{"id":6321,"date":"2023-07-05T14:38:27","date_gmt":"2023-07-05T17:38:27","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6321"},"modified":"2024-02-15T15:05:01","modified_gmt":"2024-02-15T18:05:01","slug":"caso-clinico-176xu","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-176xu\/","title":{"rendered":"Caso Cl\u00ednico 176XU"},"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: 8 meses
Sexo: f\u00eamea
Peso: 3,2 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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No dia 0 o animal apresentava aumento de volume abdominal. A paciente havia sido encaminhada de outra cl\u00ednica, na qual a primeira suspeita foi de prenhez, uma vez que a tutora informou que h\u00e1 60 dias teria entrado em cio. Entretanto, atrav\u00e9s da realiza\u00e7\u00e3o de uma ecografia, foi encontrada grande quantidade de l\u00edquido no abd\u00f4men. A tutora reporta que a gata apresentava extremo desconforto abdominal, mas continuava se alimentando, urinando e bebendo bastante \u00e1gua. A paciente foi resgatada da rua e convivia com outro gato FeLV positivo.<\/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 39,7 \u00b0C\u2191<\/mark> (ref.: 37,5-39,5).<\/li>\n\n\n\n
  • Desidrata\u00e7\u00e3o moderada.<\/li>\n\n\n\n
  • Aumento dos linfonodos inguinais.<\/li>\n\n\n\n
  • Prostra\u00e7\u00e3o.<\/li>\n\n\n\n
  • Mucosas hipocoradas e ressecadas.<\/li>\n\n\n\n
  • Presen\u00e7a de l\u00edquido livre ao exame de percuss\u00e3o.<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n
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    Exames complementares<\/strong><\/p>\n\t\t\t

    <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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    • Imunoensaio cromatogr\u00e1fico (dia 0) \u2013 anticorpos contra FIV\/ant\u00edgeno da FeLV: positivo para FeLV.<\/li>\n<\/ul>\n\n\n\n
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      • Exame microbiol\u00f3gico e teste de sensibilidade aos antibi\u00f3ticos (TSA) da efus\u00e3o cavit\u00e1ria.\n
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        • Dia 9: crescimento bacteriano em anaerobiose\n
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          • TSA\n
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            • Sens\u00edvel: gentamicina e tetraciclina;<\/li>\n\n\n\n
            • Intermedi\u00e1rio: amicacina, amixicilina + clavulanato, cefalotina, ciprofloxacina e sulfazotrin;<\/li>\n\n\n\n
            • Resistente: ampicilina, ceftazidina, penicilina;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n
            • Dia 19: aus\u00eancia de crescimento bacteriano em anaerobiose.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n
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              Tabela 1. Par\u00e2metros vitais.<\/strong><\/p>\n\n\n\n

              Par\u00e2metro (int. ref.)<\/strong><\/td>Dia 0<\/strong><\/td>Dia 4<\/strong><\/strong><\/td>Dia 7<\/strong><\/strong><\/td>Dia 9<\/strong><\/strong><\/td>Dia 19<\/strong><\/strong><\/td>Dia 26<\/strong><\/td>Dia 32<\/strong><\/td>Dia 34<\/strong><\/td><\/tr>
              Temperatura retal (37,5-39,5 \u00b0C)<\/td>39,7\u2191<\/mark><\/td>40,0\u2191<\/mark><\/td>39,6\u2191<\/mark><\/td>39,7\u2191<\/mark><\/td>40,0\u2191<\/mark><\/td>39,8\u2191<\/mark><\/td>39,4<\/td>35,6\u2193<\/mark><\/td><\/tr>
              Peso corporal (kg)<\/td>3,2<\/td>3,1<\/td>3,1<\/td>3,0<\/td>3,0<\/td>2,7<\/td>2,2<\/td>n.d.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

              n.d. = n\u00e3o determinado<\/p>\n\n\n\n

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              Tabela 2. An\u00e1lise de l\u00edquido cavit\u00e1rio.<\/strong><\/p>\n\n\n\n

