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Reply to classmates’ post. At least 125 words each and 1 scholarly reference for each within last 5 years
POSt 1
Celiac disease is an autoimmune disease caused by the ingestion of gluten. Classically, it presents with diarrhea and failure to thrive within the first couple of years of life. Diagnosis is based on abnormalities of small intestinal biopsy. However, screening for celiac disease can be initially performed using serologic markers with very high sensitivity and specificity for disease such as IgA antibodies to tissue transglutaminase (TG). With the advent of rapid screening methods and increased awareness of celiac disease, an increasing number of individuals who are otherwise asymptomatic (or have subclinical symptoms) are being diagnosed. The clinical manifestations of celiac disease that have been identified are extensive and varied and are no longer isolated to the gastrointestinal tract. Celiac disease has been associated with many other autoimmune conditions including autoimmune thyroid disease and type 1 diabetes (Barker& Liu,2008).
The classic presentation with failure to thrive, malnutrition, diarrhea, abdominal pain and distension within the first couple of years of life represents the tip of what is commonly referred to as the celiac disease iceberg (Barker& Liu,2008).
In contrast to the dramatic presentation noted typically in younger children, many patients with celiac disease present at a later age with subtle symptoms and the diagnosis of celiac disease may be delayed. Gastrointestinal symptoms may include abdominal pain, diarrhea or constipation, bloating, and excessive gas. Avoidance of foods containing gluten may also occur and a careful diet history is necessary to identify this symptom. Vitamin deficiencies due to fat malabsorption can also occur. With longer-standing disease, patients may present with profound vitamin D deficiency resulting in rickets or hypocalcemia and tetany or coagulopathy secondary to vitamin K deficiency. Anemia secondary to iron and/or folate deficiency is also observed (Barker& Liu,2008).
Patient education: Patients can’t tolerate gluten and they can control the disease by taking gluten out of the diet. A dietitian can tell them how to follow a gluten-free diet, and many cookbooks have gluten-free recipes. Most foods made from grains contain gluten. (American Family Physician, 2015). Patients should avoid the following foods unless they’re labeled as gluten-free or made with corn, rice, soy, or other gluten-free grain: Breads, cereals, pasta, cookies, cakes, gravies and sauces (American Family Physician, 2015).
POST 2
Docusate
Docusate is a stool softener utilized to remedy or prevent occasional constipation and diminish pain or rectal damage created by hard stools or straining during bowel movements. Docusate use is primarily for the prevention of constipation by promoting the incorporation of water into the stool, resulting in softer fecal mass. It may also promote electrolyte in water secretion into the colon, thereby softening the stool (Wells, Schwinghammer, DiPiro, et al., 2017). According to Vallerand, Sanoski, & Deglin (2017), small amounts of this medication “may be absorbed from the small intestine after oral administration absorption from the rectum is unknown (Vallerand, Sanoski, & Deglin, 2017).” Docusate is for short term use only and may take up to one to three days to work. Long-term use of the medication may result in electrolyte imbalance and dependency.
Monitoring
One should monitor the patient for hypersensitivity, severe abdominal pain, nausea, vomiting, especially when associated with fever or any sign of an acute abdominal event. Additionally, one must assess sudden changes in bowel habits over the preceding weeks. Also, avoid administering docusate within two hours of other laxatives, especially mineral oil, because of the potential for mineral oil absorption.
Side Effects/ Adverse Reactions
Stomach pain, diarrhea, or cramping may occur. Irritated throat (with liquid or syrup forms) may also occur. A serious allergic reaction to docusate is unlikely, but one should contact their care provider or seek immediate medical attention if it occurs. However, if symptoms of an allergic reaction (hypersensitivity) that may occur include rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, and trouble breathing. Moreover, one should decrease their dose or stop taking this medication if diarrhea occurs.
Interactions
There are no significant interactions noted in this medication’s use, and it is generally considered safe in pregnancy.
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