Chapter 24: Celiac Disease (Children)

Question 1

Celiac Disease

Answer 1

also known as “celiac sprue”, “gluten-induced enteropathy”, and “gluten-sensitive enteropathy”

• disorder in which the proximal small bowel mucosa is damaged as a result of dietary exposure to gluten
• permanent intolerance to gluten

Question 2

How do you get the disease?

Answer 2

does not present until gluten products have been introduced into the diet
-usually between 6 months and 2 years of age as table foods are introduced into the diet

Question 3

What is gluten found in?

Answer 3

-wheat
-rye
-barely
-related grains
(rice does not contain toxic gluten and can be eaten freely, as can a special preparation of oats)

Question 4

The pathology shown for Celiac Disease

Answer 4

reveals a diffuse lesion of the upper small intestine mucosa
-short, flat villi, deepened crypts, and irregular vacuolated surface epithelial layer and crypt hyperplasia are seen via light microscopy
>as the villi flatten out and atrophy (partial or complete wasting away), there is a decrease in the absorptive surface of the intestine
-malabsorption with a decreased fat absorption eventually impacts the absorption of proteins, carbohydrates, and fat-soluble vitamins A, D, E, and K

Question 5

Signs and Symptoms

Answer 5

> early manifestations: are nonspecific

• anorexia
• irritability
• weight loss
• listlessness

> Classic Presentation: begins around age 6 months to 2 years and is characterized as gluten products are introduced into the diet

• diarrhea
• abdominal distention and bloating
• steatorrhea (bulky, greasy, foul-smelling, and putty-colored stool b/c of large amount of undigested fat content)
• constipation
• vomiting
• abdominal pain
• anorexia

> Atypical Symptoms:

• protuberant abdomen, loss of subcutaneous fat, hypotonia, anorexia, lethargy, and muscle wasting b/c of protein losses
• anemia and bruising b/c of inadequate vitamin k absorption
• growth retardation
• osteoporosis
• delayed puberty development
• iron deficiency anemia
• failure to thrive
• abnormal liver function
• dental enamel defects
• an atypical presentation of celiac disease may delay diagnosis until adult years b/c the extraintestinal manifestations overshadow the GI symptoms, which may be mild or entirely absent

Question 6

Diagnosis

Answer 6

-clinical symptoms and serological markers
-small bowel biopsy essential to confirm before gluten is eliminated from diet
>positive biopsy reveals atrophy of villi and deep crypts on the intestinal mucosa (definitive test)
-laboratory studies detect antigliadin and antiendomysial antibodies in addition to malabsorption and nutritional deficiencies

Question 7

Prevention

Answer 7

• cannot be prevented
• symptoms may be reduced through careful dietary education and management
• reading labels
• gluten-free food

Question 8

Nursing Care

Answer 8

directed at diagnosis, support, and education

Question 9

Treatment

Answer 9

Gluten-free diet
-eliminate wheat, rye, and to an extent barely and oat products
>corn, rice, and millet are acceptable

Question 10

Education/ Discharge

Answer 10

• gluten-free diet can heal the damage to the intestine and prevents further damage
• instructed on hidden sources of gluten, which may be found in processed foods such as thickening agents, soups, and luncheon meats; gluten is added to many foods as hydrolyzed vegetable protein
• supplemental calories, vitamins, and minerals are recommended during the acute phase
• normal amounts of fat are suggested
• periodic measurement of transglutaminase is recommended to determine dietary compliance or to reevaluate persistent symptoms after the initiation of a gluten-free diet (GFD)

Question 11

Optimizing Outcomes for Celiac Disease

Answer 11

• requires a lifelong commitment to diet control
• involves dietary guidance
• carefully read labels for hidden sources of gluten-based products; can be found in ice cream, hot dogs, luncheon meats, soups, and cookies

Question 12

Children with more severe mucosal damage

Answer 12

-have impaired digestion of disaccharides, especially in relation to lactose; may necessitate need for lactose restriction in diet
-dietary needs: high calories and proteins with simple carbohydrates such as fruits and vegetables
>avoid high-fiber foods such as raw vegetables and fruits with skin, nuts, and raisins until bowel inflammation has been reduced