Celiac disease is a permanent intolerance to gluten that damages the small intestine. It is caused by an immune reaction to eating gluten, which is found in wheat, barley and rye. To diagnose it, doctors conduct blood tests, and often a biopsy of the small intestine. The only treatment is a lifelong gluten-free diet, which allows the intestine to heal. Managing celiac disease requires carefully reading food labels to avoid gluten.

1. CELIAC
DISEASE
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2. What is Celiac Disease?
• Permanent inability to tolerate
dietary gluten in the small
intestines.
• Is a significant medical condition
that can result in a number of
serious consequences if not
diagnosed and treated properly.
• It affects the small intestine.
• The lining of the small intestine is
damaged by gluten.

3. Causes:
• Celiac disease is caused by an interaction between
gluten (the protein portion of wheat) and the small
bowel lining in people susceptible to the disease.
• This cause damage to the lining which results in a
reduction in the surface area of the villi or finger-like
projections of the bowel lining.
• Both genetic and environmental factors play
important roles in celiac disease.

5. • The disease is triggered by surgery, pregnancy, viral infection,
or severe emotional distress.
• It is most common in young children ages 6 to 24 months but
can occur at any age.
• Symptoms typically diminish or disappear in adolescence and
reappear in early adulthood.
• Complications include impaired growth, inability to fight
infections, electrolyte imbalance, clotting disturbance, and
possible predisposition to malignant lymphoma of the small
intestine.

6. Pathogenesis
Celiac
disease
Gluten
Necessary
Causes
Gender
Infant feeding
Infections
Risk Factors
Pathogenesis
Genetics

7. Clinical
manifestations
There are no typical signs and symptoms of celiac disease. Most
people with the disease have general complaints, such as:
• Intermittent diarrhea
• Abdominal pain
• Bloating
The most common symptoms can include:
• Anaemia (low Iron folate)
• flatulence
• Fatigue, weakness and lethargy
• Nausea and vomiting
• Stomach cramps
• Weight loss – although weight gain is possible.

8. • Osteomalacia- (metabolic Bone disease
characterized by inadequate mineralization of
bone.)
• Steatorrhea- (foul-smelling stools w/ a high fat
content: results from impaired digestion of
proteins and fats due to a lack of pancreatic juice
in the intestine)
• Azotorrhea- (excess of nitrogenous matter in the
feces or urine)

9. How is Celiac
Disease Diagnosed?
The three major steps leading to diagnosis of celiac
disease are:
1. Blood tests for gluten autoantibodies
2. A small bowel biopsy to assess gut damage. For those
with suspected dermatitis herpetiformis, skin biopsies
will be taken of the healthy skin near the lesion.
3. Implement the gluten-free diet

10. • Dermatitis
herpetiformis (DH) is
an intensely itchy,
blistering skin rash
that affects 15 to 25
percent of people
with celiac disease.

11. 1: Examination
Health History
The following areas should be considered in the discussion:
(The first three are applicable to adults and children. The last
is specific to children.)
• What are the physical and emotional symptoms?
• How long have they been present? How often do they
occur? Is there a pattern?
• Is it consistent throughout the day? When and for how long
do the symptoms occur?
• Do family members have any autoimmune diseases?
• Is the child's physical and emotional health within the
normal range?

12. • Physical Examination
• Depending on the presentation
of symptoms, the physician will
perform tests to check for some
of the following items:
• emaciation
• pallor (due to anemia)
• hypotension
• edema (due to low levels of
protein, [albumin] in the blood)
• dermatitis herpetiformis (skin
lesions)
• easy bruising (lack of vitamin K)
• bone or skin
and mucosa membrane
changes due to vitamin
deficiencies
• protruding or distended
abdomen
(intestine dysmotility)
• loss of various sensations in
extremities including vibration,
position and light touch
(vitamin deficiency)
• gluten ataxia
• peripheral neuropathy
• migraine headache

13. 2: Biopsy
Intestinal Biopsy
• In the event that clinical signs and positive laboratory tests
indicate probable malabsorption, a biopsy of the small
intestine [jejunal] is scheduled to be performed by a
gastroenterologist. In this test, a small flexible biopsy
instrument is passed through:
• a tubedown the throat stomach upper end of the
small intestine.
• The tube is removed and the tissue samples are examined
under a microscope for signs of damage.

