and ananesthetic, an is uncomfortable. Before theprocedure is done, the patient fasts for eighthours. Then an IV is put in for sedation and alocal anesthetic spray is used to control thegag reflux. The procedure takes 10 to 2 0

minutes.D

uring the procedure the doctorviews the larynx, the esophagus, the stomachand the duodenum and takes a biopsy of theintestine.


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A positive biopsy is considered the goldstandart for diagnosing C eliac D isease. It ismore conclusive than a positive antibodytest. People worry about subjectingthemselves or their children to this invasive

procedure, but it results in a certaindiagnosis.Other possible tests are gluten challenge,stool studies, blood dot test, fecal test, salivatest and breath test, but these are not asconclusive as an antibody test and a biopsy.


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Treatment:

It is important to get a solid diagnosisbecause treatment for people withC eliac D isease is a strict diet of avoiding allfoods with gluten or gluten contamination forthe rest of their lives. People who are unsureof their diagnosis will have a hard timefollowing such a stringent regimen. If there isany question about the diagnosis and the dietisn't maintained, C eliac D isease can lead toserious health complications.


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Nursing ManagementThe nurse provides the patient and familyeducation regarding diet and the use of nutritional supplements regarding. It isimportant to monitor patients with diarrheafor fluid and elecrolyte imbalances. The nurseconducts ongoing assesments to determinewhether the clinical manifestations related tothe nutritional deficits have abated. Patienteducation includes information about the riskof osteoporosis related to malabsorption of calcium.


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Nursing Interventions

Make sure that the diet is free from causativeagent, but inclusive of essential nutrients,such as protein, fats, vitamins, and minerals.Maintain NPO status during initial treatmentof celiac crisis or during diagnostic testing.Provide parental nutrition as prescribed.Provide meticulous skin care after each loosestool and apply lubricant to prevent skinbreakdown.Encourage small frequent meals, but do notforce eating if the child has anorexia.


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U se meticulous hand washing technique andother procedures to prevent transmission of infection.Assess for fever, cough, irritability, or other signsof infection.Teach the parents to develop awareness of the

child s condition and behaviour; recognizechanges and care for child accordingly.Explain that the toddler may cling to infantilehabits for security. Allow this behaviour, it maydisappear as physical condition improves.Stress that the disorder is lifelong; however,changes in the mucosal lining of the intestineand in general clinical conditions are reversiblewhen dietary gluten is avoided.


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NCP PR I OR ITIZATI ON


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NCP Diarrhea


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NURSING DISCHARGE PLAN Name: XX Daignosis: Celiac Deseas


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RECOMMENDATION ANDCONCLUSI ON:

C eliac disease is an immune-mediated enteropathycaused by a permanent sensitivity to gluten ingenetically susceptible individuals. It is recommendedthat children and adolescents with symptoms of celiac

disease or an increased risk for celiac disease have ablood test for antibody to tissue transglutaminase(TTG ), that those with an elevated TT G be referred to apediatric gastroenterologist for an intestinal biopsyand that those with the characteristics of celiac diseaseon intestinal histopathology be treated with a strictgluten-free diet. The quality of your health dependsupon many pieces that not only include the health of your bodily systems, but also include a healthy diet,exercise, and spirituality.


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Dietary recommendations forceliac disease:

Because malabsorption is prevalent with celiacdisease, daily vitamin and mineralsupplementation is essential. Importantsupplements for celiac disease include iron, Bvitamins, magnesium, calcium and vitamin D .Add organic extra virgin coconut oil to your

diet to benefit from healthy plant-basedsaturated fat.


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Add foods rich in omega-3 essential fattyacids to your diet in the form of ground flaxmeal , wild-caught salmon , minimal-mercuryalbacore tuna , walnuts , fish oil, and sproutedwalnuts .

Eat plenty of vegetables and vegetable juices(kelp, sprouts, green and black olives,peppers, spinach, chard, celery, zucchini).Add nutrient-dense and unprocessed foodssuch as sprouted nuts and seeds to your diet.D rink purified water throughout the day


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F oods and other products to

AVO

ID 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 labelscarefully for hidden gluten. Foods that maycontain gluten include canned soups, saladdressings, ice cream, candy bars, instant coffee,luncheon meats, ketchup, mustard, processedand canned meats, yogurt, and sausages.All supplements that contain gluten. Wheat starchcan be used as a binding agent in tablets andcapsules.


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C osmetics. G luten can be found in cosmeticproducts such as lipstick.

All grain alcohols such as beer and malted liquors.All dairy products, since those with celiac diseasealso tend to suffer from lactose intolerance.

All foods containing refined sugar or artificialsugar-substitutes such as aspartame, Splenda ,etc. C hoose a natural sweetener like Xylosweetinstead.

Excessive caffeine intake While moderateamounts of caffeine may be beneficial, excessiveconsumption of caffeine can disrupt the body ssystems, causing irregularity ( constipation or

diarrhea )


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Sweetened fruit juices that spike blood sugarlevels too rapidlyC

arbonated soft drinks that alter pH levels,making the blood more acidicBottom crawlers, such as oysters, clams, andlobster that may contain toxic level of mercury.

D eep-sea fish such as tuna, mackerel, andswordfish that may contain toxic levels of mercury. C hoose minimal-mercury albacore tunainstead.

Sodium nitrite found in processed foods such ashot dogs, lunch meats, and baconMonosodium glutamate (MS G ) found in manyfoods as a flavor enhancer


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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 extractthat s added to foods to retain their creamytexture. For some people, carrageenanirritates the stomach.


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Other tips for Celiac

Disease:If you have silver dental fillings, get anevaluation from a mercury-free dentist whospecializes in the safe removal of mercuryamalgam fillings. Heavy metal toxicity maycause gastrointestinal symptoms.

Celiac Disease Presentation

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