{"id":7489,"date":"2023-10-30T16:00:42","date_gmt":"2023-10-30T19:00:42","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=7489"},"modified":"2023-11-01T11:00:02","modified_gmt":"2023-11-01T14:00:02","slug":"caso-clinico-17d1c","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-17d1c\/","title":{"rendered":"Caso Cl\u00ednico 17D1C"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: SRD
Idade: 2 anos
Sexo: f\u00eamea
Peso: 12,6 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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H\u00e1 1 dia o animal, supostamente abandonado, foi encontrado na estrada sem conseguir caminhar ap\u00f3s um temporal. A tutora estava fornecendo dipirona, tramadol e amoxicilina. Em atendimento veterin\u00e1rio foi realizado exame radiogr\u00e1fico que evidenciou fratura na pelve e luxa\u00e7\u00e3o na coluna. Apresentava hemat\u00faria, realizou exame ultrassonogr\u00e1fico que mostrou a presen\u00e7a de Dioctophyma renale<\/em> no rim direito.
No dia 0 a paciente ainda se movimentava apenas com os membros tor\u00e1cicos, apresentando hemat\u00faria intensa. Estava se alimentando e defecando normalmente.<\/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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Dia 0<\/strong>
Escore corporal: 5 (ref.: 1-9, ideal=5)
Estado mental: alerta
Tempo de perfus\u00e3o capilar: <2 s
Algia em palpa\u00e7\u00e3o abdominal
Infesta\u00e7\u00e3o intensa por pulgas
Desidrata\u00e7\u00e3o: 6%
Mucosas normocoradas<\/p>\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 4: <\/strong>Paciente foi submetida \u00e0 cirurgia para corre\u00e7\u00e3o da fratura na pelve e luxa\u00e7\u00e3o da coluna.<\/p>\n\n\n\n

Dia 18: <\/strong>Paciente foi submetida \u00e0 nefrectomia do rim direito, o qual apresentava perda de defini\u00e7\u00e3o e formato devido \u00e0 presen\u00e7a do parasita Dioctophyma renale<\/em>. N\u00e3o foi encontrado parasita livre na cavidade abdominal. Presen\u00e7a de discreta quantidade de l\u00edquido livre serosanguinolento na cavidade abdominal. Foi realizada ovariosalpingohisterectomia na mesma ocasi\u00e3o.<\/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><\/td>Dia 7<\/strong><\/td>Dia 12<\/strong><\/td>Dia 20<\/strong><\/td>Dia 25<\/strong><\/td>Dia 31<\/strong><\/td><\/tr>
Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>5,8<\/td>4,2\u2193<\/mark><\/td>5,1\u2193<\/mark><\/td>5,0\u2193<\/mark><\/td>6,1<\/td>6,6<\/td><\/tr>
Hemat\u00f3crito (37-55%)<\/td>38<\/td>30\u2193<\/mark><\/td>37<\/td>35\u2193<\/mark><\/td>41<\/td>41<\/td><\/tr>
Hemoglobina (12-18 g\/dL)<\/td>11,7\u2193<\/mark><\/td>8,6\u2193<\/mark><\/td>11,1\u2193<\/mark><\/td>11,0\u2193<\/mark><\/td>13,2<\/td>13,9<\/td><\/tr>
VCM (60-77 fL)<\/td>65,2<\/td>71,8<\/td>72,7<\/td>69,6<\/td>67,5<\/td>63,6<\/td><\/tr>
CHCM (32-36%)<\/td>30,8\u2193<\/mark><\/td>28,7\u2193<\/mark><\/td>30,0\u2193<\/mark><\/td>31,4\u2193<\/mark><\/td>32,2<\/td>33,1<\/td><\/tr>
RDW (14-17%)<\/td>20,3\u2191<\/mark><\/td>21,8\u2191<\/mark><\/td>21,0\u2191<\/mark><\/td>16,0<\/td>19,5\u2191<\/mark><\/td>21,4\u2191<\/mark><\/td><\/tr>
HCM (19-23 pg)<\/td>20,1<\/td>20,6<\/td>21,8<\/td>21,9<\/td>21,7<\/td>21,1<\/td><\/tr>
Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>314<\/td>195\u2193<\/mark><\/td>490<\/td>312<\/td>220<\/td>435<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Leucograma<\/strong><\/td>Dia <\/strong>0<\/strong><\/td>Dia <\/strong>7<\/strong><\/td>Dia <\/strong>12<\/strong><\/td>Dia <\/strong>20<\/strong><\/td>Dia <\/strong>25<\/strong><\/td>Dia <\/strong>31<\/strong><\/td><\/tr>
Leuc\u00f3citos totais(6.000-17.000\/\u00b5L)<\/td>19.600\u2191<\/mark><\/td>28.600\u2191<\/mark><\/td>12.500<\/td>17.400\u2191<\/mark><\/td>18.200\u2191<\/mark><\/td>19.200\u2191<\/mark><\/td><\/tr>
Miel\u00f3citos (0\/\u00b5L)<\/td>\u00a00<\/td>0<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td><\/tr>
Metamiel\u00f3citos (0\/\u00b5L)<\/td>\u00a00<\/td>0<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td><\/tr>
Neutr. bast. (<300\/\u00b5L)<\/td>\u00a00<\/td>0<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td><\/tr>
Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>15.484\u2191<\/mark><\/td>20.878\u2191<\/mark><\/td>9.000<\/td>13.224\u2191<\/mark><\/td>13.650\u2191<\/mark><\/td>14.016\u2191<\/mark><\/td><\/tr>
Bas\u00f3filos (<200\/\u00b5L)<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td>\u00a00<\/td><\/tr>
Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>196<\/td>1.144\u2191<\/mark><\/td>1.125<\/td>348<\/td>1.456\u2191<\/mark><\/td>1.920\u2191<\/mark><\/td><\/tr>
Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>2.548\u2191<\/mark><\/td>1.430\u2191<\/mark><\/td>375<\/td>1.044<\/td>182<\/td>768<\/td><\/tr>
Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>1.372<\/td>5.148<\/td>2.000<\/td>2.784<\/td>2.912<\/td>2.496<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Dia 0: plasma discretamente hemolisado, anisocitose (1+), policromasia (1+), linf\u00f3citos reativos.
Dia 7: anisocitose (1+), policromasia (1+).
Dia 12: anisocitose (1+).
Dia 20: plasma discretamente lip\u00eamico.
Dia 31: anisocitose (1+)<\/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><\/td>Dia 7<\/strong><\/td>Dia 20<\/strong><\/td>Dia 25<\/strong><\/td>Dia 28<\/strong><\/td>Dia 31<\/strong><\/td><\/tr>
Amostra<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
Hem\u00f3lise<\/td>severa\u2191<\/mark><\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>77<\/td>68<\/td>61<\/td>82\u2191<\/mark><\/td>n.d.<\/td>n.d.<\/td><\/tr>
Albumina (26-33 g\/L)<\/td>35\u2191<\/mark><\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
Ureia (21-60 mg\/dL)<\/td>54<\/td>37<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
Creatinina (<1,4 mg\/dL)<\/td>0,7<\/td>0,7<\/td>0,4<\/td>n.d.<\/td>0,8<\/td>0,7<\/td><\/tr>
FA (<156 U\/L)<\/td>307\u2191<\/mark><\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
ALT (<102 U\/L)<\/td>358\u2191<\/mark><\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/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 14<\/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>ausente<\/td><\/tr>
Cilindros<\/td>ausente<\/td><\/tr>
Hem\u00e1cias<\/td><5<\/td><\/tr>
Leuc\u00f3citos<\/td>60\u2191<\/mark><\/td><\/tr>
Bacteri\u00faria<\/td>severa\u2191<\/mark><\/td><\/tr>
Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
pH (5,5-7,0)<\/td>6,5\u00a0<\/td><\/tr>
Corpos cet\u00f4nicosC<\/sup><\/td>ausente<\/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>1,023<\/td><\/tr>
Cor<\/td>amarelo escuro<\/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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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