{"id":6286,"date":"2023-07-04T18:42:09","date_gmt":"2023-07-04T21:42:09","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6286"},"modified":"2025-08-05T08:55:32","modified_gmt":"2025-08-05T11:55:32","slug":"caso-clinico-176y7","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-176y7\/","title":{"rendered":"Caso Cl\u00ednico 176Y7"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: Poodle
Idade: 10 anos
Sexo: Macho
Peso: 11 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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Paciente castrado, vacinado e vermifugado. Apresentava sobrepeso e alimentava-se apenas com ra\u00e7\u00e3o “super premium” (quantidade oferecida n\u00e3o especificada). Onze dias antes da consulta apresentou v\u00f4mito e anorexia, tendo sido feito tratamento com plasil (antiem\u00e9tico) e fluidoterapia (Ringer-lactato). No hemograma foi evidenciada leucocitose por neutrofilia e monocitose. Na bioqu\u00edmica sangu\u00ednea foi evidenciada eleva\u00e7\u00e3o nos valores de fosfatase alcalina (715 U\/L\u2191<\/mark>; ref.: <156) e amilase (2.090 U\/L\u2191<\/mark>; ref.: <700).<\/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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Observado leve icter\u00edcia e dor abdominal.<\/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 0 – Ultrassonografia abdominal:<\/p>\n\n\n\n

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  • F\u00edgado com par\u00eanquima hipoecog\u00eanico, compat\u00edvel com congest\u00e3o acentuada\/hepatite. Observada uma mancha hiperecog\u00eanica difusa irregular na regi\u00e3o direita, compat\u00edvel com \u00e1rea de inflama\u00e7\u00e3o.<\/li>\n\n\n\n
  • Ves\u00edcula biliar com grande reple\u00e7\u00e3o, paredes espessadas e irregulares sugerindo colecistite.<\/li>\n\n\n\n
  • Papila duodenal com aspecto hiperecog\u00eanico, sugerindo inflama\u00e7\u00e3o\/presen\u00e7a de ac\u00famulo de lama biliar.<\/li>\n\n\n\n
  • P\u00e2ncreas evidenciado em topografia de lobo direito, par\u00eanquima hipoecog\u00eanico, homog\u00eaneo (inflama\u00e7\u00e3o). Imagem compat\u00edvel com pancreatite.<\/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: <\/strong>Fluidoterapia (Ringer lactato), citrato de maropitant (antiem\u00e9tico) e cloridrato de ondansetrona (antiem\u00e9tico), omeprazol (protetor g\u00e1strico), dipirona (analg\u00e9sico), enrofloxacina e metronidazol (antibi\u00f3ticos), acetilciste\u00edna (a\u00e7\u00e3o mucol\u00edtica), silimarina (protetor hep\u00e1tico) e same (regenerador metab\u00f3lico). Apresentou mucosas ict\u00e9ricas, poli\u00faria, aus\u00eancia de fezes e sialorreia.<\/p>\n\n\n\n

    Dia 1: <\/strong>Adicionados ao tratamento cloridrato de tramadol e metadona (analg\u00e9sicos). Houve dois epis\u00f3dios de v\u00f4mito ao longo do dia.<\/p>\n\n\n\n

    Dia 2: <\/strong>\u00c1cido ursodesoxic\u00f3lico (hepatoprotetor) e cloridrato de ranitidina (protetor g\u00e1strico) foram adicionados ao tratamento.\u00a0 O paciente tornou a vomitar e manteve-se em jejum durante todo o dia.<\/p>\n\n\n\n

    Dia 3: <\/strong>Acrescentado plasil (antiem\u00e9tico) ao tratamento. No turno da noite foi solicitada suspens\u00e3o das medica\u00e7\u00f5es orais. Alimentou-se no per\u00edodo da manh\u00e3.<\/p>\n\n\n\n

    Dia 5: <\/strong>Em jejum por 24 horas, apresentando um grande volume de v\u00f4mito de consist\u00eancia l\u00edquida pela manh\u00e3.<\/p>\n\n\n\n

    Dia 6:<\/strong> Epis\u00f3dio de v\u00f4mito de colora\u00e7\u00e3o amarelada. Colocada uma sonda esof\u00e1gica (por n\u00e3o fazer ingest\u00e3o de alimentos espontaneamente).<\/p>\n\n\n\n

