Celiac Disease

EXPLANATION

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Watery diarrhea. Celiac crisis is a rare but serious complication of celiac disease, particularly in children, characterized by severe and sudden onset of symptoms. It's often precipitated by factors like infections, stress, or inadvertent gluten exposure. During a celiac crisis, there is a marked increase in the severity of symptoms typically associated with celiac disease.

Watery diarrhea is a hallmark of celiac crisis and is caused by the body's reaction to gluten in individuals with celiac disease. The immune response damages the villi in the small intestine, which are responsible for nutrient absorption. When the villi are damaged, the small intestine cannot properly absorb nutrients and fluids, leading to diarrhea.

Imagine the small intestine as a sponge that soaks up nutrients from the food we eat. In celiac disease, eating gluten damages the sponge's structure, making it less effective at absorbing nutrients and water. This is like trying to clean up a spill with a torn sponge — it can't hold onto the liquid, leading to a watery mess, similar to how the damaged intestine can't absorb fluids, resulting in watery diarrhea.

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Lethargy. While lethargy or fatigue can be a symptom of celiac disease due to malabsorption and nutrient deficiencies, it is not as directly indicative of a celiac crisis as watery diarrhea. Lethargy might be present but it's not the most characteristic symptom of a celiac crisis.

Weight gain. Weight gain is not typically associated with celiac crisis. In fact, weight loss or failure to thrive is more common due to malabsorption of nutrients caused by damage to the intestine lining.

Respiratory distress. Respiratory distress is not a symptom directly associated with celiac crisis. While an upper respiratory infection may trigger a celiac crisis, the symptoms of the crisis itself are more related to gastrointestinal distress and malabsorption issues than respiratory function.

EXPLANATION

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Steatorrhea. Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. This damage impairs nutrient absorption and can lead to various symptoms, primarily affecting the gastrointestinal system. One of the hallmark symptoms of celiac disease is steatorrhea, which refers to the excretion of abnormal amounts of fat with the feces, leading to stools that are often foul-smelling, greasy, and bulky. The presence of steatorrhea is due to the malabsorption of fats, a consequence of the damage to the villi in the small intestine. The villi are responsible for nutrient absorption, and when they are damaged, as in celiac disease, the body cannot effectively absorb nutrients, including fats.

Think of the small intestine as a sponge that soaks up nutrients from the food you eat. In celiac disease, it's like the sponge has become hard and brittle (due to damage to the villi), so it can't soak up the nutrients properly. Fat, being one of the nutrients, slips through instead of being absorbed, leading to fatty, greasy stools known as steatorrhea.

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A widened pulse pressure. This is not typically associated with celiac disease. Widened pulse pressure can be indicative of conditions like aortic regurgitation or other cardiovascular issues, not celiac disease.

Stools that are clay-colored. Clay-colored stools are typically a sign of bile duct obstruction or liver diseases like hepatitis. This happens because bile salts from the liver give stool its brown color, and if the liver or bile ducts are not functioning properly, the stool may become pale or clay-colored. This is not a symptom directly associated with celiac disease.

Jaundiced sclera. Jaundiced sclera, or the yellowing of the whites of the eyes, is a sign of jaundice, often associated with liver disease or bile duct obstruction. This symptom occurs due to an accumulation of bilirubin, a byproduct of red blood cell breakdown. While celiac disease can lead to liver abnormalities, jaundiced sclera is not a direct or common symptom of celiac disease.

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A biopsy of the small intestine. The diagnosis of celiac disease typically involves a combination of serologic (blood) tests and an intestinal biopsy, with the biopsy being the gold standard for diagnosis. Here's why a biopsy of the small intestine is considered the standard approach:

When diagnosing celiac disease, healthcare professionals look for damage to the villi in the small intestine. The villi are tiny, finger-like projections that line the small intestine and are responsible for nutrient absorption. In celiac disease, ingestion of gluten leads to an immune-mediated attack on these villi, resulting in their flattening or atrophy, which impairs nutrient absorption.

A biopsy of the small intestine is usually performed during an endoscopic procedure, where a small camera is passed down into the small intestine, and tiny samples of the tissue are taken. These tissue samples are then examined under a microscope to look for changes characteristic of celiac disease, specifically villous atrophy and inflammation.

