Question

Discuss the clinical manifestations and management regarding the Celiac disease.

Make sure to focus on malabsorption, nutritional needs, and food choices.

Answer 1

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CELIAC DISEASE --- It is immune mediated inflammatory disease of small intestine caused by permanent sensitivity to GLUTEN which is found in wheat, barley, oats, rye , etc , cause damage to intestinal mucosa in genetically predisposed individuals.

PATHOPHISIOLOGY-------

It is caused by exposure of gluten , due to which small intestine atrophy occur resulting in malabsorption .

CLINICAL MANIFESTATIONS ---------

It is categorized as , gastrointestinal /classical, non- gastrointestinal / atypical, and asymptomatic.

Gastrointestinal manifestations include-

Chronic diarrhea, abdominal distension, pain, anorexia, weight loss, vomiting, steatorrhea, paradoxical constipations.

In severe cases , in infants celiac crisis , metabolic consequences of dehydration , severe malnutrition is seen.

Non- gastrointestinal symptoms are -

Short stature, delayed puberty, irritability, anemia, osteoporosis, neurological symptoms include headache, learning disabilities, seizures, hyperactivity is seen. Dermatitis herpitiform resulting in itching, blister formation , rashes in elbow, knees are observed.damage to teeth , mouth ulcers , fatigue, numbness, tingling sensation, joint pain , hepatitis, calcifications, etc.

celiac disease resulting in MALABSORPTION -----

Due to malfunctioning or any change in bowel it is less able to absorb any nutrients , minerals and especially fat soluble vitamins. Due to iron malabsorption anemia develop, due to vitamin B12 and folic acid malabsorption megaloblastic anemia occur, calcium and vitamin D malabsorption lead to osteoporosis, osteopenia. Inability to absorb fat and carbohydrates cause weight loss, stunted growth, lack of energy.

MANAGEMENT of celiac disease -

DIAGNOSIS -----

1. Stool analysis for fat.

2. Intestinal biopsy.

3. Serological testing for antibodies.

4. Folic acid levels.

5. Vitamin B12 levels.

THERAPEUTIC MANAGEMENT --------

1. Special focus on dietary management.

2. All gluten rich diets , wheat, rye, oats, barley should be removed from diet.

3. Nutritional considerations should be priority . Counselling of patient should be done and recommend source of healthy micronutrients like calcium from milk, vitamin D, legumes for iron and magnesium, Vitamin E .

corn , rice is given, lactose restrictions should be, nut , seed, fruits and vegetables are recommended. Pasta, snacks, deserts, commercially fried foods, chips, meat, soup should be avoided.

4. IV fluids are given to correct fluid and electrolyte balance.

5. Corticosteroid are given to reduce severe inflammation.

6. Albumin for shock .

7. Recall patients for regular check-up.

Thankyou.