Celiac Disease and Failure to Thrive - Medical Presentation PDF

CELIAC DISEASE AND FAILURE TO THRIVE DEVELOPED BY C. DAVIDSON  CELIAC DISEASE ALSO KNOWN AS GLUTEN SENSITIVE ENTEROPATHY OR “ CELIAC SPRUE” PERMANENT INTESTINAL INTOLERANCE TO DIETARY GLUTEN USED TO BE REFERRED TO AS DISEASE OF CHILDHOOD NOW MORE ADULT PRESENTATIONS...

CELIAC DISEASE AND FAILURE TO THRIVE DEVELOPED BY C. DAVIDSON  CELIAC DISEASE ALSO KNOWN AS GLUTEN SENSITIVE ENTEROPATHY OR “ CELIAC SPRUE” PERMANENT INTESTINAL INTOLERANCE TO DIETARY GLUTEN USED TO BE REFERRED TO AS DISEASE OF CHILDHOOD NOW MORE ADULT PRESENTATIONS SEEN MORE FREQUENTLY IN EUROPE WOMEN MORE THEN MEN RARE IN ASIANS AND BLACKS  CELIAC DISEASE EXACT CAUSE IS UNKNOWN- GENERALLY THOUGHT T-CELL MEDIATED AUTOIMMUNE AND GENETIC SMALL INTESTINE ENTEROPATHY USED TO DESCRIBE A COMPLEX SYMPTOM OF 4 CHARACTERISTICS: 1. STEATORRHEA 2. GENERAL MALNUTRITION 3. ABDOMINAL DISTENTION 4. SECONDARY VIT. DEFICIENCIES  PATHOPHYSIOLOGY VILLOUS ATROPHY IN SMALL BOWEL: T-CELLS ARE ATTACKING SELF INABILITY TO DIGEST GLIADIN COMPONENT OF GLUTEN-> DAMAGES VILI CAUSES ACCUMULATION OF TOXIC SUBSTANCE LEADS TO VILLOUS ATROPHY, HYPERPLASIA OF THE CRYPTS, INFILTRATION OF THE EPITHELIAL CELLS ATROPHY LEADS TO MALABSORPTION CAUSED BY REDUCED ABSORPTIVE SURFACE PATHOPHYSIOLOGY  PATHOPHYSIOLOGY CD4 AND T-CELLS PLAY CRUCIAL ROLE IN IMMUNE RESPONSE GENES IN HLA REGION OF CHROMOSOME 6- FOUND IN 90% OF CELIAC DISEASE CASES INFLAMMATORY REACTION ACTIVATED BY GLUTEN – CD4+TCELLS PRODUCE CYTOKINES—LEADS TO INTESTINAL DAMAGE DAMAGE: VILLOUS ATROPHY AND FLATTENING = MALABSORPTION  CLASSIC SYMPTOMS GI MANIFESTATIONS: NOTED SEVERAL MONTHS AFTER INTRODUCTION OF GLUTEN (6MOS-2YEARS)= CAN BE INSIDIOUS AND CHRONIC CHILDREN SEEN WITH : IMPAIRED GROWTH CHRONIC DIARRHEA ABDOMINAL DISTENTION MUSCLE WASTING WITH HYPOTONIA POOR APPETITE LACK OF ENERGY  CLASSIC SYMPTOMS 1ST EVIDENT WITH GROWTH FAILURE AND DIARRHEA LESS TYPICAL PRESENTATION IN CHILDREN 5-7YRS: ABDOMINAL PAIN; NAUSEA, VOMITING, BLOATING, CONSTIPATION, SHORT STATURE, PUBERTY DELAY, IRON DEFICIENCY, DENTAL ENAMEL DEFECTS, ABNORMAL LFT’S OLDER CHILDREN: OSTEOPOROSIS, CELIAC CRISIS: ABD. DISTENTION, EXPLOSIVE DIARRHEA, DEHYDRATION+ ELECTROLYTE IMBALANCE– HYPOTENSIVE SHOCK + LETHARGY  DIAGNOSTIC EVALUATION BIOPSY OF SMALL INTESTINE REMOVAL OF GLUTEN FROM DIET: FAVORABLE RESPONSE WITHIN 1-2 DAYS: WT GAIN, IMPROVED APPETITE WITHIN WEEKS: STEATORRHEA AND DIARRHEA RESOLVE NO GENETIC TESTING AVAILABLE IN CANADA  THERAPEUTIC MANAGEMENT DIETARY (PRIMARY TREATMENT) GLUTEN FREE DIET CHILDREN MAY HAVE LACTOSE INTOLERANCE NUTRIENT DEFICIENCIES  PROGNOSIS CHRONIC DISEASE MOST SEVERE SYMPTOMS: EARLY CHILDHOOD AND ADULT LIFE CAN LEAD TO LYMPHOMA: IF REPEATED INTAKE OF GLUTEN  NURSING CARE MAIN: TO HELP CHILD AND FAMILY ADHERE TO GLUTEN FREE DIET TEACHING DIETARY REGIMEN OF NO WHEAT, RYE OR BARLEY MAINTAINING THE GLUTEN FREE DIET EVEN WHEN FEELING “BETTER” FOODS