Think of the small intestine as a lush garden where the villi are like the leaves of plants, absorbing nutrients (sunlight and water) to grow. In celiac disease, eating gluten is like pouring toxic chemicals on the plants – it damages the leaves (villi), making it hard for them to absorb what they need. A biopsy is like taking a closer look at the leaves under a magnifying glass to see if they've been damaged by the chemicals.

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A bone scan: A bone scan is used to detect changes in bones and is not a method for diagnosing celiac disease. However, long-term effects of untreated celiac disease can lead to bone density issues due to malabsorption of calcium and vitamin D, but this is not a diagnostic tool for celiac disease itself.

An MRI: An MRI (Magnetic Resonance Imaging) is an imaging technique used to visualize internal structures of the body in detail. It's not used as a standard method for diagnosing celiac disease, as it does not provide the detailed view of the small intestine's lining necessary to diagnose celiac disease.

A blood pressure test: A blood pressure test measures the pressure in your arteries as your heart pumps and is not related to diagnosing celiac disease.

EXPLANATION

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"Our child must maintain these dietary restrictions lifelong." Celiac disease is a chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. When a person with celiac disease consumes gluten, their immune system responds by damaging the villi of the small intestine, leading to malabsorption of nutrients and a wide range of gastrointestinal and non-gastrointestinal symptoms. The only current treatment for celiac disease is a strict, lifelong adherence to a gluten-free diet. This means avoiding all products containing wheat, barley, rye, and derivatives of these grains.

When the parents say, "Our child must maintain these dietary restrictions lifelong," they demonstrate a correct understanding of the chronic nature of celiac disease and the necessity to adhere to a gluten-free diet indefinitely to manage symptoms and prevent complications.

Think of celiac disease like a severe allergy to gluten. Just as someone with a peanut allergy must avoid peanuts permanently to prevent a reaction, someone with celiac disease must avoid gluten permanently to prevent damage to their intestines and other symptoms.

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"Our child must maintain these dietary restrictions until adulthood." This statement is incorrect because celiac disease does not resolve or diminish with age. The requirement for a gluten-free diet is not limited to childhood or adolescence but is indeed a lifelong commitment.

"We'll follow these instructions until our child’s symptoms disappear." This statement is incorrect as celiac disease is a chronic condition. While symptoms may improve or disappear once a gluten-free diet is started, this does not signify that the disease is cured. Gluten consumption at any time, even without apparent symptoms, can damage the intestine and lead to complications.

"We’ll follow these instructions until our child has completely grown and developed." This statement is incorrect because celiac disease is not outgrown or resolved by physical maturity. The need for a gluten-free diet remains essential throughout the individual’s life to maintain health and prevent disease-related complications.

EXPLANATION

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Hirschsprung disease. Hirschsprung disease is a congenital condition that affects the large intestine (colon) and causes problems with passing stool. It's the result of missing nerve cells in the muscles of part or all of the baby's colon. A newborn who has not passed meconium within the first 24 to 48 hours after birth may have Hirschsprung disease. The absence of these nerve cells causes the muscles in the bowel to lose the ability to move stool through the intestine, leading to a blockage of stool.

Think of the intestine as a highway. In Hirschsprung disease, it's like part of the highway doesn't have the traffic signals (nerve cells). So, the cars (stool) get stuck in a traffic jam because the signals that tell them when to go are missing.

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A defect in the abdominal wall. A defect in the abdominal wall, such as gastroschisis or omphalocele, involves the intestines or other abdominal organs protruding outside the body. While these are serious conditions that require immediate medical attention, they are not typically associated with a failure to pass meconium unless there is associated intestinal obstruction or damage.

Celiac disease. Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley, and rye. It primarily affects the small intestine and is not usually a condition diagnosed in newborns, as symptoms typically appear in later infancy or early childhood and are related to the ingestion of gluten.

Intussusception. Intussusception is a condition in which part of the intestine telescopes into itself, leading to an intestinal blockage. It is most common in infants and young children and can lead to symptoms such as abdominal pain and swelling, vomiting, and the passage of blood or, in some cases, a currant jelly-like stool. While it can cause an obstruction, it is not typically associated with a failure to pass meconium in the first 24 hours of life.

EXPLANATION

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 Rice. Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. Gluten is a protein found in wheat, barley, and rye. When someone with celiac disease consumes gluten, their body mounts an immune response that attacks the small intestine, leading to damage to the villi, small fingerlike projections that line the small intestine and promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.

