{"id":6200,"date":"2023-07-03T16:29:55","date_gmt":"2023-07-03T19:29:55","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6200"},"modified":"2024-02-15T15:02:28","modified_gmt":"2024-02-15T18:02:28","slug":"caso-clinico-177po","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-177po\/","title":{"rendered":"Caso Cl\u00ednico 177PO"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Felina
Ra\u00e7a: SRD
Idade: 3 anos
Sexo: Macho
Peso: 4,3 kg<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Anamnese<\/strong><\/p>\n\t\t\t

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O paciente foi atendido no dia 0 com a queixa de prostra\u00e7\u00e3o e que h\u00e1 4 dias estava tentando urinar em diversos locais, sem sucesso. O tutor relatou que o felino apresentava anorexia, adipsia, dis\u00faria e polaqui\u00faria. Esta seria a primeira vez que o paciente apresenta este quadro. H\u00e1 3 meses o tutor havia se mudado e com isso o paciente passou a ter contato com outros gatos e estava exposto a brigas.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Exame f\u00edsico<\/strong><\/p>\n\t\t\t

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Temperatura retal: 35,8 \u00b0C\u2193<\/mark> (ref: 37,8-39,2).
Paciente bastante prostrado e com a bexiga repleta; escore corporal ideal; desidratado.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Exames complementares<\/strong><\/p>\n\t\t\t

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Dia 1 – Ultrassonografia<\/p>\n\n\n\n

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  • Rins sim\u00e9tricos, medindo cerca de 5,5 cm de eixo longitudinal; contornos regulares; arquitetura, ecogenicidade e rela\u00e7\u00e3o corticomedular preservadas.<\/li>\n\n\n\n
  • Presen\u00e7a de sinal de dilata\u00e7\u00e3o de pelve renal medindo cerca de 0,36 cm no rim esquerdo e 0,27 cm no rim direito.<\/li>\n\n\n\n
  • Bexiga urin\u00e1ria pouco a medianamente distendida, parede espessada e irregular, medindo cerca de 1,0 cm na regi\u00e3o cr\u00e2nio-ventral; conte\u00fado anecog\u00eanico com v\u00e1rios pontos ecog\u00eanicos em suspens\u00e3o.<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n
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    Tratamento e evolu\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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    Dia 0: realizada cateteriza\u00e7\u00e3o para desobstru\u00e7\u00e3o uretral. Durante a seda\u00e7\u00e3o, o felino apresentou estado mental alterado e cianose, teve um epis\u00f3dio de apneia e necessitou receber oxigenioterapia. Foram administrados tramadol (analg\u00e9sico), escopolamina (antiespasm\u00f3dico), diazepam (para relaxamento de esf\u00edncter e estimulo \u00e0 mic\u00e7\u00e3o) e solu\u00e7\u00e3o de Ringer-lactato (hidrata\u00e7\u00e3o). A bexiga era esvaziada e lavada com soro fisiol\u00f3gico.<\/p>\n\n\n\n

    Dia 1: mantidas as prescri\u00e7\u00f5es do dia 0, por\u00e9m a escopolamina foi substitu\u00edda pela dipirona.<\/p>\n\n\n\n

    Dia 2: felino arrancou a sonda vesical, necessitando, com isso, de compress\u00e3o para urinar. Foi administrado meloxicam (anti-inflamat\u00f3rio) e ampicilina (antibi\u00f3tico) devido aos espirros, secre\u00e7\u00f5es e prostra\u00e7\u00e3o. Realizada nebuliza\u00e7\u00e3o.<\/p>\n\n\n\n

    Dia 4: muito prostrado, sendo a ampicilina substitu\u00edda por amoxicilina\/\u00e1cido clavul\u00e2nico. Administrado um complexo de vitaminas do complexo B, nicotinamida, frutose, amino\u00e1cidos, macro e microminerais.<\/p>\n\n\n\n