              <\/td>Dia 2<\/strong><\/td>Dia 9<\/strong><\/strong><\/td><\/tr>
              Exame f\u00edsico<\/strong><\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
              Volume<\/td>5 mL<\/td>6 mL<\/td><\/tr>
              Cor<\/td>amarela<\/td>amarelo palha<\/td><\/tr>
              Aspecto<\/td>l\u00edmpido<\/td>turvo<\/td><\/tr>
              Densidade<\/td>1,044<\/td>1,044<\/td><\/tr>
              pH<\/td>7,0<\/td>7,5<\/td><\/tr>
              Exame qu\u00edmico<\/strong><\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
              Glicose<\/td>113,9 mg\/dL<\/td>106 mg\/dL<\/td><\/tr>
              Prote\u00ednas<\/td>5,87 g\/dL<\/td>6,5 g\/dL<\/td><\/tr>
              Leuc\u00f3citos<\/td>++<\/td>negativo<\/td><\/tr>
              Coagula\u00e7\u00e3o<\/td>positivo<\/td>negativo<\/td><\/tr>
              Teste de Rivalta<\/td>positivo<\/td>positivo<\/td><\/tr>
              Sangue<\/td>negativo<\/td>negativo<\/td><\/tr>
              Pigmentos biliares<\/td>negativo<\/td>negativo<\/td><\/tr>
              Rela\u00e7\u00e3o albumina\/globulina<\/td>n.d.<\/td>0,5<\/td><\/tr>
              Citometria<\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
              \u00a0<\/td>Celularidade: 22.800\/\u00b5L
              C\u00e9lulas nucleadas: 22.800\/\u00b5L
              Neutr\u00f3filos n\u00e3o degenerados: 81%
              Pequenos linf\u00f3citos: 10%
              Macr\u00f3fagos com debris celulares: 7%
              Plasm\u00f3citos: 2%
              Raras hem\u00e1cias
              Presen\u00e7a de co\u00e1gulos de fibrina<\/td>              		C\u00e9lulas nucleadas: 30.000\/\u00b5L (n\u00e3o fidedigna)
              Neutr\u00f3filos degenerados: 88%
              Macr\u00f3fagos ativos: 6%
              Linf\u00f3citos reativos: 4%
              Leucofagia
              Eritrofagia
              Presen\u00e7a de bact\u00e9rias intra e extracelulares
              Fundo de l\u00e2mina protein\u00e1ceo<\/td><\/tr><\/tbody><\/table><\/figure>\n\n<\/div>\n\t\t<\/div>\n\n
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              Tratamento e evolu\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

              <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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              Dia 0\u00a0\u2011\u00a0permaneceu internada por 24 horas para tratamento com fluidoterapia a base de Ringer lactato (reidrata\u00e7\u00e3o e restabelecimento do equil\u00edbrio hidroeletrol\u00edtico); amoxicilina + \u00e1cido clavul\u00e2nico (antibi\u00f3tico); prednisolona (anti-inflamat\u00f3rio esteroidal); cobalamina (estimulante de apetite). Teve alta com prescri\u00e7\u00e3o para uso de clavulanato de pot\u00e1ssio + amoxicilina (antibi\u00f3tico de amplo espectro), dipirona (anti-inflamat\u00f3rio n\u00e3o esteroidal, analg\u00e9sico e antipir\u00e9tico), polivitam\u00ednico e interferon-\u03b2 (imunoregulador).<\/p>\n\n\n\n

              Dia 4\u00a0\u2011\u00a0paciente encontrava-se mais ativa e alimentava-se normalmente. Foi mantido o tratamento inicial.<\/p>\n\n\n\n

              Dia 7\u00a0\u2011\u00a0discreta melhor cl\u00ednica; feita drenagem de mais l\u00edquido abdominal. \u00a0<\/p>\n\n\n\n

              Dias 9, 14, 19, 23, 26 e 32\u00a0\u2011\u00a0novas consultas com drenagem de l\u00edquido do abd\u00f4men e progressiva perda de peso e falta de apetite. Foi mantido o tratamento inicial, acrescido de simeticona (tensoativo), uma vez que a paciente n\u00e3o estava defecando diariamente, cobamina (estimulador de apetite) e suplemento alimentar.<\/p>\n\n\n\n