14. Intestinal Biopsy
Shuttle
Device

15. 3: Diet
• When gluten is removed from the diet, most of the
damage that was done to the small intestine (the
jejunum) is repaired. It takes only three to six days for
the intestinal lining (the mucosa) to show
improvement. Within three to six months, most
symptoms subside as the mucosa returns to its
normal (or nearly normal) state.

16. • The only treatment is the avoidance of all gluten containing
foods. This allows the bowel lining to recover. This strict
attention to diet must be lifelong.
Foods that contain gluten include:
• bread, cakes and pasta.
• However, there is also a whole range of ingredients within
prepared and commercial foods that can come from a gluten
source.
• It is essential that a person with celiac disease become
‘ingredient aware’.

17. Pay attention to processed foods that may
contain gluten. Wheat flour is a common
ingredient in many processed foods.
Examples of foods that may contain gluten
include:
• Canned soups
• Salad dressings
• Ice cream
• Candy bars
• Instant coffee
• Luncheon meats and processed or canned meats
• Ketchup and mustard
• Yogurt
• Pasta

18. Gluten Diet After GFD for 10 weeks

19. Nursing diagnosis
• Altered nutrition, less than body requirement related
to Intermittent diarrhea.
Interventions:
• Assess nutritional Identify factors contributed to nutritional
intake
• Assess patient nutritional dietary pattern to plan the proper
meals
• Assess weight changes
• Assess lab values for (protein, creatinine iron)
• Provide preference food

20. Acute Pain related to Abdominal rigidity
Goal: pain is resolved or controlled
Intervention:
• Maintain bed rest in a comfortable position, do not support the
knee.
• Assess the location, weight and type of pain
• Assess effectiveness and monitor side effects analgesic; avoid
morphine
• Provide a planned rest period.
• Change positions frequently and give her back rubbing and skin
care.
• Give and recommend alternative pain relief measures.

21. Nursing
Management:
• Monitor dietary intake,MIO, weight, serum electrolytes, and
hydration status.
• Maintain NPO status during initial treatment of celiac crisis or
during diagnostic testing.
• Provide parenteral nutrition as prescribed.
• Provide meticulous skin care after each loose stool and apply
lubricant to prevent skin breakdown.
• Use meticulous hand washing technique and other procedures to
prevent transmission of infection.
• Assess for fever, cough, irritability, or other signs of infection.
• Stress that the disorder is lifelong; however, changes in the
mucosal lining of the intestine and in general clinical conditions
are reversible when dietary gluten is avoided.

22. Management
C Consultation with skilled dietitian
E Education about disease
L Lifelong adherence to gluten-free diet
I Identification & Rx of nutritional
deficiencies
A Access to an advocacy group
C Continuous long-term follow-up by
multidisciplinary team

23. Summary of
points to
remember
• People with celiac disease cannot tolerate gluten, a protein
in wheat, rye, and barley.
• Untreated celiac disease damages the small intestine and
interferes with nutrient absorption.
• Without treatment, people with celiac disease can develop
complications such as osteoporosis, anemia, and cancer.
• A person with celiac disease may or may not have
symptoms.
• Diagnosis involves blood tests and, in most cases, a biopsy
of the small intestine.

24. • No treatment can cure celiac disease.
• There is no surgical treatment for celiac disease.
• Since celiac disease is hereditary, family members of a
person with celiac disease may wish to be tested.
• Celiac disease is treated by eliminating all gluten from
the diet. The gluten-free diet is a lifetime requirement.
• A dietitian can teach a person with celiac disease about
food selection, label reading, and other strategies to
help manage the disease.

25. • Thank you
For
Listening!
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