    Dia 5: as medica\u00e7\u00f5es foram mantidas. Medicado com dimeticona (antifis\u00e9tico) devido \u00e0 presen\u00e7a de gases.<\/p>\n\n\n\n

    Dia 6: adicionado fanciclovir (antiviral recomendado para o tratamento da rinotraque\u00edte) \u00e0s medica\u00e7\u00f5es j\u00e1 prescritas.<\/p>\n\n\n\n

    Dia 8: \u00f3bito.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Hemograma<\/strong><\/p>\n\t\t\t

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    Eritrograma<\/strong><\/td>Dia 0<\/strong><\/strong><\/td>Dia 7<\/strong><\/strong><\/td><\/tr>
    Eritr\u00f3citos (5-10 milh\u00f5es\/\u00b5L)<\/td>9,62<\/td>5,35<\/td><\/tr>
    Hemat\u00f3crito (24-45%)<\/td>41<\/td>21\u2193<\/mark><\/mark><\/td><\/tr>
    Hemoglobina (8-15 g\/dL)<\/td>14,0<\/td>7,7\u2193<\/mark><\/strong><\/mark><\/td><\/tr>
    VCM (39-55 fL)<\/td>43<\/td>40<\/td><\/tr>
    CHCM (31-35%)<\/td>34<\/td>37\u2191<\/mark><\/td><\/tr>
    Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Quantidade (200-600 \u00d7103<\/sup>\/\u00b5L)<\/td>220<\/td>n.d.*<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Observa\u00e7\u00f5es: Dia 7 – *agrega\u00e7\u00e3o plaquet\u00e1ria; plaquetas gigantes; corp\u00fasculos de Heinz em cerca de 80% dos eritr\u00f3citos; plasma discretamente ict\u00e9rico; n.d.: n\u00e3o determinado.<\/p>\n\n\n\n

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    Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 7<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (5.000-19.500\/\u00b5L)<\/td>31.900\u2191<\/mark><\/td>79.900\u2191<\/mark><\/td><\/tr>
    Miel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
    Metamiel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
    Neutr. bast. (<300\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
    Neutr. seg. (2.500-12.500\/\u00b5L)<\/td>29.667\u2191<\/mark><\/td>71.111\u2191<\/mark><\/td><\/tr>
    Bas\u00f3filos (<100\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
    Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>0\u2193<\/mark><\/strong><\/mark><\/td>0\u2193<\/mark><\/strong><\/mark><\/td><\/tr>
    Mon\u00f3citos (<850\/\u00b5L)<\/td>319<\/td>2.397\u2191<\/mark><\/td><\/tr>
    Linf\u00f3citos (1.500-7.000\/\u00b5L)<\/td>1.914<\/td>6.392<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Observa\u00e7\u00f5es: Dia 7 – neutr\u00f3filos t\u00f3xicos (2+)<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Bioqu\u00edmica sangu\u00ednea<\/strong><\/p>\n\t\t\t

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    <\/td>Dia 0<\/strong><\/strong><\/td>Dia 2<\/strong><\/strong><\/td>Dia 7<\/strong><\/strong><\/td><\/tr>
    Amostra<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
    Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
    Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>82\u2191<\/mark><\/td>n.d.<\/td>82\u2191<\/mark><\/td><\/tr>
    Prote\u00ednas totaisC<\/sup> (54-78 g\/L)<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Albumina (21-33 g\/L)<\/td>30<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Ureia (43-64 mg\/dL)<\/td>622\u2191<\/mark><\/td>148\u2191<\/mark><\/td>561\u2191<\/mark><\/td><\/tr>
    Creatinina (<1,6 mg\/dL)<\/td>19,8\u2191<\/mark><\/td>1,6\u2191<\/mark><\/td>4,7\u2191<\/mark><\/td><\/tr>
    FA (<93 U\/L)<\/td>n.d.<\/td>39,4<\/td>n.d.<\/td><\/tr>
    ALT (<83 U\/L)<\/td>224\u2191<\/mark><\/td>81<\/td>n.d.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    B<\/sup>Estimadas por refratometria; C<\/sup>Determinadas por espectrofotometria<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Urin\u00e1lise<\/strong><\/p>\n\t\t\t

