Celiac Disease
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Outline
Overview
- Intolerance to gluten (protein found in wheat, barley, oats, rye)
Nursing Points
General
- Villi do not absorb nutrients
- Only treatment is gluten-free diet
Assessment
- Signs of malabsorption
- Diarrhea
- Steatorrhea (fatty/foul smelling stool)
- Abdominal distention
- Signs of malnutrition
- Muscle wasting
- Weight loss
- Growth delay
- Anemia
- Behaviour changes
- Irritability
- Apathy
- Celiac Crisis
- Rare and life threatening complication
- Causes
- Infection
- Fasting
- Stress
- Symptoms
- Severe, watery diarrhea, vomiting
- Can cause electrolyte abnormalities
Therapeutic Management
- Strict gluten free diet
- Severe cases
- Glucocorticoids
- Volume replacement
Nursing Concepts
- Gastrointestinal/Liver Metabolism
- Elimination
- Nutrition
Patient Education
- Foods that include gluten
- Notify provider of bloody stools
References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
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Transcript
Hey everyone in this lesson we’re going to be talking about celiac disease.
Ok so celiac disease is a chronic GI disorder that is usually diagnosed between 1 and 5 years of age when solid foods containing gluten are introduced into the diet. Gluten is a protein that is found in carbohydrates like wheat and patients with celiac disease are not able to digest and process it. When patients with celiac disease eat gluten an allergic reaction will occur in the intestines that is so severe it actually causes damage to the villi.
Just a quick Anatomy reminder the villi in the small intestines are these little finger like projections that come off the surface of the small intestinal wall. And these villi are really important for the process of absorbing nutrients. So if the villi are being damaged by gluten the patient is going to have trouble with absorbing the nutrients that they need.
So most of the symptoms that were going to be looking in our assessment stem from this being a problem with absorption. We’re going to see a lot of changes in the patient’s bowel movements. And usually the parents are going to describe their child’s stools as being pale, frothy and foul smelling. The medical term for this is Steatorrhea and it’s caused by increased amounts of fat in the stool..
The next thing we’re going to see that is a result of the malabsorption is abdominal and GI discomfort and usually this presents as generalized abdominal pain and you may also notice some abdominal distension.
Kids with celiac disease are also going to have problems with their nutrition and the way this primarily presents is in anemia and with vitamin deficiencies. So these kids are often pale, tired and losing weight.
Behavioral changes can also be seen with celiac disease. These kids may be irritable and sort of apathetic about things and are not really interested in playing and getting out there and doing normal kid things.
And the last thing to be very aware of when you’re doing your assessment of a child with celiac disease is something called celiac crisis. And what happens when a celiac crisis as you get this episode of severe profuse watery diarrhea and vomiting. And because of this you end up with severe electrolyte abnormalities that can be life-threatening.
Definitive diagnosis of celiac disease requires a biopsy of the intestines. Once this diagnosis has been confirmed, the disease is managed by starting a gluten-free diet. So this means that patients are avoiding foods that contain wheat, oats and rye. A lot of times foods like corn and rice are used as a substitute for the grain products that they can’t eat.
In more severe cases of celiac disease glucocorticoids may be need to be used to help manage symptoms but this is very rare in children.
For a patient in celiac crisis fluid and electrolyte replacement are essential.
Dietary changes of this magnitude are never easy. Kids are going to complain and want to eat all those things kids love to eat like pizza and cake! So it’s really important that we make sure parents know how important the diet is and how many health issues their child may face if they don’t stick to it. Another thing we can do to help this patient’s is make sure they get support from a variety of healthcare providers. For example, it’s very important for them to be referred to dieticians to make sure they have the support and knowledge they need to make this dietary adjustment.
Your priority nursing concepts for a pediatric patient with celiac disease are gastrointestinal and liver metabolism, elimination, and nutrition.
Ok so let’s go over your key points for this lesson. So first thing to know is that a patient with celiac disease is intolerant of gluten. Which means there are small intestines are not able to process the protein gluten which is found in wheat products. This inability to process gluten results in absorption problems that cause diarrhea and those fatty stools that we talked about. These kids are also often malnourished because of the absorption problem so they be anemic and will most likely be deficient in certain vitamins and nutrients. Treatment for celiac disease is a life-long gluten-free diet. This diet can be very difficult to adhere to because gluten is found in so many foods, so do so it’s very important that we educate families and make sure they are receiving multidisciplinary support.
That’s it for our lesson on Celiac disease. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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