Celiac Disease: Symptoms, Pathophysiology, Diet Nursing NCLEX Lecture

Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video, I'm going to be doing an

NCLEX review over celiac disease. This video is part of a gastrointestinal NCLEX review series,

so be sure to check out the other videos in this series. And as always, in the YouTube description

below or at the end of this YouTube video, you can access the free review quiz that will test

you on celiacs. So let's get started. So what is celiac disease? Celiac disease is an autoimmune

gastrointestinal disorder where when the person eats something that contains gluten and gluten is

found in wheat, barley, rye, and they ingest that and it enters into the small intestine,

it causes an immune response, which in turn damages the intestinal villi. And you're going

to learn in this lecture intestinal villi are so important because they play a role in absorbing

nutrients. So first, before we dive into our lecture, let's talk about the key points you need

to know about celiac disease. Okay, with celiac disease, we're really concentrating on wheat

products and things that really contain gluten because that is our big problem. And a wheat

consists of several proteins and the protein that we're interested in is gluten. Now gluten itself

is made up of a group of proteins, such as gliadin and glutenin. What we're really concerned

about in celiacs is gliadin. So remember gliadin. Okay, why? What happens is that gliadin, the body

is unable to properly break down gliadin. Gliadin is a protein and it's made up of amino acids and

the body can't break those down properly, which we'll really talk about in the patho part,

sends off at an immune response because your body views some parts of that amino acid that it can't

break down properly as a foreign invader. And in the process of that little war with your immune

system and the gliadin, it kills the villi. Now celiac disease tends to be genetic and it will run

in families. So mom, dad had it. Your patient is having signs and symptoms of it. They may

have this because it runs in families and it occurs in both adults and children. So you want

to screen your pediatric patients for this as well. There is no cure. A patient who has celiacs,

they will have to for their life long follow a gluten-free diet. And this will be consuming

foods that have no gluten in them and substituting things, which we'll go over in depth in the

nursing interventions. And by doing this, this will allow the intestinal villi to heal and

increase their nutrition intake. Because once those villi are damaged, the person is really

at risk for malabsorption. And celiac disease is different from a wheat allergy or a gluten

sensitivity. They may have the same signs and symptoms as someone with celiacs, but the damage

to the small intestinal villi is not as severe as it is in celiac disease. Now let's look at what is

going on in celiac disease. Who are key players and why is this happening? Okay, so we have a

patient. They may have celiac disease and they ingest a wheat product. Well, we know from earlier

that wheat is made up of some proteins. Specifically what we care about is gluten. And gluten is further

made up of some other proteins, specifically glutenin and gliadin. And gliadin is what we

really care about because this is what's causing our immune reaction. And what is gliadin? Let's

talk a little bit more about it. Okay, gliadin is a wheat prolamin and this is a plant storage protein

that is high in amino acids. And what are amino acids? What do they do? Amino acids give your

protein its structure. It also helps with storing and transporting nutrients. Now these specific

amino acids that we're talking about in celiac disease that make up gliadin are proline and

glutamine. So what's happening in a nutshell is that the body is unable to break these amino acids

down properly like how it normally should. And instead they're not broken down correctly. They

pass through that gut cell. The immune system sees that and thinks it's like a foreign invader,

like a virus or bacteria, and attacks it. It makes antibodies. And in the process of doing

all that it kills the intestinal villi. So let's look at how normally the body would break down

a protein. Okay, here we have our long strand of amino acids which make up the protein. Those are

your little circular areas, your amino acids. Now normally whenever you ingest this your body has

all these specialized cells that will take these amino acids and pull them apart. And each are

assigned to take certain parts of that chain apart and it breaks it down into single amino acids.

That's what should happen normally. Well in celiac disease that's not what happens. Whenever they

ingest that gliadin protein the amino acids that break up the gliadin don't break apart into these

single little amino acids. Instead it breaks down into the short little chain known as a peptide.

And whenever this crosses that cell that immune system proceeds to attack it. And when the immune

system does this its main objective is to kill this gliadin. So the immune cells see the gliadin

and it's like we've got to get rid of you. And the gliadin will react with the TTG enzyme which is

the tissue transglutamase enzyme. And whenever this happens antibodies will form. And these antibodies

are made so the next time this patient ingests gluten there will be an army on standby to go and

to attack that gluten. You'll have this continuous cycle over and over. And the antibodies that are

produced as a nurse I would be familiar with these antibodies because if you have a patient

who's being checked for celiacs whenever the doctor orders these specific tests you'll know

why. Because it's like hey these are the antibodies being produced whenever this

immune system reaction is going on. So the antibodies produced are tissue transglutamase

antibody TTG antibody IGA and endomycel antibody which is EMAs. Now the antibodies will be formed

during all this raging war going on. You have the unlucky bystander which are your intestinal

