• Celiac Disease
• Gluten Intolerance…found in wheat, barley, rye, and oats.
• Early Stages
  Fat absorption effected. Large quantities of steatorrhea. Frothy and foul smelling.
• Late Stages Impaired--Absorption of Protein, Calcium, Iron, Folic Acid, Vit D, K B12.
  What happens when….Malabsorption of…
  Fats---Steatorrhea. Proteins and CHO---peripheral edema, malnutrition. Vit D and Calcium--Osteomalacia and osteoporosis. Vit K--blood coag problem. Iron, folic acid and vit B12---anemia.
  Growth failure will result if not stopped.
• First Evidence of Disease
  Failure to gain weight. Poor appetite, bout of diarrhea, constipation/vomiting, abdominal pain, irritability.
  As disease progresses
  General wasting. Some children to not show signs until 5 years.
• Celiac Crisis
  Acute--child has profuse, pale, bulky, stools…vomiting..wasted appearance. Dependent edema. Smooth tongue. Crisis precipitated by GI infections, prolonged fasting, and of course…eating gluten.
• Diagnosis
  Stool for fat. Serum albumin. CBC for anemia.. PT for hypothrombinemia. Serum iron. Folic acid level. B12 levels. Immunoglobulin levels. Bowel studies for dilated flaccid bowel loops. Pancreatic function studies. Sweat test to rule out CF. Small bowel biopsy.
• Treatment
  Remove gluten from diet. Give corn, hominy, rice, potato instead. Treat malnutrition. High calorie diet. May need TPN.
• Treat Crisis
  Life threatening. Correct dehydration, metabolic acidosis. NG tube to decrease abd distention. IV fluids with K+, Ca+, and magnesium. Albumin to treat low protein. IV steroids to decrease the bowel inflamation.
  Nursing--Teach Diet
  Avoid cereals and baked goods. Hydrolyzed vegetable oils, processed food fillers. NO bread, cakes, cookies, spagetti, pizza, lunch meat, meat gravy, They CAN have Tacos and Mexican food.
  Very hard….must follow diet for life. Increased risk for lymphoma or GI cancer if diet not followed. Teach patient and family--Anticholinergic drugs precipitate crisis: Inform MDs and Dentists.