    Dia 8: <\/strong>A tutora optou por levar o paciente para casa. Foi informado que, ap\u00f3s alguns dias, o paciente foi a \u00f3bito.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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

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    Sangue VENOSO<\/strong><\/td>Dia 8<\/strong><\/td><\/tr>
    pH (7,351-7,443)<\/td>7,265\u2193<\/mark><\/mark><\/td><\/tr>
    pCO2<\/sub> (33,6-41,2 mmHg)<\/td>27,6\u2193<\/mark><\/td><\/tr>
    pO2<\/sub> (47,9-56,3 mmHg)<\/td>34\u2193<\/mark><\/td><\/tr>
    BEecf (-3 a 2 mmol\/L)<\/td>-14\u2193<\/mark><\/mark><\/td><\/tr>
    HCO3<\/sub> (21-25 mmol\/L)<\/td>12,5\u2193<\/mark><\/mark><\/td><\/tr>
    tCO2<\/sub> (mmol\/L)<\/td>13<\/td><\/tr>
    sO2<\/sub> (%)<\/td>58<\/td><\/tr>
    Na (140-155 mmol\/L)<\/td>166\u2191<\/mark><\/td><\/tr>
    K (3,5-5,7 mmol\/L)<\/td>2,7\u2193<\/mark><\/mark><\/td><\/tr>
    iCa (1,3-1,5 mmol\/L)<\/td>1,36<\/td><\/tr><\/tbody><\/table><\/figure>\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 4<\/strong><\/strong><\/td>Dia 7<\/strong><\/strong><\/td><\/tr>
    Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>4,61\u2193<\/mark><\/mark><\/td>3,75\u2193<\/mark><\/mark><\/td>3,17\u2193<\/mark><\/mark><\/td><\/tr>
    Hemat\u00f3crito (37-55%)<\/td>36\u2193<\/mark><\/mark><\/td>32\u2193<\/mark><\/mark><\/td>28\u2193<\/mark><\/mark><\/td><\/tr>
    Hemoglobina (12-18 g\/dL)<\/td>11,2\u2193<\/mark><\/mark><\/td>9,7\u2193<\/mark><\/mark><\/td>7,7\u2193<\/mark><\/mark><\/td><\/tr>
    VCM (60-77 fL)<\/td>78\u2191<\/mark><\/td>85\u2191<\/mark><\/td>88\u2191<\/mark><\/td><\/tr>
    CHCM (32-36%)<\/td>31\u2193<\/mark><\/mark><\/td>30\u2193<\/mark><\/mark><\/td>28\u2193<\/mark><\/mark><\/td><\/tr>
    Reticul\u00f3citos (<1%)<\/td>n.d.<\/td>n.d.<\/td>2,36\u2191<\/mark><\/td><\/tr>
    Metarrubr\u00edcitos (\/100 leuc\u00f3citos)<\/td>n.d.<\/td>4<\/td>2<\/td><\/tr>
    Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Observa\u00e7\u00f5es:
    n.d.: n\u00e3o determinado.
    Dia 0: <\/strong>Plasma ict\u00e9rico.
    Dia 4:<\/strong> Plasma ict\u00e9rico, policromasia 2+, anisocitose 2+, hipocromasia 1+.
    Dia 7:<\/strong> Plasma ict\u00e9rico, hipocromasia 2+, cod\u00f3citos, policromasia 2+, anisocitose 2+.<\/p>\n\n\n\n