villi. Now to help us understand the signs and symptoms we're going to see in celiacs

and why we need them to avoid gluten we need to understand the role of the intestinal villi

because this is why the patient is really getting so sick. Because these guys are gone and they're

not being able to do their function. So what is their function? Okay the villi are found in the

small intestine and they have a unique look to them. They are finger-like projections that aid

in the absorption of nutrients. And how they do this is by increasing the surface area for

absorption. So they have nice long protrusions which give them that surface area and

whenever they become damaged flattened they lose that surface area. So you lose the amount of area

for nutrients to be absorbed. Now they are surrounded by a network of blood vessels and

this helps easily for that nutrients that's being absorbed to enter into that bloodstream.

And each villus, each individual villus has enterocytes which are those cells that aid in

absorbing food and aid in digestion. Now let's look at a picture of what happens to those villi

in someone who doesn't have celiacs compared to someone who does. Okay so over here on the left

you see the opening of the small intestine. You see those finger-like projections those are your

villi. And then the middle picture is just a villi blown up and as you can see surrounding it

is that network of blood vessels that's helping absorb taking that nutrients that's absorbed and

taking it through the bloodstream so the body can use it appropriately. Now the picture on the bottom

is a picture of what normal villi should look like. They're tall, they have those finger-like

projections which help with the increased surface area for absorption of food. Now the top picture

is a picture of someone who's been eating gluten and the body does not like that and the immune

system has attacked that area and notice how they have completely just flattened and you have the

dead epithelial cells. It's just not working appropriately and this is why you're going to see

a lot of malabsorption complications in these patients. Now when the patient quits eating gluten

over a long period of time these villi will start to repair themselves and they'll start to grow

back and the patient will be able to absorb food but as long as they're taking in gluten and they're

having these reactions the patient is at major risk for malnutrition. Now let's look at the signs

and symptoms of some things you may see in a patient with celiac disease or they may report to

you and to help you remember these signs and symptoms remember the word malnourished because

that is the whole reason these patients are getting sick with celiacs. They're malnourished,

those villi are not working appropriately, we can't absorb our nutrients. Okay so M for mouth

ulcers. Inside the mouth, inside the lip they may have ulcers that have formed so your patient may

report that to you. A for anemia, low red blood cells. Why anemia? Well what's happening is that

your body is not able to absorb all those vitamins and all those minerals that it needs and with red

blood cells you need a good supply of vitamin b12, you need a good supply of folic acid and iron in

the body but celiacs isn't absorbing that so they will have low red blood cell production which will

lead to anemia. Also L for lactose intolerant. Many times patients who have celiacs they will not

be able to tolerate dairy products these things these two tend to go hand in hand and that's

because they've lost that ability to digest that enzyme in dairy products the lactose so they'll

have the diarrheal that classic signs and symptoms that go with lactose intolerance but as they remove

gluten from their diet those villi heal back they can tolerate dairy again. N for nausea and vomiting.

O for osseo changes, that's your bone changes. Again the body can't absorb good amounts of

calcium or vitamin d which play a role in bone health so they'll have thin bones or fractures.

U for unexplained slow growth and puberty and this is really in your kids all of a sudden a

parent may report the doctor may assess and see the patient's really not in a good percentile for

their height or the puberty or they haven't started menstruation in girls or something's going on

and in adults they may have weight loss and again this just is coming from that inability to absorb

that nutrients that plays a role in allowing a child to flourish and grow. R for rashes.

With celiacs you will see a very unique rash on these patients and it's called dermatitis

herpetiformis and this is a type of rash that can be found it's blister type bumps that can be found

on the knees the elbow the backside or the hairline and the patient will say it is very very itchy and

that is present with celiacs sometimes. I for irregular periods and another I for irritability

again just don't have the nutrients for regular menstruation and being low and a lot of those

vitamins can cause depression and mental health problems. S for stools will be greasy like an

appearance to them and very odorous. H for hair loss. E for enamel changes on the teeth you may

see yellow or brown spots or deformed parts of the enamel and then D the last one diarrhea patients

can have that as well. Now let's talk about how celiacs is diagnosed. As the nurse you need to

be familiar with what the physician may order so you can talk to your patient about if they have

any questions okay. We talked about those antibodies that are formed in the pathophysiology

part so physician may order like a blood test like a TTG an IGA serum serum or an EMA or they will

order or do both an endoscopy where they take a scope and they'll assess that upper GI tract down

in the small intestine and they may take a biopsy of the intestinal villi look at that under a scope

and see what they look like do they look abnormal are they flat like that picture we looked at and

if so celiacs is probably present. Okay now let's talk about the complications okay with celiacs we

know big thing they're going to have is malnourishment and this is going to affect every

body system. We're going to have bone problems, skin problems, mental problems, growth problems,

and reproductive problems. Everything's going to be affected. Also another complication is that the

patient has an increased risk of cancer like lymphoma and sometimes these villi never heal

back they're gone forever and that is a term refractory celiac disease and if the patient

gets this and they'll never be able to really absorb the nutrients from their food so they'll

need some type of supplementation like through an IV. Now let's look at those nursing interventions.

