2. INTRODUCTION
Celiac disease also known as coeliac disease, It is an
autoimmune disorder of the small intestine that occurs
in genetically predisposed people of all ages from middle
infancy. Celiac disease is caused by a reaction to gliadin, a
gluten protein found in wheat, rye and barley .
3. DEFINITION
Celiac disease is an autoimmune disorder where the
ingestion of gluten leads to damage in small intestine.
4. INCIDENCE
• It is estimated to affect 1 in 100 people world wide.
• Prevalence was 4% in South America 0.5%in Africa and 0.6% in
Asia.
Prevalence in children between 2.5 and 15 years of age
• 3-13/1000 children
• Approximately 1 in 300 to 1 in 80 children.
6. ANATOMY
• Mouth: The mouth is the first part of our digestive system.
Food is ingested through the mouth.
• Oral cavity: The oral cavity comprises the palate, tongue and
teeth.
• Pharynx :It is the common passage for food and air. Epiglottis
prevents the entry of food into the windpipe.
• Oesophagus:It is a muscular tube through which small bolus
of food passes from the mouth to the stomach.
7. CONTI...
• Stomach :It is a muscular bag, positioned at the upper left part of
the abdominal cavity. It has four parts- cardiac, fundus, body and
pyloric portion.
Cardiac part
Fundus
Body
Pyloric
8. CONTI...
• Small Intestine :It is the longest part of the alimentary canal
and comprises three parts- Duodenum, Jejunum, and Ileum
• Large Intestine :The small intestine leads into the large
intestine. It has three parts- Caecum, Colon, and Rectum
9. PHYSIOLOGY
1. Ingestion of food.
2. Secretion of fluids and digestive enzymes.
3. Mixing and movement of food and wastes through the body.
4. Digestion of food into smaller pieces.
5. Absorption of nutrients.
6. Excretion of wastes
10. RISK FACTORS
• A Family member with celiac disease.
• Type 1 diabetes mellitus
• Down syndrome or Turner syndrome
• Adisson’s disease
• Rheumatoid arthritis
11. PATHOPHYSIOLOGY
• Celiac disease occurs from an interaction between genes, eating
foods with gluten and other environmental factors, but the
precise cause isn’t known.
• When the body’s immune system over reacts to gluten in food.
• The reaction damages the tiny hair like projections (villi) that
line the small intestine.
• Villi absorbs vitamins, minerals &other nutrients from the food.
• If the villi get damaged, child didn’t get enough nutrients.
12. CLINICAL MANIFESTATION
In Children under 2 years of age, the typical signs and symptoms
include,
1. Vomiting
2. Chronic diarrhoea
3. Swollen belly
4. Failure to thrive
5. Poor appetite
6. Muscle wasting
16. MEDICAL MANAGEMENT
Pharmacological Management
Mineral and vitamin supplements (treat nutritional problems)
Enzyme Therapy
Folate supplements
Iron supplements
dapsone, (taken by mouth, can control the skin symptoms).
(Exactly There is no medication that treats celiac disease).
20. NURSING MANAGEMENT
Assessment
• History. Carefully gather a history from the family caregivers,
noting especially the history of stooling; ask about the onset of
constipation, the character and odor of stools, the frequency of
bowel movements, and the presence of poor feeding habits,
anorexia, and irritability.
• Physical examination. During the physical exam, observe for
distended abdomen and signs of poor nutrition; record weight
and vital signs.
21. CONTI...
Nursing Diagnosis
Altered nutrition, less than body requirement related to
vomitting.
Risk for Fluid Volume Deficit related to poor gastrointestinal
absorption of nutrients related to diarrhea.
22. CONTI...
Acute Pain related to Abdominal rigidity
Imbalanced Nutrition less than body requirements r/t
malabsorption due to immune effects of gluten
Diarrhea related to malabsorption of food, immune
effects of gluten on gastrointestinal system
23. CONTI...
Nursing Intervention
• Eliminate gluten from the diet.
• Give the child corn and rice products, soy and potato,flour,
breast milk or soy-based formula, and fresh fruits.
• Replace vitamins and calories; give small, frequent meals.
• Monitor for steatorrhea - its disappearance is a good indicator
that the child's ability to absorb nutrients is improving.
• Maintain fluid volume within normal limits
24. PATIENT TEACHING
Be sure to cover:
• the disease and signs and symptoms of complications
• the importance of following a gluten-free diet
• that the child’s weight should return to within a normal range
within 6 months to 1 year after starting the diet
• how to read food labels and to avoid products with hidden
gluten content such as food containing “vegetable protein.”
26. COMPLICATIONS
• Intestinal T- cell lymphoma
• Carcinoma of small intestine
• Ulcerative jejunitis
• Complicationa of nutritional deficiency
1. Anemia, peripheral neuropathy
2. Osteomalacia, osteoporosis
27. CONCLUSION
Celiac disease is an autoimmune inflammatory disorder of the
small intestine triggered by gluten, and is a very common chronic
disease A gluten-free diet typically reverses all signs and
symptoms within a short time.Monitoring of the patient to verify
ongoing dietetic compliance is fundamental in order to ensure
that all possible complications, including malignancies, are
avoided.
