celiac disease

Question 1

what is celiac disease?

Answer 1

condition in which the absorptive state of the small intestine is damaged by gluten (digestive disease)

results in inability pf body to absorb nutrients (proteins, fats, carbs, vit, minerals) d/t damaged small intestine (malabsorption)

** mimic CF but this time issue is in the small intestine

Question 2

what are the 4 characteristics of celiacs?

Answer 2

1) steatorrhea
2) general malnutrition
3) abdominal distention
4) secondary vit deficiency

Question 3

what are causes/risk factors of celiacs?

Answer 3

• genetics
• immune response involving cd4 t cells
• inflammatory response contributes to intestinal damage

Question 4

how can you prevent celiacs?

Answer 4

breastfeed for at least 4mo and gradually introduce gluten in infants diet

Question 5

pathophysiology?

Answer 5

individual unable to digest gliadin (component of gluten), which leads to an accumulation of toxic substance -> damages mucosal cells of small bowel

villous atrophy leads to malabsorption bcz of reduces absorptive surface

Question 6

what are the clinical manifestations of celiacs?

Answer 6

• decreased intestinal hormones
• decreased secretion of pancreatic enzymes
• decreased expulsion of bile from gallbladder
• malabsorption
• potassium loss
• vit K, folic acid, vit b12, iron def
• water and electrolytes secreted = diarrhea

Question 7

what are the s and s of classic celiac disease? (FDAMPLP)

Answer 7

• Failure to thrive, or weight loss
• Diarrhea
• Abdominal distension
• muscle wasting w hypotonia
• poor appetite
• lack of energy
• Positive serology, HLA, and villous atrophy

Question 8

what are the s and s of atypical celiac disease?
(ISDAIOPAP)

Patients who present with other symptoms are said to have atypical celiac disease.

Answer 8

• Iron deficiency anemia
• Short stature
• dental enamel defects
• Arthritis
• Infertility
• Osteoporosis
• Peripheral neuropathy
• Abnormal LFTs
• positive serology, HLA, and varying degrees of villous atrophy

Question 9

how is celiacs diagnosed?

Answer 9

1) biopsy of small intestine
- obtained by performing a
esophagogastroduodeniscopy (EGD)
- tissue sample examined by pathologist for
abnormal cell proliferation upon integration
of gluten

2) blood tests: igA and igG
- screening 1st gen relatives

3) stool cultures

4) antibody markers for celiac

Question 10

what are dietary management for celiac disease patients? (10)

Answer 10

1) gluten free diet (low)
2) no BROW (barley, rye, oat, wheet)
3) corn and rice = substitutes
4) lactose also removed
5) supplements (nutritional deficiencies)
6) high cal high protein
7) simple carbs: fruits and veggies
8) low fat
9) avoid fibre (bcz bowel inflammed)
- no raisins, raw veggies, nuts
10) if dont respond to diet
- TPN and immunosuppressant (decreased
inflammatory response)

Question 11

what indicates the efficacy of the diet?

Answer 11

within 1-2 days: wt gain and improved appetite in kids

within few wks: resolution of diarrhea and steatorrhea

Question 12

what are some teaching points?

Answer 12

• teach abt disease process
• dietary restrictions (financial burden)
• importance of maintaining diet even if no symptoms
• advise to read labels carefully

Question 13

what are the complications of celiac disease?

Answer 13

• growth delay
• anemia
• osteomalacia (softening of bones)
• malignant lymphoma of small intestine
• cancer
• small bowel ulcers