What are you going to be doing for a patient who has celiacs? Okay our biggest role as the nurse

is to really help them understand what this diagnosis means and help them with their diet

because they're going to have to really adjust their food around to help make sure that they

avoid gluten. So first let's talk about assessing. We want to assess our patients of course, screen

them. Are they at risk for this? Do we need to let the doctor know so they can maybe order some tests?

So we're going to assess our patient and if they report you know I'm having a lot of abdominal

bloating, diarrhea, mental fog, you need to ask them well when do you notice these signs and symptoms

and what foods are you eating whenever these signs and symptoms come on. So you might want to have

them keep a food diary along with the signs and symptoms so whenever you look at that

diary you can see that they ate some pizza and then they had a sandwich which is all high in

wheat and then they had these signs and symptoms so it's correlating. Assess their skin for that

dermatitis herpetiformis, their teeth, they got any enamel changes or their mouth they have any

sores in there. Also ask do they have a family history? Does mom or dad have it? Sister or brother?

Then you want to assess their knowledge of celiacs. How well do they understand this and

their knowledge of gluten and especially their knowledge of what foods contain gluten because

it's really an eye opener to see what how many foods out there really contain gluten. So you want

to see where their knowledge is. Then you want to assess their ability to read the food label

especially the ingredients part and a lot of things will have a humongous paragraph of

ingredients and they literally have to look at each ingredient make sure does it contain some

of these things and whenever a parent has a child who has celiacs they have to be really careful

with this. They have to read every food label and you want to show them how to do this because they

don't want to give their child gluten and you got to educate them that they must avoid any foods

with gluten so those villi can grow back and let them know why they need to do this because what's

going to happen in the body and when you avoid eating gluten your intestinal villi are going to

grow back you're going to be absorbing food better you're going to feel better. Now another thing is

as a nurse we're going to be implementing the gluten-free diet. The doctor will order this

so you want to make sure that the patient's food tray has the right food on it and that if family

members are bringing them food that they're not bringing them food that contains gluten because

again there's a lot of things that have hidden gluten in them that you're not really aware that

it has in it so you want to make sure that and administering medications per physician's order

like those supplements to help with those vitamin deficiencies. Now let's go over quickly foods that

don't contain gluten versus foods that do contain gluten and this is a list but you can even take

this even further but for testing purposes and NCLEX let's hit the highlights. Okay so foods

that don't contain gluten that's safe for them to eat any plain meats like your fish your poultry

and your beef anything that has breading the patient needs to stop and think is this wheat

breading what type of breading is this because chances are it's wheat and it has gluten but now

grocery chains and restaurants are really expanding their gluten-free options and they're

using like rice flour, corn flour to bread their things that they can eat which don't contain

gluten so have the patient keep that in mind. Grains that are safe for a patient to have are

like rice they can make rice flour, corn, soy, millet, tapioca, chai, buckwheat and really in

the gluten-free diet nowadays they're taking these grains they're able to produce pasta noodles,

breads, things like that. Cookies make cookies out of that so it can really expand the diet

for the celiac and your plain fruits and vegetables, nuts, beans, legumes, and dairy but

just no malt in the dairy. However I have an asterisk by this because remember patients who

have celiacs they may be lactose intolerant so you want to be super careful with that.

Okay foods with gluten your typical foods that will contain this anything with wheat so watch

out for that don't get buckwheat confused two completely different things but if you see the

word wheat unless it's not in the word buckwheat don't need to have it contains gluten because we

learned that all those proteins make up wheat. Barley, malt, beer, rye, pasta noodles and seasonings

a lot of seasonings have that hidden gluten additive just to give it that thicker consistency

soups especially your canned soups will have wheat in them. Any type of breaded foods unless it's

made with this type of grain and it's usually labeled gluten-free so you want your patients

to really look at the labels to see if it says gluten-free because manufacturers are getting

really good about putting that on there and anything that looks like a bread type thing like

a crouton, crackers, cookies, bread, dough, most of your cereals and oats. Oats themselves really don't

contain gluten but they're processed and they're round items that do contain gluten so they can

become contaminated and so they can eat oats if they're specifically gluten-free oats so keep that

in mind and really let your patients know that most foods that are just processed probably contain

gluten so always look at those food labels very very closely. Okay so that wraps up this lecture

on celiac disease. Thank you so much for watching don't forget to take the free quiz and to subscribe

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