This NCLEX review will discuss Celiac Disease.
As a nursing student, you must be familiar with Celiac Disease and how to care for patients who are experiencing this condition.
These type of questions may be found on NCLEX and definitely on nursing lecture exams.
Don’t forget to take the Celiac Disease quiz.
You will learn the following from this NCLEX review:
- Definition of Celiac Disease
- Signs and Symptoms
- How it is diagnosed
- Nursing Interventions for Celiac Disease
- Gluten Free Diet
Lecture on Celiac Disease
Celiac Disease NCLEX Review
What is Celiac Disease? An autoimmune, GI disorder where when gluten is ingested, which is found in wheat barley, grains, and rye products, it causes damage to the small intestine, specifically the intestinal villi.
Key Points about Celiac Disease
- Wheat is a problem for patients with Celiac Disease. There are several proteins in wheat and one of them is called GLUTEN.
- Gluten itself is constructed of a group of proteins called gliadin and glutenin. Gliadin is the problem with Celiac Disease.
- Celiac Disease tends to be genetic and occurs in both children and adults.
- Celiac Disease is different from a wheat allergy or gluten sensitivity in that it can cause similar signs and symptoms BUT there isn’t the same extensive damage to the small intestine as in Celiac Disease.
- No cure: follow gluten-free diet for life
- Celiac disease causes damage to the small intestine due to an autoimmune response. The body sees the protein Gliadin as a foreign invader because it can NOT be broken down correctly.
Key Players in Celiac Disease
Gliadin and the amino acids that make up the protein:
Gliadin is a wheat prolamin which is a plant storage protein that is high in the amino acids, particularly proline and glutamine.
What do amino acids do? They help store and transport nutrients and give the protein its structure. The body can’t break down the amino acids correctly. Therefore, it crosses the gut cells and causes an immune response.
What does the body do NORMALLY with proteins? Normally, the body will take proteins, which start out as long amino acid chains, and break them down into single amino acids. The GI cells will then use them appropriately. However, the amino acids (proline and glutamine) of Gliadin can NOT be broken down into a single amino acid but stay as a small collection of amino acids called peptides (this is what causes the immune response).
The enterocytes which are found in the villi allows them to cross and the immune system doesn’t like this and views it as a bacteria or virus and attacks.
Immune System: sends immune cells to kill the Gliadin. The Gliadin reacts with TTG (Tissue Transglutaminase) enzyme and antibodies are formed by the immune cells to fight the gliadin because the body thinks it is bad. The antibodies formed are:
- Tissue Transglutaminase Antibodies (tTg)
- Antibody IgA
- Endomysial antibody (EMAs)
NOTE: in the process of doing this “warfare” between the immune system and glidian the VILLI of the small intestine are damaged.
Intestinal Villi: found in the small intestine and normally look like little finger-like projections that aid in the absorption of the nutrients by increasing the surface area for absorption. They are surrounded by are a network of blood vessels that easily take the nutrient collected from the food and allows it in the blood stream. Each villus contain cells called enterocytes which help absorb nutrients and aid in digestion.
From recurrent immune system overdrive from fighting the gluten entering the body, the villi LOSES its finger-like like projections and become FLAT (see the top picture in the image above). This LEADS TO DECREASE SURFACE AREA FOR ABSORPTION. Hence, the patient is going to experience malnutrition.
**All of this tends to occur in the jejunum of the small intestine
Signs and Symptoms of Celiac Disease
Lactose intolerance (can’t break down lactos)
Osteo change (thinning, fractures)
Unexplained slow growth, delay puberty (children) and weight loss
Rashes (very itchy dermatitis herpetiformis…elbows, backside, and knees)
Irregular periods, irritable (depression) (loss of nutrients)
Stools: greasy and odorous
Enamel changes to the teeth (yellow or brown spot and deformity)
Diagnosing Celiac Disease
Blood tests are used to check for antibodies:
- Tissue Transglutaminase Antibodies (tTG-IgA)
- IgA serum
- IgA Endomysial antibody (EMA)
And/OR Endoscopy: a biopsy will look at the villi for abnormalities
Complications of Celiac Disease
- Malnourishment (bone, skin, teeth, health mental, growth, reproductive problems)
- Cancer (lymphoma)
- Villi take time to heal BUT sometimes the villi never heal back (condition called refractory celiac disease) and the patient suffers from constant malnourishment and will need IV supplementation.
Nursing Interventions for Celiac Disease
Signs and symptoms of Celiac Disease by asking patient when they notice the most oblivious signs and symptoms and to list what foods they eat on a regular basis…( do they have bloating abdomen, diarrhea/constipation, irritable, depression, or mental fog after eating foods with gluten?)
Patient needs to keep a food dairy along with the signs and symptoms and the nurse should assess the diet log (look for foods that contain gluten)
Skin, teeth, weight (normal vs abnormal)
Ability to read food labels and the patient’s or families’ knowledge about gluten
Educate: AVOID ALL FOOD CONTAINING GLUTEN (watch foods with hidden gluten) and substitute with foods that do not contain gluten
More than ever grocery chains and restaurants are carrying more and more gluten free foods to help people enjoy foods they normally couldn’t and food labels will say GLUTEN FREE- like this:
Always read food labels and pay close attention to the ingredients
Foods Without Gluten
- Plain Meats (fish, beef, chicken, turkey etc.)
- Grains: Rice, Corn, Soy, Millet, Quinoa, Tapioca, Chia, Buckwheat (most of these are used as substitutes for baking as in cakes, breading on meats, pasta etc.)
- Vegetables and Fruits
- Nuts, Beans, Legumes
- Dairy (not malt)….however watch dairy because many patients with Celiac Disease may be lactose intolerant
Foods with GLUTEN TO AVOID
- Wheat (anything that says wheat expect buckwheat)
- Pasta Noodles
- Seasonings, soups
- Anything with breading that doesn’t say GF
- Anything that looks like bread: croutons, crackers, breads, dough, cookies, most cereals, oats unless they say GF
*most processed foods have gluten
Implementing the GF diet and making sure food trays are GF and that patient and family understand the importance of following the gluten-free diet
Administering per MD order supplements to help with any vitamin deficiencies
- “Celiac Disease | NIDDK”. National Institute of Diabetes and Digestive and Kidney Diseases. Web. 11 Apr. 2017.
- “‘Gluten-Free’ Now Means What It Says”. Fda.gov. Web. 10 Apr. 2017.
- “Gluten Sensitivity | Gluten Intolerance | Medlineplus”. Medlineplus.gov. Web. 10 Apr. 2017.