In the context of celiac disease, the dietary management is primarily focused on avoiding gluten-containing foods. Rice is a safe option for individuals with celiac disease as it is naturally gluten-free. It does not contain gluten protein, making it a suitable carbohydrate source for children with celiac disease. Rice can be an important part of the diet, providing essential nutrients and energy without causing an immune response.

Think of the small intestine as a fluffy carpet with lots of tiny bristles (villi) that help catch and absorb nutrients from food. In celiac disease, eating gluten is like walking on this carpet with muddy boots (immune response), flattening and damaging the bristles, making it hard for the carpet to do its job. Rice is like walking on the carpet with clean slippers – it doesn’t cause damage and allows the carpet to stay fluffy and do its job properly.

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White bread. White bread is typically made from wheat, which contains gluten. Therefore, it is not suitable for a child with celiac disease as it can trigger the immune response and damage the lining of the small intestine.

Rye toast. Rye is another grain that contains gluten, similar to wheat and barley. Consuming rye, even in the form of toast, can lead to the same harmful effects on the small intestine as other gluten-containing grains in individuals with celiac disease.

Oatmeal. Oats themselves are naturally gluten-free, but they are often cross-contaminated with wheat during growing, harvesting, or processing. Some individuals with celiac disease may also react to a protein in oats called avenin. While pure, uncontaminated oats may be tolerated by most individuals with celiac disease, it's generally advised to introduce them into a gluten-free diet with caution and under medical supervision.

EXPLANATION

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Wheat. Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. Gluten is a protein found in wheat, barley, and rye. Consuming gluten, even in small amounts, can trigger an immune response that damages the lining of the small intestine and prevents absorption of some nutrients (malabsorption). This damage often causes stomach pain, bloating, diarrhea, and can lead to serious complications if not managed properly.

When Nurse Martinez advises the parents to ensure Lucas avoids wheat, she is directly addressing the need to eliminate the primary source of gluten from his diet. This is crucial for managing celiac disease and preventing the associated symptoms and complications.

Think of gluten in someone with celiac disease as a wrong key inserted into a lock. Just as the wrong key can damage the lock's mechanism, gluten can damage the lining of the small intestine in celiac disease. Just as you would avoid using the wrong key to prevent damage to the lock, patients with celiac disease need to avoid gluten to prevent damage to their intestines.

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Milk. Milk and dairy products do not contain gluten, and they are typically safe for individuals with celiac disease unless they have a coexisting lactose intolerance or a milk allergy. Therefore, advising to avoid milk is not directly related to the management of celiac disease.

Rice. Rice is a gluten-free grain and is considered safe for individuals with celiac disease. It can be a good part of a gluten-free diet, providing essential nutrients and energy.

 Chicken. Chicken is naturally gluten-free and is safe for individuals with celiac disease, as long as it is not prepared with ingredients that contain gluten, such as certain marinades, breading, or sauces.

EXPLANATION

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All of the choices. Celiac disease is a multifaceted autoimmune disorder that can affect various parts of the body, not just the digestive system. It is known for a wide range of symptoms, and different individuals may experience different sets of symptoms, which can make diagnosis challenging. The symptoms mentioned in the options are indeed associated with celiac disease:

• Excessive gas: This is a common gastrointestinal symptom associated with celiac disease. When a person with celiac disease consumes gluten, it can lead to damage of the villi in the small intestine. This damage impairs the absorption of nutrients and can lead to malabsorption, which in turn can cause excessive gas formation as well as bloating and discomfort.
• Joint pain: Celiac disease is an autoimmune condition, and like other autoimmune diseases, it can lead to systemic inflammation. This inflammation can manifest in different parts of the body, including the joints, leading to pain and discomfort. Joint pain in celiac disease is not the most prominent symptom but can be a part of the array of non-digestive symptoms that some individuals experience.
• Diarrhea: This is one of the classic symptoms of celiac disease, particularly in its classic presentation. The damage to the intestinal villi caused by an immune response to gluten can lead to malabsorption of nutrients and fats, which often results in diarrhea. The stools may be loose, bulky, and more frequent.