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    <\/td>Dia 0<\/strong><\/td><\/tr>
    M\u00e9todo de coletaA<\/sup><\/td>cat<\/td><\/tr>
    Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
    C\u00e9lulas epiteliais<\/td>escamosas (1)<\/td><\/tr>
    Cilindros<\/td>ausente<\/td><\/tr>
    Hem\u00e1cias<\/td>100\u2191<\/mark><\/td><\/tr>
    Leuc\u00f3citos<\/td>100\u2191<\/mark><\/td><\/tr>
    Bacteri\u00faria<\/td>moderada\u2191<\/mark><\/td><\/tr>
    Outros<\/td>espermatozoides<\/td><\/tr>
    Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
    pH (6,0-7,0)<\/td>8,0\u2191<\/mark><\/td><\/tr>
    Corpos cet\u00f4nicosC<\/sup><\/td>ausente<\/td><\/tr>
    GlicoseD<\/sup><\/td>ausente<\/td><\/tr>
    BilirrubinaE<\/sup><\/td>ausente<\/td><\/tr>
    Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2 mg\/dL<\/td><\/tr>
    Prote\u00ednaF<\/sup><\/td>+++\u2191<\/mark><\/td><\/tr>
    SangueG<\/sup><\/td>+++\u2191<\/mark><\/td><\/tr>
    RPCUH<\/sup><\/td>n.d.<\/td><\/tr>
    Exame f\u00edsico<\/strong><\/td>\u00a0<\/td><\/tr>
    Dens. espec. (1,015-1,060)<\/td>1,018<\/td><\/tr>
    Cor<\/td>vermelha\u2191<\/mark><\/td><\/tr>
    Consist\u00eancia<\/td>fluida<\/td><\/tr>
    Aspecto<\/td>turvo<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    A<\/sup>mic, mic\u00e7\u00e3o natural \u25cf cat, cateteriza\u00e7\u00e3o \u25cf cist, cistocentese \u25cf out, outros (especificar em \u201cObserva\u00e7\u00f5es\u201d)
    B<\/sup>N\u00famero m\u00e9dio de elementos por campo de 400 x
    C<\/sup>tra\u00e7os, \u22485 mg\/dL \u25cf +, \u224815 mg\/dL \u25cf ++, \u224840 mg\/dL \u25cf +++, \u224880 md\/dL \u25cf ++++, \u2265160 mg\/dL
    D<\/sup>tra\u00e7os, \u2248100 mg\/dL \u25cf +, \u2248250 mg\/dL \u25cf ++, \u2248500 mg\/dL \u25cf +++, \u22481000 mg\/dL \u25cf ++++, \u22652000 mg\/dL
    E<\/sup>+, leve \u25cf ++, moderada \u25cf +++, alta
    F<\/sup>+, \u224830 mg\/dL \u25cf ++, \u2248100 mg\/dL \u25cf +++, \u2248300 mg\/dL \u25cf ++++, \u22652000 mg\/dL
    G<\/sup>nh, n\u00e3o hemolisado \u25cf h, hemolisado \u25cf +, leve \u25cf ++, moderada \u25cf +++, alto
    H<\/sup>RPCU, rela\u00e7\u00e3o prote\u00edna\/creatinina urin\u00e1ria (na aus\u00eancia de sedimento ativo)
    – Caninos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,5, protein\u00faria lim\u00edtrofe \u25cf >0,5, protein\u00farico
    – Felinos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,4, protein\u00faria lim\u00edtrofe \u25cf >0,4, protein\u00farico
    – Equinos: <0,93, n\u00e3o protein\u00farico
    n.d.: n\u00e3o determinado<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Necropsia e histopatologia<\/strong><\/p>\n\t\t\t

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    Exame macrosc\u00f3pico<\/p>\n\n\n\n