CONTAINING GLUTEN: BREADS, CEREAL, CRACKERS, MUFFINS, PASTA, PIZZA, CAKES, PIES, AND MUCH MORE; FRIED CHICKEN CAN BE OFF LIMITS, DUE TO THE BREADING  FAILURE TO THRIVE GROWTH FAILURE SIGN OF INADEQUATE GROWTH RESULTING FROM INABILITY TO OBTAIN OR USE CALORIES REQUIRED FOR GROWTH WT & HT < 5TH PERCENTILE FOR CHILD’S AGE ANTHROPOMETRIC DATA PATTERN OF PERSISTENT DEVIATION FROM ESTABLISHED GROWTH PARAMETERS MOST CASES OF FTT HAVE MIXED CAUSES  PATHOPHYSIOLOGY CAUSES OF FTT: INADEQUATE CALORIC INTAKE: INCORRECT FORMULA PREP; NEGLECT; FOOD FADS; EXCESSIVE JUICE, LACK OF FOOD AVAILABILITY; BREASTFEEDING DIFFICULTY; BEHAVIORAL ISSUES; CNS CONDITIONS AFFECTING INTAKE INADEQUATE ABSORPTION: FOOD ALLERGY; MALABSORPTION; PYLORIC STENOSIS; GASTROINTESTINAL ATRESIA; ERRORS IN METABOLISM EXCESSIVE CALORIC EXPENDITURE: HYPERTHYROIDISM; MALIGNANCY; CONGENITAL HEART DISEASE; PULMONARY DISEASE; CHRONIC IMMUNODEFICIENCY  PATHOPHYSIOLOGY MULTIFACTORIAL INVOLVE INFANTS ORGANIC DISEASE, DYSFUNCTIONAL PARENTING , NEURO OR BEHAVIORAL ISSUES, DISTURBING PARENT/CHILD INTERACTIONS PRIMARY ETIOLOGY: INADEQUATE CALORIC INTAKE REGARDLESS OF THE CAUSE OTHER FACTORS: FINANCIAL RESOURCES; BELIEF IN FOOD FADS; INADEQUATE FOOD KNOWLEDGE; FAMILY STRESS; FEEDING RESISTANCE; INSUFFICIENT BREASTMILK; POOR SUCKING IN INFANTS < 8 WKS  PROGNOSIS RELATED TO CAUSE PARENT TEACHING SHORTENED HEIGHT AND DELAYED DEVELOPMENT FACTORS RELATED TO POOR PROGNOSIS: SEVERE FEEDING RESISTANCE; PARENTS LACK OF AWARENESS; LIMITED FAMILY INCOME; LOW MATERNAL EDUCATION LEVEL; ADOLESCENT MOTHER; PRETERM BIRTH, IUGR; EARLY AGE ONSET OF FTT LATER COGNITIVE AND MOTOR FUNCTION  DIAGNOSTIC EVALUATION EVIDENCE OF GROWTH FAILURE IF FTT IS RECENT: WT NOT HT IS BELOW STANDARD NORMS IF FTT IS LONG STANDING: BOTH HT AND WT ARE LOW COMPLETE HEALTH AND DIETARY HISTORY PHYSICAL EXAMINATION DIETARY HISTORY HOUSEHOLD ORGANIZATION  THERAPEUTIC MANAGEMENT PRIMARY MANAGEMENT: REVERSING THE CAUSE NEED MULTIDISCIPLINARY TEAM: RN, MD, OT, DIETICIAN, CHILD LIFE SPECIALIST, SW FAMILY THERAPY HOSPITALIZATION:1) EVIDENCE OF SEVERE MALNUTRITION 2) CHILD ABUSE OR NEGLECT 3) SIGNIFICANT DEHYDRATED 4) CARETAKER SUBSTANCE USE OR PSYCHOSIS 5) SERIOUS INFECTION 6) OUTPATIENT DOES NOT RESULT IN WT GAIN  NURSING CARE NURSES PLAY CRITICAL ROLE: ASSESSMENT OF CHILD, PARENT AND FAMILY INTERACTIONS KNOWLEDGE OF FTT CHARACTERISTICS ACCURATE ASSESSMENT OF DAILY WT , FOOD INTAKE ASSESS CHILD’S FEEDING BEHAVIORS PARENTAL EDUCATION: FEEDING NUTRITION REQUIRED  NURSING CARE FEEDING A CHILD WITH GROWTH FAILURE: CONSISTENCY OF STAFF QUIET ATMOSPHERE MAINTAIN CALMNESS BE PERSISTENT FACE TO FACE WITH CHILD INTRODUCE NEW FOOD SLOWLY DEVELOP STRUCTURED ROUTINE  NURSING CARE FOUR PRIMARY GOALS IN NUTRITIONAL MANAGEMENT OF FTT: 1) CORRECT NUTRITIONAL DEFICIENCIES AND ACHIEVE IDEAL WT FOR HT 2) PROVIDE ADEQUATE CALORIES FOR CATCH UP GROWTH 3) RESTORE OPTIMUM BODY COMPOSITION 4) EDUCATE PARENT/CAREGIVER