Nursing Assessment, Management and Treatment of Autoimmune Diseases
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Pathophysiology When people with celiac disease ingest gluten, the immune system responds and attacks the cells of the small intestine. Eventually the villi of the small intestine are damaged. Villi are the projections that line the small intestine and facilitate the absorption of protein (Celiac Disease Foundation, n.d.). | NURSING CONSIDERATION Celiac disease cannot be prevented, but adherence to a strict gluten-free diet may stop and reverse small in- testine damage (My Health Alberta, 2021). Figure 2 illustrates the various stages of celiac disease. These stages can be ex- plained as follows (Celiac Disease Foun- dation, n.d.; Goebel, 2019): ● Stage 1 : Pre-infiltrate. There is an increased percentage of intraepithelial lymphocytes (>30%).
● Stage 2 : Infiltrative hyperplastic. This stage is characterized by the presence of inflammatory cells and crypt cell (which act as immunoglobulin receptors) proliferation while preserving the architecture of the villa. ● Stage 3 : Flat destructive. Stage 3 is characterized by villous atrophy progressing from mild to total atrophy. ● Stage 4 : Atrophic hypoplastic. Stage 4 is characterized by total mucosal hypoplasia. | NURSING CONSIDERATION Dermatitis herpetiformis (DH) is an itchy, bumpy rash commonly found in people with celiac disease. DH causes blisters that resemble herpes, but they are associated with celiac disease. The antibody produced by the intes- tines in the presence of celiac disease, called IgA, can enter the bloodstream and accumulate in blood vessels un- der the skin. This causes the DH rash (Nazario, 2020).
Figure 2. Upper Jejunal Mucosal Immunopathology
Note . From Wikipedia Commons, 2020.
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