              Dia 34\u00a0\u2011\u00a0interna\u00e7\u00e3o hospitalar, pois n\u00e3o estava mais se alimentando. Neste per\u00edodo foi mantido seu protocolo terap\u00eautico inicial e adicionados: fluidoterapia a base de Ringer lactato + KCL (pot\u00e1ssio, para reposi\u00e7\u00e3o eletrol\u00edtica); metoclopamida (antiem\u00e9tico); omeprazol (anti-ulceroso, que reduz\u00a0a secre\u00e7\u00e3o \u00e1cida do est\u00f4mago). Na tarde do dia 34 o animal foi a \u00f3bito.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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

              <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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              Eritrograma<\/strong><\/strong><\/td>Dia 2<\/strong><\/td>Dia <\/strong>19<\/strong><\/td>Dia <\/strong>34<\/strong><\/td><\/tr>
              Eritr\u00f3citos (5-10 milh\u00f5es\/\u00b5L)<\/td>7,42\u00a0<\/td>4,09\u2193<\/mark><\/td>1,72\u2193<\/mark><\/td><\/tr>
              Hemat\u00f3crito (24-45%)<\/td>32\u00a0<\/td>28\u00a0<\/td>10\u2193<\/mark><\/td><\/tr>
              Hemoglobina (8-15 g\/dL)<\/td>10,6\u00a0<\/td>6,8\u2193<\/mark><\/td>3,0\u2193<\/mark><\/td><\/tr>
              VCM (39-55 fL)<\/td>43,1\u00a0<\/td>68,5\u2191<\/mark><\/td>58,1\u2191<\/mark><\/td><\/tr>
              CHCM (31-35%)<\/td>33,1\u00a0<\/td>24,3\u2193<\/mark><\/td>30\u2193<\/mark><\/td><\/tr>
              Reticul\u00f3citos (<0,4%)<\/td>n.d.\u00a0<\/td>0,72\u2191<\/mark><\/td>n.d.\u00a0<\/td><\/tr>
              Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
              Quantidade (200-600 \u00d7103<\/sup>\/\u00b5L)<\/td>300<\/td>n.d.\u00a0<\/td>150\u2193<\/mark><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

              Observa\u00e7\u00f5es: Dia 34: Hipocromasia 1+, Policromasia 1+, Neutr\u00f3filos t\u00f3xicos 2+. n.d: n\u00e3o determinado.<\/p>\n\n\n\n

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              Leucograma<\/strong><\/td>Dia 2<\/strong><\/td>Dia 19<\/strong><\/td>Dia 34<\/strong><\/td><\/tr>
              Leuc\u00f3citos totais (5.000-19.500\/\u00b5L)<\/td>24.400\u2191<\/mark><\/td>22.400\u2191<\/mark><\/td>25.800\u2191<\/mark><\/td><\/tr>
              Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
              Metamiel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
              Neutr. bast. (<300\/\u00b5L)<\/td>0\u00a0<\/td>672\u2191<\/mark><\/td>0\u00a0<\/td><\/tr>
              Neutr. seg. (2.500-12.500\/\u00b5L)<\/td>23.668\u2191<\/mark><\/td>21.056\u2191<\/mark><\/td>23.478\u2191<\/mark><\/td><\/tr>
              Bas\u00f3filos (<100\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
              Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>0\u2193<\/mark><\/td>0\u2193<\/mark><\/td>0\u2193<\/mark><\/td><\/tr>
              Mon\u00f3citos (<850\/\u00b5L)<\/td>244\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
              Linf\u00f3citos (1.500-7.000\/\u00b5L)<\/td>488\u2193<\/mark><\/td>672\u2193<\/mark><\/td>2.322\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\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 2<\/strong><\/td>Dia 9<\/strong><\/td>Dia 34<\/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>n.d.\u00a0<\/td>n.d.\u00a0<\/td>60\u00a0<\/td><\/tr>
              Prote\u00ednas totaisC<\/sup> (54-78 g\/L)<\/td>86\u2191<\/mark><\/td>78\u00a0<\/td>56\u00a0<\/td><\/tr>
              Albumina (21-33 g\/L)<\/td>13,8\u2193<\/mark><\/td>26\u00a0<\/td>22\u00a0<\/td><\/tr>
              Globulinas (26-51 g\/L)<\/td>72,2\u2191<\/mark><\/td>52\u2191<\/mark><\/td>34\u00a0<\/td><\/tr>
              Glicose (73-134 mg\/dL)<\/td>n.d.\u00a0<\/td>131\u00a0<\/td>n.d.<\/td><\/tr>
              Ureia (43-64 mg\/dL)<\/td>n.d.\u00a0<\/td>39\u2193<\/mark><\/td>107\u2191<\/mark><\/td><\/tr>
              Creatinina (<1,6 mg\/dL)<\/td>0,39<\/td>0,8\u00a0<\/td>0,44<\/td><\/tr>
              FA (<93 U\/L)<\/td>n.d.\u00a0<\/td>33\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
              ALT (<83 U\/L)<\/td>45,6\u00a0<\/td>109\u2191<\/mark><\/td>90\u2191<\/mark><\/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