You can think of celiac disease like a bad software glitch in a highly versatile smartphone. Just as the glitch might cause trouble in various apps or functions of the phone (digestive symptoms like gas or diarrhea, or systemic symptoms like joint pain), celiac disease can cause a range of symptoms throughout the body, not just in the digestive system.

While these symptoms can be associated with celiac disease, it's important to note that they can also be indicative of other health conditions. A proper diagnosis typically involves blood tests for specific antibodies and a biopsy of the small intestine to look for damage to the villi.

EXPLANATION

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A cheese omelet. Celiac disease requires strict adherence to a gluten-free diet to prevent immune-mediated damage to the intestines. Gluten is a protein found in wheat, barley, and rye, and thus, foods containing these grains should be avoided.

A cheese omelet is typically made from eggs and cheese, both of which are naturally gluten-free. It's a safe choice for someone with celiac disease, assuming no gluten-containing ingredients are added during preparation.

Imagine gluten as a "no-entry" sign for someone with celiac disease. In a food world, the cheese omelet is like a safe playground with no "no-entry" signs, where the child can enjoy without any worries.

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 A hamburger with ketchup. A typical hamburger bun is made from wheat, which contains gluten. Even if the hamburger is served without a bun, cross-contamination with gluten-containing products must be considered unless the kitchen is strictly gluten-free.

 Spaghetti and meatballs. Traditional spaghetti is made from wheat, which contains gluten. The meatballs might also contain breadcrumbs or other binders that are not gluten-free.

 A ham sandwich on whole-wheat toast. Whole-wheat toast is made from wheat, a primary source of gluten, making this option unsuitable for someone with celiac disease.

EXPLANATION

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All of the choices. Celiac disease is a complex autoimmune disorder that occurs in genetically predisposed individuals. It involves an immune-mediated reaction to dietary gluten (found in wheat, barley, and rye), leading to inflammation and damage in the lining of the small intestine. However, not all individuals with genetic susceptibility develop celiac disease, suggesting that environmental factors also play a crucial role in its onset. Several triggers have been proposed to potentially activate celiac disease in genetically predisposed individuals:

• Pregnancy: Pregnancy can be a trigger for the onset of celiac disease. The significant hormonal changes and immune system adaptations that occur during pregnancy might trigger its onset or exacerbate existing symptoms. Some women experience their first symptoms of celiac disease during or shortly after pregnancy.
• A viral infection: There is evidence to suggest that certain viral infections might trigger the onset of celiac disease in genetically predisposed individuals. For instance, infections with enteroviruses or reoviruses have been implicated in the development of the disease. The theory is that these infections may alter the gut environment or immune response, leading to an inappropriate immune reaction to dietary gluten.
• Emotional stress: While emotional stress is not a direct cause of celiac disease, it can be a triggering factor for the onset of symptoms in predisposed individuals. Stress can affect the body in numerous ways, including altering gut motility and permeability, and possibly triggering an immune response that could contribute to the onset of celiac disease in genetically susceptible individuals.

Think of celiac disease like a dormant volcano on an island (the genetically predisposed individual). The volcano may stay dormant for years, but certain events (like an earthquake (pregnancy), a storm (viral infection), or a sudden change in pressure (emotional stress)) might trigger the volcano to erupt (activation of celiac disease). While not all volcanoes will erupt due to these triggers, those with certain underlying conditions are more likely to do so.

It's important to note that while these factors can trigger the onset of celiac disease, the underlying cause is a combination of genetic predisposition and the ingestion of gluten. The exact mechanism by which these triggers may lead to the development of celiac disease is not fully understood and is likely multifactorial and individual-specific.

EXPLANATION

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A change in diet. The mainstay of treatment for celiac disease is a strict lifelong adherence to a gluten-free diet. This approach is crucial for managing symptoms, promoting intestinal healing, and preventing complications associated with the disease. Gluten is a protein found in wheat, barley, rye, and triticale. When a person with celiac disease consumes gluten, their immune system responds by damaging the villi of the small intestine, leading to malabsorption of nutrients and a wide array of potential symptoms and complications.

By removing gluten from the diet, the immune response is halted, the inflammation in the intestine subsides, and the villi can heal. This allows for the proper absorption of nutrients and can lead to the resolution of symptoms and prevention of disease-related complications.

