Celiac Disease

1. Big picture

Celiac disease is an immune-mediated enteropathy triggered by gluten in genetically predisposed children. It damages the small intestinal mucosa, causing malabsorption, but the presentation in children is often much broader than diarrhea.

For the exam, think:

Gluten exposure
↓
immune reaction in genetically susceptible child
↓
villous atrophy in proximal small intestine
↓
malabsorption
↓
diarrhea, abdominal distension, failure to thrive, anemia, short stature, delayed puberty, abnormal liver enzymes

The examiner wants you to know that celiac disease is not only a gastrointestinal disease. It may present with iron deficiency anemia, poor growth, delayed puberty, recurrent abdominal pain, or fatigue even without diarrhea.

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