1. step 11
1.1. Review and evaluate
1.2. Group members
1.2.1. algain
1.2.2. moayyasar
1.2.3. turkustani
1.2.4. maqati
1.3. Chairman
1.4. Scribe
1.5. Tutor
1.6. Material
1.7. 10 minutes
2. Step 9
2.1. Review session 2
2.2. mechanism flow chart
2.3. 20 minutes
3. Step 10
3.1. Management
3.1.1. goal of management
3.1.1.1. enhance the healing of the GI tract
3.1.1.2. reduce the symptoms
3.1.1.3. improve quality of life
3.1.1.3.1. prevent complication
3.1.1.3.2. restore thee normal GI function
3.1.1.4. lifestyle modification
3.1.2. in some cases, refractory disease may occur .. those managed by corticosteroids
3.1.2.1. repeat the biopsy after one year
3.1.3. diet
3.1.3.1. Vitamins and minerals supplement
3.1.3.1.1. folate
3.1.3.1.2. iron
3.1.3.1.3. Vit. D,K
3.1.3.1.4. calcium
3.1.3.1.5. vit. B12
3.1.3.2. gluten-free diet
3.1.3.2.1. they may have lactose intolerance if they cont' having gluten
3.1.3.2.2. family should be educated
3.1.3.2.3. not complete absence but to decrease the intake to less than 20mg\kg
3.1.3.2.4. educate the patient about the gluten containing food such as pasta and bread
3.1.3.2.5. tight control is needed if there is remission
3.1.3.2.6. the protein can is not essential for the body
3.1.3.2.7. refer to dietitian
3.1.3.2.8. Oats can be used as a substitute .. but should be monitored ... other sources for Carbs other than breads like rice should be recommended
3.1.3.2.9. aware the patient of gluten contamination
3.1.3.2.10. we should make sure of the diagnosis if the symptoms persist after the gluten free diet
3.1.3.2.11. fibers should be giving .. to prevent constipation caused by fibers deficiency
3.2. Prevention
3.2.1. primary
3.2.1.1. no actual prevention
3.2.2. secondary
3.2.2.1. screening
3.2.2.1.1. may leads to over diagnosis of the disease
3.2.2.1.2. high risk people such as those with family history or have other autoimmune disease should be screened
3.2.3. tertiary
3.2.3.1. education about the importance of gluten free diet