Think of celiac disease like a skin allergy to a specific fabric. If you wear a sweater made of this fabric, you'll get a rash (immune reaction). The only way to stop the rash and prevent further skin damage is to stop wearing the sweater (remove gluten from the diet), not just treat the rash itself. Just as the skin heals when it's no longer in contact with the irritant, the intestines can heal when they're no longer exposed to gluten.

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Surgery: Surgery is not a treatment for celiac disease. The disease is managed through dietary changes rather than surgical intervention.

Antibiotics: Antibiotics are used to treat bacterial infections and have no role in the treatment of celiac disease, which is an autoimmune disorder, not a bacterial infection.

Radiation therapy: Radiation therapy is a treatment that uses high doses of radiation to kill cancer cells and shrink tumors. It is not applicable to celiac disease, which is an autoimmune condition, not a form of cancer.

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A Rice Krispies bar with milk. Celiac disease is an autoimmune disorder where individuals cannot tolerate gluten, a protein found in wheat, barley, and rye. Consuming gluten can damage their small intestine and prevent the absorption of some nutrients. Therefore, it is crucial for individuals with celiac disease to avoid gluten-containing foods.

A Rice Krispies bar with milk is generally considered safe for individuals with celiac disease, assuming the bar is made with gluten-free Rice Krispies. It's essential to note that while traditional Rice Krispies contain malt flavoring, which is derived from barley (a source of gluten), there are gluten-free versions available. Milk is naturally gluten-free and safe unless there's a coexisting lactose intolerance.

Think of gluten as a red light for someone with celiac disease. Foods containing wheat, barley, or rye have this "red light" and must be avoided. Rice, on the other hand, is like a green light, safe to "go" unless processed or mixed with gluten-containing ingredients.

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Toast with jam and apple juice. This meal is not suitable because toast is typically made from wheat bread, which contains gluten. While jam and apple juice are gluten-free, the toast makes this option unsafe for someone with celiac disease.

Peanut butter cookies with milk. Peanut butter cookies are usually made with wheat flour, which contains gluten. Even if the milk is gluten-free, the cookies make this meal inappropriate for someone with celiac disease.

Wheat bread with butter. Wheat bread is a direct source of gluten and should be avoided by individuals with celiac disease. Butter is gluten-free, but the wheat bread disqualifies this option.

EXPLANATION

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All of the choices. Celiac disease, if not managed properly through a strict gluten-free diet, can lead to several long-term complications. This is due to the chronic inflammation and malabsorption of nutrients associated with ongoing intestinal damage. The complications mentioned in the options can all be associated with celiac disease:

• Lymphoma: Individuals with celiac disease have an increased risk of developing certain types of cancer, especially lymphoma, which is a cancer of the lymphatic system. The risk is particularly heightened for a type called Enteropathy-associated T-cell lymphoma (EATL), which is a rare and often aggressive form of non-Hodgkin lymphoma. The exact reason for this increased risk is not entirely clear, but it's thought to be related to the chronic inflammation in the intestine.
• Osteoporosis: Osteoporosis, a condition characterized by weak and brittle bones, is a common complication of celiac disease. This is largely due to malabsorption of calcium and vitamin D caused by damage to the small intestine's villi. These nutrients are essential for bone health, and their deficiency can lead to decreased bone density and increased risk of fractures.
• Seizures: While less common, seizures can be a complication of celiac disease, often associated with a condition known as cerebral calcification. This is a condition where calcium deposits build up in the brain, potentially leading to seizures. The exact mechanism is not fully understood but may be related to malabsorption of certain nutrients, such as folic acid, that are important for neurological function.

Think of the small intestine as a nutrient delivery system and the body as a house with various rooms (organs and systems). If the delivery system is damaged (as in celiac disease), essential supplies (nutrients) don't get delivered properly. Over time, this can lead to problems in various rooms, like the structure weakening (osteoporosis), the electrical system malfunctioning (seizures), or even critical systems breaking down (lymphoma).

It's important to note that while these complications are serious, adherence to a strict gluten-free diet can significantly reduce the risk of developing these and other complications associated with celiac disease.

EXPLANATION

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Grains, especially wheat, rye, and barley. Celiac disease is an autoimmune condition characterized by an inappropriate immune response to gluten, a protein found in certain grains. When individuals with celiac disease consume gluten, their immune system responds by damaging the villi of the small intestine, small fingerlike projections that are crucial for nutrient absorption. This impairs the body's ability to absorb nutrients effectively.

