Hepatite aguda secundária ao abuso de cocaína, associada a severa rabdomiólise

A cocaína é uma droga com notória capacidade de afetar adversamente quase todos os órgãos do corpo e pode causar uma infinidade de anormalidades multisistêmicas secundárias. No presente estudo, relatamos três casos de insuficiência hepática aguda complicada por rabdomiólise e lesão renal aguda após consumo de cocaína e álcool. O início da doença, as manifestações clínicas, os dados laboratoriais, o diagnóstico e a terapêutica de cada paciente foram registrados. Nota-se a presença de causas multifatoriais para a ocorrência de Insuficiência Hepática e Rabdomiólise nos três casos relatados. Os testes laboratoriais revelaram que a concentração sérica de transaminases, bem como os de creatinafosfoquinase (CPK) aumentaram e que os sintomas de insuficiência renal aguda estavam presentes, o que forneceu um diagnóstico exato de insuficiência hepática aguda complicada por grave rabdomiólise e lesão renal aguda dialítica. Rabdomiólise é uma condição de hipermioglobinúria, sendo uma dos principais fatores que fomentam uma piora da função renal. A terapia da fase inicial envolveu suporte a ressuscitação volêmica associada a terapia dialítica com rigoroso controle da função renal. Os três pacientes desenvolveram comprometimento de múltiplos órgãos, mas apenas um foi a óbito devido a gravidade do quadro. Considerando os três casos apresentados, concluímos que a insuficiência hepática, complicada por rabdomiólise, secundária ao uso de cocaína e álcool pode ter mau prognóstico clínico, a depender de vários fatores. E os médicos devem estar cientes dos potenciais efeitos causados pela cocaína, a fim de gerir as múltiplas complicações associadas ao abuso destas substâncias.Cocaine is a drug with a noticeable ability to adversely affect almost every organ in the body and can cause a multitude of secondary multisystem abnormalities. In the present study, we report three cases of acute liver failure complicated by rhabdomyolysis and acute kidney injury following cocaine and alcohol use. The disease onset, clinical manifestations, laboratory data, diagnosis and treatment of each patient were recorded. Note the presence of multifactorial causes for the occurrence of liver failure and rhabdomyolysis in the three reported cases. Laboratory tests revealed that serum trasaminases as well as creatine phosphokinase (CPK) concentrations increased, and symptoms of acute renal failure were present, which provided an accurate diagnosis of acute liver failure complicated by severe rhabdomyolysis and acute renal injury. dialytic rhabdomyolysis is a condition of hypermyoglobinuria, being one of the main factors that promote a deterioration of renal function. Early phase therapy involved support for volume resuscitation associated with dialysis therapy with strict control of renal function. All three patients developed multiple organ involvement, but only one died due to the severity of the condition. Considering the three cases presented, we conclude that liver failure, complicated by rhabdomyolysis, secondary to cocaine and alcohol use may have a poor clinical prognosis, depending on several factors. And doctors should be aware of the potential effects caused by cocaine in order to manage the multiple complications associated with substance abuse

Esteatose hepática aguda da gravidez: relato de caso e revisão de literatura

A esteatose hepática aguda da gravidez (EHAG) é uma complicação obstétrica rara e grave, que ocorre durante o terceiro trimestre de gestação. O objetivo deste estudo é o relato de caso de EHAG em paciente internada em hospital terciário. Gestante, 36 anos, na 37ª semana de gravidez previamente hígida até quatro dias antes da admissão hospitalar. Iniciou quadro de dor abdominal em epigástrio e hipocôndrio direito, icterícia progressiva, desidratação, febre e calafrios. Evoluiu com piora dos sintomas, hematêmese, hipotensão e hipoglicemia. A função hepática apresentava alterações. O coagulograma revelava tempo de protrombina e de tromboplastina parcial alargados. Os marcadores virais para hepatites A, B e C foram negativos. No pós-operatório imediato da Cesárea, a paciente evoluiu com distúrbio da coagulação, episódios de hipoglicemia, piora da icterícia e encefalopatia hepática, caracterizando o diagnóstico de insuficiência hepática aguda (IHA). Após quatro dias de tratamento da encefalopatia hepática houve melhora do sensório até apresentar-se consciente, orientada, sem flapping, apenas com tratamento conservador e não preencheu os critérios do King’s Collegue de indicação para transplante hepático. No 15o dia de internação tanto a paciente e filho encontravam-se bem. Com o conhecimento e diagnóstico de EHAG, no reconhecimento precoce de casos mais leves, incluindo interrupção precoce da gravidez por cesariana e grandes volume de plasma fresco congelado e albumina, alternadamente, o prognóstico de EHAG pode melhorar

Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil

Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population

Severe dengue in the early postoperative period after kidney transplantation: two case reports from Hospital Geral de Fortaleza

Abstract: Dengue is an arbovirosis that ranges from an asymptomatic presentation to a more severe disease, which is characterized by a vascular leakage syndrome where abdominal pain is a major symptom. Transplant recipients are immunosuppressed and are less likely to develop a severe form of the disease because of a reduction in immune-mediated responses that trigger plasma extravasation events. Herein, we report two cases of severe dengue in the early postoperative period of two kidney transplant recipients. Considering the severity of the cases, we emphasize the importance of dengue screening immediately before transplantation in areas endemic for the disease

Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients

<div><p>Abstract Objective: To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. Materials and Methods: This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. Results: The celiac trunk was "normal" (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta) in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries) was seen in 82 patients. We observed six types of variations of the hepatic artery. Conclusion: We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications.</p></div