Doença

Celíaca
UC: Patologia do Sistema Digestivo -
Gastroenterologia
Prof Dr. Francisco Portela

Bárbara Santos | Gonzalo Gil | Karyna Chornenka | Naira Gomes | Teresa

 CONTEÚDOS A ABORDAR

01 02 03
SOBRE A DOENÇA PATOGÉNESE DIAGNÓSTICO
Introdução Patogénese, sinais e Triagem de casos,
sintomas clínicos, fatores de hemograma e imagiologia
risco e prevalência

04 05 06
TRATAMENTO CASOS CLÍNICOS CONCLUSÕES
Tratamento e prevenção Prevenção e
recomendações
 01 SOBRE A
DOENÇA
Doença Celíaca:
intolerância permanente
ao glúten
1
Doença autoimune que causa
intolerância permanente ao glúten
Resposta inflamatória do
sistema imunológico
2
Lorem ipsum dolor sit amet, consectetur
adipiscing elit, sed do eiusmod tempor. Donec
facilisis lacus eget mauris.
Lesões Intestinais
3
Lorem ipsum dolor sit amet, consectetur adipiscing
elit, sed do eiusmod tempor. Donec facilisis lacus
eget mauris.
 02
PATOGÉNESE
 02 PATOGÉNESE
Mucosa com microvilosidades atrofiadas
(DC)

O GLÚTEN é uma proteína presente no trigo, centeio, malte e

cevada. A sua ingestão desencadeia uma reação inflamatória da
mucosa e submucosa intestinal:

❏ Resposta imunológica local à presença do antigénio (glúten)

❏ Formação de infiltrado inflamatório na lâmina própria
❏ Atrofia vilosa e perda de profundidade das criptas de Lieberkuhn
❏ Aumento de células intraepiteliais e hiperplasia das criptas
Mucosa com microvilosidades normais
 SINTOMAS DA DOENÇA CELÍACA

UNEXPECTED WEIGHT LOSS HEADACHES INFERTILITY

Despite being red, Mars is Mercury is the smallest planet in Saturn is a gas giant, composed
actually a cold place our Solar System mostly of hydrogen and helium

NUMBNESS & TINGLING IN

LEGS STOMACH & MUSCLE CRAMPS CHRONIC DIARRHEA

Venus has a beautiful name, but Neptune is the farthest planet from Jupiter is a gas giant and the
it’s very hot the Sun biggest planet in our Solar System
 TIPOS DE DOENÇA E SINTOMATOLOGIA

CLÁSSICA ATÍPICA ASSINTOMÁTICA

Síndrome de Má Absorção: Crise celíaca: diarreia aquosa, barriga Ausência de

inchada, desidratação e hipotensão sintomas (mas)
diarreia crónica e/ou
esteatorreia, flatulência, Sintomas da clássica entre Lesões
cólicas abdominais, anorexia; intestinais!
Outros:
Anemia ferropénica ou Ginecológicos: amenorreia; infertilidade;
megaloblástica (déf. ácido menopausa precoce; aborto expontâneo; parto
fólico e/ou vit. B12); prematuro
Osteopenia (déf. ca2+ e Psiquiátricos: depressão, ansiedade;
vitaminas; Neurológicos: epilépsia, autismo
Sangramentos (déf. vitamina Dentários: estomatite aftosa, defeitos no esmalte
K) Reumáticos: artralgia, neuropatia periférica
Qual é a diferença entre sensibilidade ao glúten
(SGNC) e doença celíaca?
 ETIOLOGIA

FATORES FATORES AMBIENTAIS -

FATORES GENÉTICOS IMUNOLÓGICOS ADQUIRIDOS

Despite being red, Mars is a Jupiter is a gas giant and the Venus has a beautiful name
cold place. The planet is full biggest planet in our Solar and is the second planet from
of iron oxide dust System the Sun
 FATORES DE RISCO
20
30 % 5%
25
10
% %
%

10
%

DOWN CELIAC AUTOIMMUNE ADDISON’S MICROSCOPIC TYPE 1

SYNDROME DISEASE THYROIDITIS DISEASE COLITIS DIABETES
 PREVALÊNCI
A Doença Celíaca é uma doença largamente A
subdiagnosticada que merece ser rastreada
caso a pessoa tenha alguns dos sintomas
referidos

Europa: 1% população (1:200)

Portugal: 1-3% população (1:134)
Diagnósticados: 10.0000 celíacos

Estima-se que existam entre 70.000 a 100.000 celíacos por diagnosticar em Portugal
 03
DIAGNÓSTI
CO
You could enter a subtitle
here if you need it
 DIAGNÓSTICO