Nurse Martinez should emphasize that grains, especially wheat, rye, and barley, are problematic for people with celiac disease because these grains contain gluten. These grains and their derivatives should be avoided as even small amounts of gluten can trigger symptoms and intestinal damage. The focus should be on maintaining a strict gluten-free diet to manage the condition effectively and prevent complications.

You can think of gluten in celiac disease like a key that fits into a lock (the immune system of someone with celiac disease). When the key (gluten) fits into the lock (the immune system), it triggers an alarm (immune response) causing damage (to the villi in the small intestine). Grains like wheat, rye, and barley are like keychains full of these specific keys, so they should be avoided to prevent setting off the alarm.

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Peanuts and nuts. Peanuts and nuts are generally gluten-free and safe for individuals with celiac disease unless contaminated with gluten-containing grains during processing or packaging. They are not inherently problematic for people with celiac disease and are a good source of protein and healthy fats.

Fruits, especially strawberries. Fruits, including strawberries, are naturally gluten-free and are generally safe for individuals with celiac disease. They are an important part of a balanced diet and provide essential vitamins, minerals, and fiber.

Dairy products, especially milk. While some individuals with celiac disease may initially have lactose intolerance due to damage to the small intestine (where lactase, the enzyme that breaks down lactose, is produced), dairy products themselves do not contain gluten. After the intestine heals on a gluten-free diet, many people with celiac disease can tolerate dairy products again. However, it's important to check for any added ingredients in flavored or processed dairy products that might contain gluten.

EXPLANATION

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All of the listed conditions. Celiac disease is a chronic autoimmune disorder that primarily affects the small intestine but can have systemic implications. When individuals with celiac disease consume gluten—a protein found in wheat, barley, and rye—their immune system responds by damaging the villi of the small intestine. This hampers nutrient absorption and can lead to various complications.

There is a well-established link between celiac disease and several other autoimmune disorders. Individuals with celiac disease are at a higher risk of developing other autoimmune conditions due to common genetic predispositions and the mechanism of molecular mimicry, where the immune system mistakenly attacks the body's own tissues, thinking they are foreign, similar to gluten.

1. Type 1 Diabetes: Type 1 diabetes is an autoimmune condition where the pancreas produces little or no insulin. There is a genetic overlap between celiac disease and type 1 diabetes, and the presence of one condition increases the risk of the other. Research indicates that about 5% to 10% of people with type 1 diabetes also have celiac disease.
2. Rheumatoid Arthritis: Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammation of the joints. The association between RA and celiac disease is due to shared genetic factors and similar autoimmune pathways. While not as strong as the link with type 1 diabetes, the prevalence of celiac disease in patients with RA is higher than in the general population.
3. Autoimmune Thyroid Disease: This includes conditions like Hashimoto's thyroiditis and Graves' disease. The thyroid gland is affected, leading to under or over-production of thyroid hormones. The link between celiac disease and autoimmune thyroid disease is one of the most common and well-documented. Both conditions share a common genetic predisposition, and the prevalence of autoimmune thyroid disease in those with celiac disease is significantly higher than in the general population.

Think of the immune system as a security system for the body, designed to protect against external threats. In autoimmune conditions like celiac disease, the security system becomes overly sensitive and starts to mistakenly identify normal parts of the body (like the small intestine, or in the case of other autoimmune conditions, the pancreas, joints, or thyroid gland) as threats, leading to a series of reactions that cause damage and affect the body's normal functions.

In celiac disease, the ingestion of gluten leads to an immune-mediated attack on the small intestine's villi, impairing nutrient absorption. This chronic inflammatory state and genetic predisposition make the body more susceptible to other autoimmune conditions, where similar mechanisms of immune dysregulation occur. In type 1 diabetes, the immune system attacks pancreatic beta cells; in rheumatoid arthritis, it targets the synovial joints; and in autoimmune thyroid diseases, it affects the thyroid gland.

✘Incorrect answer options:

Type 1 diabetes., Rheumatoid arthritis. & Autoimmune thyroid disease. These options are incorrect individually because, while each condition is associated with celiac disease, the question asks for all conditions Lisa is at risk for, making "All of the listed conditions" the most comprehensive and accurate choice.