CELIAC DISEASE ASSESSMENT

 SYMPTOMS
 anorectic and irritable child
 gradually fall behind other children
their age in height and weight
 appear skinny, with spindly extremities
and wasted buttocks
 face may be plump and well-rounded
 diagnosis is based on the history
 clinical symptoms:
 bulky stools
Malabsorption Syndrome
 malnutrition
Gluten-Induced Enteropathy
 distended abdomen
sensitivity or abnormal immunologic
 anemia (noticeable between 6 and 18
response to protein, particularly the
months of age)
gluten factor of protein found in grains—
 serum analysis of antibodies against
wheat, rye, oats, and barley
gluten (IgA antigliadin antibodies)
occurs most frequently in children of a
 biopsy of the intestinal mucosa (done by
northern European background
endoscopy) which establishes the typical
dominantly inherited illness
changes in intestinal villi
children with the disorder ingesting gluten   oral glucose tolerance test, which will
changes occur in intestinal mucosa or villi  reveal poor absorption
preventing absorption of foods, especially fat,  stool may be collected to test for fat
across the intestinal villi into the bloodstream  content, which will be increased
children develop:  child’s response to gluten is observed by
placing the child on a gluten-free diet
 steatorrhea (bulky, foul-smelling, fatty
 response to this diet:
stools)
 gain of weight
 deficiency of fat-soluble vitamins A, D, K,
 steatorrhea improves
and E (the vitamins are not absorbed
 irritability fades
because the fat is not absorbed)
 malnutrition
 distended abdomen from the fat, bulky
THERAPEUTIC MANAGEMENT
stools
 continue the gluten-free diet for life,
COMPLICATIONS
because these children are more prone to
 rickets or loss of calcium from bones (loss GI carcinoma later in life if they do not
of Vitamin D) continue the diet into adulthood
 Hypoprothrombinemia (loss of Vitamin K)  children need to have water-soluble forms
 hypochromic anemia (iron-deficiency of vitamins A and D administered
anemia)  Both iron and folate may be necessary as
 hypoalbuminemia (poor protein well to correct any anemia present
absorption)
 type 1 diabetes mellitus
 IgA deficiency
 Down syndrome
NURSING DIAGNOSIS

1. Imbalanced nutrition, less than body

requirements, related to malabsorption of
food
 Parents need to record the
consistency, appearance, size, and
number of stools that the child passes.
 disappearance of steatorrhea is a good
indicator that the child’s ability to
absorb nutrients is improving
 Parents need a great deal of nutritional
counseling when their child is first
placed on a gluten-free diet so they
can recognize foods that contain
gluten (wheat, rye, oats, and barley
products).
 Teach parents to be careful shoppers
and read food labels carefully.
 Help parents create incentives to eat,
such as inviting dolls to “tea” or eating
a picnic outside in nice weather.