1. Malabsorption syndrome
Celiac disease

2. Malabsorption syndrome
Chronic diarrhea and Malabsorption of nutrients characterize malabsorption syndrome.
The main complication of Malabsorption syndrome in children is failure to thrive (FTT).
Most cases are classified according to the location of the supposed anatomic or biochemical defect :
a. Digestive defect : in which the enzymes necessary for digestion are diminished or absent (eg CF, billary liver disease, lactose deficiency).

3. Malabsorption syndrome
b. Absorptive defect: in which the intestinal mucosal transport system is impaired eg.:
Celiac disease CD :primary defect .
Ulcerative colitis : secondary defect.
Hirschsprung disease: obstructive disease.
C. anatomic defect: short-bowel syndrome.

4. Celiac disease
Celiac disease: gluten-induced enteropathy: gluten-sensitive enteropathy (GSE): Celiac disease (CD).
CD is childhood & adult disease.
CD more seen in Europe & American (white ) than Asian (black) 1 in 250 individuals (American Association 2001)
CD th exact cause of it is unknown, but there appesrs to be an inherited predisposition with an influence by environmental factors.

5. Celiac disease CD is used to describe four ch-ch:
Steatorrhea (fatty, foul frothy, bulky stools).
General malnutrition.
Abdominal distention.
Secondary vitamin deficiency.

6. Pathophysiology
The disease is characterized by intolerance to the protein gluten, which found in wheat, barley, rye, and oats.
So the patients are unable to digest the gliadin component of gluten, resulting in accumulation of toxic substance that is damaging to the mucosal cells.

7. Clinical manifestation
Clinical manifestation of CD. box p:886
Impaired fat absorption:
Steatorrhea (excessively large , pale, oily, frothy stools).
Exceedingly foul-smelling stools.
Impaired absorption of nutrients: malnutrition, anemia. Anorexia.
Abdominal distention.
Muscle wasting (especially prominent in legs and buttocks).

8. Clinical manifestation
Behavioral changes:
Irritability. Fretfulness.
Uncooperativeness. Apathy.
Celiac crisis: acute, sever episodes of profuse watery diarrhea and vomiting
Infection (especially GE)
Prolonged fluid and electrolyte depletion.
Emotional disturbance.

9. Diagnostic Evaluation
Biopsy of the small intestine: demonstrating the characteristic changes of mucosal inflammation, crypt hyperplasia, and villous atrophy.
Serologic testing: to detect antibodies to connective tissue (reticulin, endomysial) and gliadin. So the presence of antigladin, antireticulin and antiendomysial IgG and IgA antibodies aids in diagnosis.
more specific enzyme tissue transglutaminase (tTG) which has been found to be the autoantigen recognized by antiendomysial.

10. Therapeutic managements
Diet: Gluten-free diet (actually low in gluten) corn and rice become substitute grain foods.
children with untreated CD may have associated lactose intolerance related to intestinal mucosal lesions.
Specific nutritional deficiencies are treated with appropriate supplements& including vitamins, iron, calories.

11. Prognosis Varies among children:
The most serious complication of the disease is Lymphoma, but strict dietary avoidance of gluten prevents symptoms and may minimize the risk of delivery lymphoma.

12. Nursing consideration
The main Ng consideration is helping the child adhere to dietary management:
Explain to the child& the parents the
Disease process.
Restricted food.
Anemia. Gluten effect.
Growth retardation.
Osteomalascia.
The nurse must advise parents to reed carefully all intergradient on labels to avoid hidden source of glutens.

13. Nursing consideration
It is easy to eliminate food (gluten-containing product) from the infant's & young child's diet but in school age child and adolescents are more difficult.
Inform the parents that CD is having risk of developing malignant lymphoma of small intestine or other GI.
Child with sever mucosal damage need to strict also on Lactose product as milk, so need temporary lactose-free diet.

14. Nursing consideration
The management include a diet high in calories and proteins, with simple CHO such as fruit& vegetables, but low in fat
Strict high fiber diet (nuts, raw vegetables, raw fruit with skin). Until inflammation has subsided.
Family support resources to help family cope with this disease.