Essay Example on Celiac disease is an autoimmune inflammatory Disorder

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Introduction Celiac disease is an autoimmune inflammatory disorder with predominant intestinal involvement It gets triggered by diet containing gluten 1 Patients may present with wide spectrum of symptoms occurring due to malabsorption that include diarrhea abdominal pain abdominal bloating and weight loss The disease may present as delayed menarche early menopause secondary amenorrhea infertility recurrent abortions and intrauterine growth restriction This disease in females may affect the menstrual and reproductive health This can be prevented by an early diagnosis and treatment Celiac disease is associated with multiple systemic involvements such as gastroenterological neurological ophthalmic pancreatic and other systemic involvement 2 Hence celiac disease should be considered and screening tests should be performed in women presenting with menstrual and reproductive problems and treated accordingly 3 We present a case of celiac disease in pregnancy and its outcome CASE REPORT A 25 year old patient known case of celiac disease came to the antenatal outpatient department at 6 4 weeks of gestation for antenatal registration She had history of one spontaneous abortion At the age of 11 years patient presented with pain in abdomen vomiting and confusion Her blood pressure and pulse were within normal limits Sugars were in the range of 240mg L and urinary ketones were positive which was suggestive of diabetic ketoacidosis Patient was then diagnosed with type 1 diabetes mellitus 



She was managed conservatively with human insulin along with intravenous fluids Since then the patient had regular follow up in endocrinology Patient was continued on insulin and followed diabetic diet Sugars were monitored regularly In 2015 during evaluation for hypothyroidism anti TPO and anti TTG antibodies were found to be positive suggestive of autoimmune thyroiditis Gastroenterologists were consulted for anti TTG positivity Patient was kept on gluten free diet and duodenal biopsy was performed in March 2015 which showed villi with normal architecture and minimal increase in intraepithelial lymphocytes and mild lymphocytic inflammation in lamina propria Repeat biopsy was done four months later after keeping the patient on gluten diet The Villi were found to be of normal architecture there was patchy increase in intraepithelial lymphocytes and moderate lymphoplasmacytic infiltrates with eosinophils This proved that patient had increased intraepithelial lymphocytes and lymphoplasmacytic inflammation when wheat products were taken Hence the patient was diagnosed with silent celiac disease in August 2015 and was advised gluten free diet Patient had a regular follow up in gastroenterology OPD In December 2016 patient conceived spontaneously and got registered at 6 weeks of gestation She was admitted in the antenatal ward for management of deranged sugar levels ranging up to 250mg dl Endocrinologists advised insulin dose adjustment injectable human insulin regular 8 8 8 8 units subcutaneously and Injectable Levimir 0 0 8 units subcutaneously 



Patient was advised SMBG 6 times Tablet thyroxine was continued for hypothyroidism Neurologists were consulted in view of history of hypoglycemic unawareness to the patient No neurological symptoms were found Patient also developed acneiform eruptions over face and upper back which was managed conservatively Daily sugar levels were found to be within normal limits with the insulin dose adjustment Patient got discharged at 7 2 weeks of gestation with controlled sugars She had regular follow up in the OPD and was started on iron calcium and multivitamin tablets from 12 weeks of gestation On 6th June 2017 patient was readmitted at 32 4 weeks of gestation for evaluation polyhydramnios All routine investigations were found to be normal Her hemoglobin valued 10 10 gm percent fasting and postprandial sugars 72mg dl and 147 mg dl respectively Serum TSH was 1 84Miu Ml and glycosylated hemoglobin was 5 8gram percent Patient had received two doses of injection Tetanus toxoid and regular iron and calcium tablets were taken She was on injectable regular insulin 9 7 5 0 units subcutaneous and injectable Levimir 4 0 0 8 units subcutaneous

Ultrasonography was done suggestive of polyhydramnios with AFI 25 USG malformation scan and fetal 2D Echo was done It was found to be within normal limits Ophthalmology faculty was consulted to rule out diabetic retinopathy on 14 June 2016 No evidence of diabetic retinopathy Patient was advised gluten free diet and managed conservatively Two doses of steroids injections were given Blood sugar levels were found to be within normal limit and patient had no chief complaints Hence patient got discharged on 12th of june 2017 Patient got admitted at 38 4 weeks gestation for safe confinement All routine investigations were found to be within normal limits Ultrasonography was found to be normal and there was no intrauterine growth restriction Dinoprostone gel induction of labour was done and baby delivered by full term outlet forceps application in view of fetal distress in second stage of labour She delivered a female child of 3 553 kg with apgar score of 9 10 Baby was shifted to neonatal intensive care unit for HGT monitoring Sepsis screen of the baby was negative Baby was shifted back to mother after 24hrs of sugar monitoring

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