CELIAC DISEASE

1. Definition:
Celiac disease is an illness caused by an immune reaction to eating gluten. Gluten is a protein found in
foods containing wheat, barley or rye.
If celiac disease is present, eating gluten triggers an immune response to the gluten protein in the small
intestine. Over time, this reaction damages the small intestine's lining and prevents it from absorbing
nutrients, a condition called malabsorption.

2. Assessment tools/Diagnostic Tools:

a. Serology Testing / Blood Testing
• Specific antibody blood tests are used to diagnose patients with CD. These blood
tests are also used to test people who may be at risk for having CD but have no
symptoms (relatives of patients with CD). The 2 most used tests are the endomysia
antibody and tissue transglutaminase antibody tests.
b. Biopsy / Endoscopy
• Establishing a firm diagnosis of CD requires taking biopsy samples of the small
bowel using endoscopy. Endoscopy involves insertion of a thin flexible tube through
the mouth into the stomach and small bowel. Samples are taken from the wall of the
small bowel and are examined under a microscope for changes of CD. This test is
usually performed with the aid of sedatives

3. Signs and Symptoms:

• Abdominal pains
• Bloating and gas
• Diarrhea
• Foul odor stools
• Poor growth or weight loss
• Anemia
• Nausea and vomiting
• Weakness
• Bone and joint pains
• Skin rash

4. Nursing Intervention
a. Provide gluten free diet careful to avoid accidental exposure via cross contamination while
food is prepared and or cooked.
b. An initial diet high in protein, relatively low in fat, low in lactose and free from gluten may be
necessary if the newly diagnosed child exhibits severe malabsorption.
c. Maintain NPO status during the initial treatment of celiac crisis. Take special precautions to
ensure proper restriction if the child is ambulatory.
d. Provide the family with assistance to obtain a variety of gluten free foods.
e. Administer supplements of vitamins and minerals as prescribed.
5. Management
Medical Management
• There is no medication that treat celiac disease. To avoid the health problems patient can go
completely gluten free diet.
o Avoid all foods contain wheat, rye and barley and their derivatives because even a
small amount of trace contaminant may cause a pathologic response
• Supplemental vitamins and minerals may be used clinically indicated although there is
currently no standard for use.
o Folic acids if low levels is suspected or detected
o Vitamins A and D
o Iron up to 3 months if anemic
o Vitamin K if there is an evidence of bleeding
o Calcium if milk is restricted
• Steroids are used to suppress the immune system but only in the most severe cases.
• The most common sources of gluten that should be avoided include:
o Bread: This includes all types of bread (unless labeled "gluten-free") such as rolls, buns, bagels,
biscuits, and flour tortillas.
o Baked goods: Baked goods like cake, cookies, doughnuts, muffins, and pies contain gluten, as
well as pancakes and waffles.
o Pasta: All wheat pasta contains gluten, including spaghetti, fettuccine, macaroni, lasagna, and
ravioli.
o Cereal: Not all breakfast cereals contain wheat, but many do, so be sure to check the nutrition
labels. Also, be aware that oats are often raised and processed with wheat. Therefore, unless
they are labeled gluten-free, oat products will also contain gluten.
o Crackers: Popular snack foods like crackers, pretzels, and some types of chips have gluten.
o Beer: Beer is made from malted barley, which has gluten. Some liquors have added wheat, so
be sure to research the ingredients.
o Gravy: Gravies and ready-meals containing gravy contain gluten. Powdered gravy mixes also
contain gluten unless specifically labeled "gluten-free."
o Soup: Many canned and boxed soups use wheat flour as a thickening agent. Check nutrition
labels to find premade soups without gluten.

Surgical Management
• Bowel Resection
To remove the disabled part of the bowel, the operation can be
done in two ways:
▪ The surgeon will open the abdomen above the navel
down in a straight line. The wound will be either
stitched or stapled or glue, Surgery can be also be
done laparoscopically.
▪ The last part of the small bowel resection together
with some of the right side of the large bowel
including the appendix is removed. The two cut ends
are joined together.
References:
Celiac disease - Symptoms and causes - Mayo Clinic. (2023, September 12). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220
Celiac disease. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-
diseases/celiac-disease
WebMD Editorial Contributor. (2023, October 23). Foods high in gluten. WebMD.
https://www.webmd.com/diet/foods-high-in-gluten