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    Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 4<\/strong><\/td>Dia 7<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>29.700\u2191<\/mark><\/td>44.900\u2191<\/mark><\/td>49.300\u2191<\/mark><\/td><\/tr>
    Miel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Metamiel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Neutr. bast. (<300\/\u00b5L)<\/td>0<\/td>0<\/td>3.451\u2191<\/mark><\/td><\/tr>
    Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>27.027\u2191<\/mark><\/td>34.573\u2191<\/mark><\/td>36.975\u2191<\/mark><\/td><\/tr>
    Bas\u00f3filos (<200\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>297<\/td>449<\/td>493<\/td><\/tr>
    Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>594<\/td>7.633\u2191<\/mark><\/td>5.916\u2191<\/mark><\/td><\/tr>
    Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>1.782<\/td>2.245<\/td>2.465<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Observa\u00e7\u00f5es: n.d.: n\u00e3o determinado; Dia 4:<\/strong> Neutr\u00f3filos t\u00f3xicos; Dia 7<\/strong>: Neutr\u00f3filos t\u00f3xicos 2+, mon\u00f3citos ativados.<\/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 4<\/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>72<\/td>60<\/td>64<\/td><\/tr>
    Prote\u00ednas totaisC<\/sup> (54-71 g\/L)<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Albumina (26-33 g\/L)<\/td>26<\/td>22\u2193<\/mark><\/mark><\/td>22\u2193<\/mark><\/mark><\/td><\/tr>
    Globulinas (27-44 g\/L)<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Colesterol total (135-270 mg\/dL)<\/td>368\u2191<\/mark><\/td>290\u2191<\/mark><\/td>319\u2191<\/mark><\/td><\/tr>
    Ureia (21-60 mg\/dL)<\/td>10\u2193<\/mark><\/mark><\/td>6\u2193<\/mark><\/mark><\/td>n.d.<\/td><\/tr>
    Creatinina (<1,4 mg\/dL)<\/td>0,5<\/td>0,5<\/td>0,5<\/td><\/tr>
    FA (<156 U\/L)<\/td>7.968\u2191<\/mark><\/td>7.492\u2191<\/mark><\/td>6.548\u2191<\/mark><\/td><\/tr>
    ALT (<102 U\/L)<\/td>1.164\u2191<\/mark><\/td>521\u2191<\/mark><\/td>346\u2191<\/mark><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    B<\/sup>Estimadas por refratometria; C<\/sup>Determinadas por espectrofotometria
    Observa\u00e7\u00f5es: n.d., n\u00e3o determinado; Dia 0<\/strong>: Soro ict\u00e9rico, Lipase Canina (SNAP): sem altera\u00e7\u00e3o.<\/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 7<\/strong><\/strong><\/td><\/tr>
    M\u00e9todo de coletaA<\/sup><\/td>mic<\/td><\/tr>
    Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
    C\u00e9lulas epiteliais<\/td>Escamosas (2), transi\u00e7\u00e3o (3), caudatas (2)<\/td><\/tr>
    Cilindros<\/td>ausente<\/td><\/tr>
    Hem\u00e1cias<\/td>ausente<\/td><\/tr>
    Leuc\u00f3citos<\/td><5<\/td><\/tr>
    Bacteri\u00faria<\/td>ausente<\/td><\/tr>
    Outros<\/td>\u00a0<\/td><\/tr>
    Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
    pH (5,5-7,0)<\/td>8,0\u2191<\/mark><\/td><\/tr>
    Corpos cet\u00f4nicosC<\/sup><\/td>+\u2191<\/mark><\/td><\/tr>
    GlicoseD<\/sup><\/td>ausente<\/td><\/tr>
    BilirrubinaE<\/sup><\/td>+++\u2191<\/mark><\/td><\/tr>
    Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2<\/td><\/tr>
    Prote\u00ednaF<\/sup><\/td>+\u2191<\/mark><\/td><\/tr>
    SangueG<\/sup><\/td>ausente<\/td><\/tr>
    RPCUH<\/sup><\/td>n.d.<\/td><\/tr>
    Exame f\u00edsico<\/strong><\/td>\u00a0<\/td><\/tr>
    Dens. espec. (1,015-1,045)<\/td>1,012\u2193<\/mark><\/mark><\/td><\/tr>
    Cor<\/td>Amarelo escuro<\/td><\/tr>
    Consist\u00eancia<\/td>fluida<\/td><\/tr>
    Aspecto<\/td>l\u00edmpido<\/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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    Discuss\u00e3o e refer\u00eancias bibliogr\u00e1ficas<\/strong><\/p>\n\t\t\t

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    Devem ser discutidos os achados laboratoriais alterados (referentes a urin\u00e1lise, bioqu\u00edmica sangu\u00ednea e hemograma), estabelecendo as correla\u00e7\u00f5es relevantes com o quadro cl\u00ednico do paciente. N\u00e3o deve ser discutido o tratamento realizado. As altera\u00e7\u00f5es nos achados laboratoriais devem ser justificadas com base nas informa\u00e7\u00f5es contidas na literatura especializada. \u00c9 sugerido organizar a discuss\u00e3o nos seguintes grandes t\u00f3picos:<\/p>\n\n\n\n