Which clinical manifestations would the nurse be alert to when assessing a child for the presence of celiac disease? Select all that apply.

Choice A rationale Steatorrhea, which is the presence of pale, bulky, greasy, and foul-smelling stools, is a classic sign of celiac disease. This occurs because the damaged villi in the small intestine, caused by gluten exposure, cannot properly absorb fat, leading to excessive fat content in the feces due to malabsorption. Choice B rationale A thin, drawn face is a manifestation of general malnutrition, which is a common consequence of chronic malabsorption caused by celiac disease. The inability to absorb essential nutrients, fats, and calories due to damaged intestinal lining results in a failure to thrive and muscle wasting, particularly noticeable in the face. Choice C rationale Iron-deficiency anemia is highly prevalent in clients with celiac disease. The inflammation and damage to the proximal small intestine (duodenum) impair the absorption of dietary iron, leading to chronic iron loss and subsequent microcytic, hypochromic anemia. This is a frequent presenting sign of celiac disease. Choice D rationale Distended abdomen is a common physical finding in children with celiac disease due to impaired absorption, leading to fluid retention and gas accumulation within the bowel. The combination of muscle wasting in the extremities and a distended abdomen contributes to the characteristic appearance of a child with untreated celiac disease. Choice E rationale Chronic diarrhea, often alternating with periods of constipation, is a primary gastrointestinal symptom of celiac disease. The presence of unabsorbed nutrients and bile salts in the colon causes an osmotic and secretory effect, leading to increased water content and frequency of stools, contributing to significant fluid loss. Choice F rationale Hyperalbuminemia, an abnormally high level of albumin (normal range 3.5 to 5.0 g/dL), is not a clinical manifestation of celiac disease. On the contrary, chronic malnutrition and malabsorption can lead to hypoalbuminemia (low albumin) due to poor protein absorption and potential protein-losing enteropathy.