complicações hepáticas na doença falciforme hepatic complications in sickle cell disease
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2007
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Abstract
Doentes falciformes podem apresentar alterações hepáticas agudas ou crônicas. As agudas são caracterizadas por dor no quadrante superior direito e icterícia. O diagnóstico diferencial inclui crise aguda de falcização hepática, seqüestro hepático, colestase intra-hepática, colelitíase, coledocolitíase, colecistite e hepatite viral aguda. Estas complicações devem ser diagnosticadas precocemente, através de história clínica, testes de função hepática e exames radiológicos, e o tratamento deve ser prontamente iniciado. Transfusão sangüínea é essencial para o tratamento das manifestações agudas causadas pelo processo de vaso-oclusão, como seqüestro hepático e colestase intra-hepática. As alterações hepáticas crônicas são freqüentemente causadas pela hemólise crônica e múltiplas transfusões. Para prevenção, diagnóstico precoce e orientação terapêutica da alteração hepática crônica, os doentes falciformes devem ser submetidos a exames de rotina: testes de função hepática, sorologia para hepatite B e C, dosagem sérica de ferritina e ultra-sonografia de abdômen. A biópsia hepática deve ser realizada em pacientes com hepatite viral e em pacientes com alterações hepáticas crônicas acentuadas e persistentes, afora das manifestações agudas.
Patients with sickle cell disease may present acute or chronic hepatopathy. The acute syndrome is characterized by right upper quadrant abdominal pain and jaundice. The differential diagnoses include acute sickle hepatic crises, hepatic sequestration, sickle cell intrahepatic cholestasis, cholecystitis, choledocholithiasis and acute viral hepatitis. These alterations can be differentiated by a careful history, liver function tests and hepatobiliary imaging studies. The specific treatment must be promptly initiated. Red blood cell transfusion is essential for the treatment of the clinical syndromes caused by the sickling process such as hepatic sequestration and sickle cell intrahepatic cholestasis. Chronic liver disease is frequently caused by chronic hemolysis and multiple transfusions. In an attempt to prevent, early diagnosis and treatment of chronic liver disease, sickle cell disease patients must be routinely submitted to liver function tests, serologic tests for hepatitis B and C, serum ferritin levels and abdominal ultrasound. Liver biopsy may be indicated in patients with virus hepatitis and in patients with persistent and accentuated alterations in liver function tests, out of acute sickle cell hepatic crises.
Patients with sickle cell disease may present acute or chronic hepatopathy. The acute syndrome is characterized by right upper quadrant abdominal pain and jaundice. The differential diagnoses include acute sickle hepatic crises, hepatic sequestration, sickle cell intrahepatic cholestasis, cholecystitis, choledocholithiasis and acute viral hepatitis. These alterations can be differentiated by a careful history, liver function tests and hepatobiliary imaging studies. The specific treatment must be promptly initiated. Red blood cell transfusion is essential for the treatment of the clinical syndromes caused by the sickling process such as hepatic sequestration and sickle cell intrahepatic cholestasis. Chronic liver disease is frequently caused by chronic hemolysis and multiple transfusions. In an attempt to prevent, early diagnosis and treatment of chronic liver disease, sickle cell disease patients must be routinely submitted to liver function tests, serologic tests for hepatitis B and C, serum ferritin levels and abdominal ultrasound. Liver biopsy may be indicated in patients with virus hepatitis and in patients with persistent and accentuated alterations in liver function tests, out of acute sickle cell hepatic crises.
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traina2007revistacomplicaes
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| Authors | ;Fabíola Traina;Sara T. O. Saad |
| Journal | journal of computational and graphical statistics : a joint publication of american statistical association, institute of mathematical statistics, interface foundation of north america |
| Year | 2007 |
| DOI |
10.1590/S1516-84842007000300021
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