Is a mal-absorption disease of the proximal small intestine , that is characterized by abnormal mucosa with permanent intolerance to gluten .
Etiology :1. unknown .
2. genetics .
3. toxic .
4. allergic .
Altered physiology :
Characteristics of the disease include :- Impaired intestinal absorption .
- Histological abnormalities of small intestine .
- Clinical and histological improvement with gluten-free diet .
- Recurrence of clinical manifestations and histological changes after reintroduction of dietary gluten .
Histological changes :- Loss of normal villous pattern .
- Obliteration of intervillous spaces .
- Loss of epithelial cell brush border .
These changes result in disaccharide deficiency , inability to absorb fates , fat-soluble vitamins , minerals and some proteins and carbohydrates .
Mal-absorption result from decreased area of absorption .
Clinical manifestations :- Diagnoses is most commonly made at 6-24 months of age ( it can be made in adult .
- Chronic or recurrent diarrhea ( foul . bulky , and greasy stool ) .
- Anorexia , vomiting , abdominal distention , muscle wasting and hypotonia .
- Steatorrhea .
- Malnutrition .
- Weight loss and dehydration .
- Mood changes ( irritability and nervousness ) .
- Secondary deficiencies such as anemia , hypocalcaemia and hypoproteinemia .
Diagnostic evaluations :- History and general status .
- Small bowel biopsy .
- D-xylose test ( less than 20-25mg/dl at 60 minute ) .
- Hb level .
- Stool test ( fecal fat excretion ).
- Sweet test ( to rule out cystic fibrosis ) .
- X-ray .
Treatment :- Lifelong gluten free diet .
- Adequate caloric intake .
- Supplemental vitamins .
- Decreased fat intake .
Treatment of celiac crisis :-1. Restore fluid and electrolyte balance .
2. Parenteral hyperalimination .
3. Steroids .