              <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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              <\/td>Dia 9<\/strong><\/td><\/tr>
              M\u00e9todo de coletaA<\/sup><\/td>cist<\/td><\/tr>
              Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
              C\u00e9lulas epiteliais<\/td>escamosas (1-2)<\/td><\/tr>
              Cilindros<\/td>ausentes<\/td><\/tr>
              Hem\u00e1cias<\/td><5<\/td><\/tr>
              Leuc\u00f3citos<\/td>ausentes<\/td><\/tr>
              Bacteri\u00faria<\/td>leve\u2191<\/mark><\/td><\/tr>
              Outros<\/td>\u00a0\u00a0\u00a0\u00a0\u00a0<\/td><\/tr>
              Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
              pH (6,0-7,0)<\/td>6,5\u00a0<\/td><\/tr>
              Corpos cet\u00f4nicosC<\/sup><\/td>ausente\u00a0<\/td><\/tr>
              GlicoseD<\/sup><\/td>ausente\u00a0<\/td><\/tr>
              BilirrubinaE<\/sup><\/td>ausente\u00a0<\/td><\/tr>
              Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2\u00a0<\/td><\/tr>
              Prote\u00ednaF<\/sup><\/td>+\u2191<\/mark><\/td><\/tr>
              SangueG<\/sup><\/td>tra\u00e7os (nh)\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>1,046\u00a0<\/td><\/tr>
              Cor<\/td>amarela<\/td><\/tr>
              Consist\u00eancia<\/td>fluida<\/td><\/tr>
              Aspecto<\/td>discretamente 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 +<\/strong>, \u224815 mg\/dL \u25cf ++<\/strong>, \u224840 mg\/dL \u25cf +++<\/strong>, \u224880 md\/dL \u25cf ++++<\/strong>, \u2265160 mg\/dL
              D<\/sup>tra\u00e7os, \u2248100 mg\/dL \u25cf +<\/strong>, \u2248250 mg\/dL \u25cf ++<\/strong>, \u2248500 mg\/dL \u25cf +++<\/strong>, \u22481000 mg\/dL \u25cf ++++<\/strong>, \u22652000 mg\/dL
              E<\/sup>+<\/strong>, leve \u25cf ++<\/strong>, moderada \u25cf +++<\/strong>, alta
              F<\/sup>+<\/strong>, \u224830 mg\/dL \u25cf ++<\/strong>, \u2248100 mg\/dL \u25cf +++<\/strong>, \u2248300 mg\/dL \u25cf ++++<\/strong>, \u22652000 mg\/dL
              G<\/sup>nh, n\u00e3o hemolisado \u25cf h, hemolisado \u25cf +<\/strong>, leve \u25cf ++<\/strong>, moderada \u25cf +++<\/strong>, 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

              <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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              Necropsia<\/strong><\/p>\n\n\n\n