Jupiter is a gas giant Neptune is the fourth- Venus has a beautiful Saturn is the ringed
and the biggest planet largest planet in our name and is the second one. It’s a gas giant,
in our Solar System Solar System planet from the Sun composed of hydrogen

TESTES ENDOSCOPIA + HEMOGRAMA OUTROS

GENÉTICOS BIÓPSIA DUODENAL
 DIAGNÓSTI
CO

EDA + BIÓPSIA IMUNOFENOTIPAGEM

DUODENAL

Alelo HLA
DQ2

Biópsia Endoscopia Marcadores Tipagem HLA

Alelo HLA
DQ8

Anticorpos Anticorpos antigliadina

Anticorpos
antitransglutaminase (AGA IgA)
Classificação Histológica: Imunohistoquímica antiendomísio (EMA)
tecidual (anti-tTG IgA)
- MARCH
- Outras! (ver)
CD2+ CD3+
70-90% células T
CD8+
ENDOSCOPIA DIGESTIVA

Marcadores endoscópicos de doença celíaca:

A. Pregas Escalonadas “scalloping” (aparência
nodular das pregas duodenais)
B. Padrão em Mosaico “cobblestone” (aparência
micronodular da superfície da mucosa)
C. Micronodularidade
D. Redução ou ausência de pregas duodenais, com
presença de fissuras, sulcos ou ranhuras nas
mucosas
E
BIÓPSIA: Classificação de
MARCH
Lesões da Mucosa Intestinal clássicas:

● Aumento de linfócitos intraepiteliais (IEL)

● Aumento da celularidade na lâmina própria
● Danos nos enterócitos
● Atrofia das vilosidades / hiperplasia de
criptas
FLUXOGRAMA DE DIAGNÓSTICO DA DC
 Triagem para doença celíaca

GLUTEN
CELIAC IRRITABLE
INTOLERANC
DISEASE BOWEL
E

Gluten-free diet

Extraintestinal manifestations

Related autoimmune diseases

 04
TRATAMENT
O
You could enter a subtitle
here if you need it
 TRATAMENTO E PREVENÇÃO

Jupiter is a gas giant Neptune is the fourth- Venus has a beautiful Saturn is the ringed
and the biggest planet largest planet in our name and is the second one. It’s a gas giant,
in our Solar System Solar System planet from the Sun composed of hydrogen

MEDICAL ALTERNATIV AVOID GLUTEN-

TESTS E DIET CROSS- FREE
CONTAMINAT PRODUCTS
ION
TRATAMENTO

Mercury is the closest planet to the Sun

and the smallest one in the Solar System
—it’s only a bit larger than our Moon.
The planet’s name has nothing to do with
the liquid metal, since it was named after
the Roman messenger god, Mercury
05 CASOS
CLÍNICOS
CASO 1
(quadro “This is a quote. Words full of wisdom
típico) that someone important said and can
make the reader get inspired.”
—SOMEONE FAMOUS
CASO 2
(quadro “This is a quote. Words full of wisdom
atípico) that someone important said and can
make the reader get inspired.”
—SOMEONE FAMOUS
 06
CONCLUSÕE
S
You could enter a subtitle
here if you need it
 RECOMMENDATIONS

01 02
Neptune is the fourth-largest Venus has a beautiful name, but
planet in our Solar System and the it’s terribly hot, even hotter than
farthest from the Sun Mercury

03 04
Jupiter is a gas giant and the Saturn is the ringed planet. It’s a
biggest planet in our Solar System gas giant, composed mostly of
hydrogen and helium
 CONCLUSIONS

A
Jupiter is a gas giant and the biggest planet in our
Solar System. It’s also the fourth-brightest object
in the sky

B
Despite being red, Mars is actually a cold place.
It’s full of iron oxide dust, which gives the planet
its reddish cast
THANKS
!
Does anyone have any questions?

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yourcompany.com

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 REFERENCES

AUTOR YEAR TITLE PUBLISHER

Jessica Doe 2001 Mars Publisher 1

Paul Roe 2002 Venus Publisher 2

Timothy Martin 2003 Jupiter Publisher 3

ALLERGIES ICONS
ALTERNATIVE RESOURCES
 RESOURCES

PHOTOS

● Close-up golden wheat spices

● Close-up golden wheat spice

ICONS

● Allergies
● Virus
● Health
● Fertilize
● Knee
● Headache
● Toilet paper
● DNA
● Stomach
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