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Celiac Disease in Pediatrics

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Abby McAfoose

on 25 October 2014

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Transcript of Celiac Disease in Pediatrics

Submitted by Abby M. and Karmen W.
USF FNP Students
Celiac Disease in Pediatrics
Incidence and Prevalence
SOAP note
Research Study
Implications for Practice
Participation Station
Table of Contents
An autoimmune disease characterized by an immume-based reaction to dietary gluten (found in wheat, barley, and rye) primarily affecting the small intestine of genetically predisposed individuals.
What is Celiac Disease?
Northern European Ancestry
Female > Male 3:2
In the U.S. 1 in every 133-160 people affected
About 3 million Americans
Prevalence increasing worldwide
Incidence and Prevalence
The Interview.....
Inquire about the following:
Bone or joint pain
Family Hx of Celiac disease or gluten intolerance
When parent(s) first noticed symptoms
Abdominal cramping/pain
Gas pains
Fatty stools (steatorrhea)
Muscle cramps
Weight loss or delayed growth
The Interview Cont.....
An Appointment with Samantha Sprue
2 year old patient, brought in by her mother because of "weird-looking diarrhea", and her small stature.
Differential Diagnoses
Short bowel syndrome
Pancreatic disease
Crohn's disease
Whipple disease
Acute enteritis
Eosinophilic gastroenteritis
Many times, physical exam is negative
Labs: IgA-EmA, IgA-anti-TTG, total serum IgA
Diagnosis cannot be made based on serology alone
Endoscopy with multiple diagnostic biopsies of the duodenal mucosa is necessary for a definitive diagnosis of Celiac disease
National average price- $3K
Samantha Sprue is a 2 year old Caucasian female brought to the office by her mother, presents with "weird looking diarrhea," abdominal cramping, and delayed growth. Mother denies fever, weakness, bloody stools, or recent travel. Mother first noticed symptoms at about 6 months of age. Symptoms have been constant, but worse after eating. Cramping causes mother to have to hold/console for at least two hours per episode. Mother has tried gas drops, which have provided no relief. Mother states that "all the women in the family have stomach problems."
Samantha is an under nourished child, who appears small for age, alert to self, responds appropriately for developmental age, sitting in mother's lap with doubled over posture, abdomen distended, patient guarding abdomen.

Top Differentials
Celiac disease
Pancreatic disease

Serum antibody levels
Fecal fat test

Refer to GI specialist for endoscopy
Refer to Dietician for diet planning and education
Lifelong removal of gluten from diet
Careful monitoring of food labels for gluten and gluten additives
Symptoms should improve within 7 days if compliant with gluten-free diet

Research Findings
Psychosocial aspects of celiac disease: A cross-sectional survey of a UK population.

Women are more likely to respond emotionally to this disease than men.
Depressive symptoms present due to perceived limitations because of a restricted diet.
Less likely to adhere to diet because of perceived limitations.
"Stronger percieved personal control was associated with greater self-efficacy for the diet" (Ford et. al.,2012)
Implications for Practice
Education and support of the patient and family's lifestyle modification(s)
Understanding of when to refer outside the primary care office
APN basic knowledge of disease process and the dietary limitations
Knowledge of increasing prevalence and under diagnosis
Participation Station
Please choose a meal (breakfast, lunch, or dinner) and create an age-appropriate menu for Samantha following a gluten-free diet. Provide rationale for your choices. You are not limited to the foods shown.
Participation Station
You educate Samantha's mother on the etiology of Celiac disease. Which statement by her mother would indicate an understanding of the information?
A. "I will keep her away from mosquitoes."
B. "I will keep her away from sick people."
C. "The women in my family should be tested for this disease."
D. "I will not take her out of the country."

Celiac disease: What kids have to say (2009). [Video
file]. Retrieved from http:://www.youtube.com/watch?v=kGR6lgh2LdE.

Chennubhotla, S., Ghotra, A., Abell, T. (2014). 5MCC
(Version 17.0.2)[Mobile Application Software]. Retrieved from Skyscape NP Suite.

Endoscopy cost and procedure information (n.d.).
Retrieved from http://www.newchoicehealth.com/endoscopy-cost.

Ford, S., Howard, R., Oyebode, J. (2012).
Psychosocial aspects of coeliac disease: A cross-sectional survey of a UK population. British Journal of Health Psychology, 17, 743-757.

Winslow, T. (2009). Celiac disease. [Video file].
Retrieved from http:://www.youtube.com/watch?v=EmZczwtsbVc.
What Kids Have to Say...
Made Easy
Inquire about:

(New Choice)
Full transcript