Gastrointestinal bleeding in patients with COVID-19: an integrative review.

INTRODUCTION: In 2020, the world suffered a major impact from the COVID-19 pandemic, especially due to the high transmissibility of the virus. It is a disease that predominates with respiratory manifestations, but there is involvement of the gastrointestinal tract, causing symptoms ranging from mild to more severe. Highlighting gastrointestinal bleeding, it is a symptom resulting from the involvement of the SARS-CoV-2 virus described by several reports and case series. METHODS: through an integrative literature review, of a qualitative nature, works that corresponded to the eligibility criteria were selected, totaling 16 articles included in this review. RESULTS: of the patients who manifested gastrointestinal symptoms associated with the disease, common comorbidities and clinical manifestations were identified, in addition to therapies used to treat the infection, which were predisposing factors for the development of gastrointestinal bleeding. CONCLUSION: The presence of gastrointestinal bleeding in patients with COVID-19 is established in the literature, since the pathophysiological mechanisms of the disease directly affect the GIT. Early recognition of symptoms and suspicion of gastrointestinal involvement allows better management of patients and complications.

Post-COVID-19 irritable bowel syndrome: an integrative review.

INTRODUCTION: the persistence of long-term symptoms of COVID-19 represents a new challenge for the medical-scientific community, it is the condition called long-term COVID-19. Irritable Bowel Syndrome (IBS) is one of the most common Disorders of the Gut-Brain Interaction and its post-infection development is already validated. According to the Rome IV criteria, it is characterized by the presence of recurrent abdominal pain, on average, at least 1 day a week in the last 3 months with onset of symptoms at least 6 months before diagnosis, associated with 2 or more factors: related to defecation and/or associated with change in stool frequency and/or associated with change in stool form. This study aimed to review data on post-COVID-19 IBS. METHODS: this is an integrative review of studies published between January 1, 2020 and April 30, 2023, which presented data on IBS with previously diagnosed COVID-19 disease. The PubMed database was used, the descriptors were "Irritable bowel syndrome" AND "COVID-19"; the reference list of the articles was also retrieved. RESULTS: eight studies were reviewed, it was observed that 0.6% to 11.6% of patients had IBS again after a minimum period of 6 months of infection. Risk factors were female gender, severity of COVID-19, presence of acute-phase gastrointestinal symptoms, and depression/anxiety. CONCLUSION: the results obtained suggest that COVID-19 may be associated with the emergence of de novo IBS. Further studies are needed to investigate its long-term effects and clinical spectra.

Acute abdomen in patients with covid-19: an integrative review.

INTRODUCTION: upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. METHODOLOGY: this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. RESULTS: the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. CONCLUSION: the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.

Acute pancreatitis and COVID-19: an integrative review of the literature.

The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrapulmonary manifestations were reported worldwide. Acute pancreatitis concomitant with the diagnosis of SARS-CoV-2 infection has been observed in some patients, in the absence of the most common etiologies described in the literature. It is postulated that the presence of the ECA-2 viral receptor in the pancreas is responsible for the direct cellular damage and that the hyperinflammatory state of COVID-19 favors the development of pancreatitis through an immune-mediated mechanism. This study aimed to analyze the correlation between acute pancreatitis and COVID-19 disease as a probable causality factor. An integrative literature review was carried out, including studies published between January 2020 and December 2022 that brought data on patients diagnosed with acute pancreatitis according to the revised Atlanta Classification with a confirmed diagnosis of COVID-19 in the same period. A total of thirty studies were reviewed. Demographic, clinical, laboratory and imaging aspects were analyzed and discussed. It is believed that SARS-CoV-2 was responsible for the development of acute pancreatitis in these patients, due to the absence of other precipitating risk factors, as well as the close temporal relationship between both. Attention should be given to gastrointestinal manifestations in patients affected by COVID-19.

Intraabdominal hypertension and Abdominal Compartment Syndrome in patients with COVID-19: an integrative review.

The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory distress syndrome, requiring support in Intensive Care Units. Intra-abdominal Hypertension and Abdominal Compartment Syndrome are characterized by increased intra-abdominal pressure, and are subject to several predisposing factors, such as mechanical ventilation assistance, extracorporeal membrane oxygenation, elevated PEEP, intestinal obstructions, excessive fluid replacement, major burns and coagulopathies. Hence, for the management of patients with severe COVID-19, there are numerous risk factors for the development of intra-abdominal hypertension and abdominal compartment syndrome. Therefore, this study proposes to analyze the variables that directly interfere with the increase in intra-abdominal pressure in patients with COVID-19, as well as the changes in the organic systems caused, through an integrative literature review.

Combined liver-kidney transplant in polycystic diseases: a case report.

Polycystic liver disease, a hereditary pathology, usually manifests as autosomal dominant polycystic kidney disease. The many cysts in the liver cause massive hepatomegaly, majorly affecting the patient's quality of life. In cases of refractory symptoms, liver transplantation is the only treatment choice. A 43-year-old woman was followed up as a hepatology outpatient in August 2020, with a progressive increase in abdominal volume, lower limb edema, and cachexia. The patient was diagnosed with polycystic renal and liver disease with massive hepatomegaly in March 2021, a combined kidney-liver transplant. Liver size represented 13% of the patient's corporal composition, weighing 8.6kg. The patient was discharged on the 7th postoperative day with no complications. Only 10-20% of patients with polycystic liver disease have clinical manifestations, most of which result from hepatomegaly. An increase in liver volume deteriorates liver function until the condition becomes end-stage liver disease, as kidney function is already compromised; liver-kidney transplantation remains the only treatment choice. The case described drew significant attention to the massive hepatomegaly presented in the patient, with the liver representing over 10% of the patient's body weight, approximately five to six times larger than a normal-sized liver.

Acute mesenteric ischemia and COVID-19: an integrative review of the literature.

The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.

Acute mesenteric ischemia and COVID-19: an integrative review of the literature / Isquemia mesentérica aguda e COVID-19: uma revisão integrativa da literatura

ABSTRACT The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.

RESUMO A doença do novo coronavírus 2019 (COVID-19) disseminou-se rapidamente pelo mundo após os primeiros casos serem relatados em dezembro de 2019 na China. Apesar da prevalência dos sintomas respiratórios, manifestações extrapulmonares foram sendo identificadas. Particularmente, houve um aumento de casos de Isquemia Mesentérica Aguda (IMA), elevando sua incidência para 1,9%-3,8% em pacientes infectados. O objetivo deste estudo foi investigar a existência de uma associação entre IMA e a COVID-19 através da literatura. Realizou-se uma Revisão Integrativa da Literatura. A pergunta de pesquisa foi "isquemia mesentérica em pacientes com COVID-19: coincidência ou associação?". Após a busca na base de dados e aplicação dos critérios de inclusão e exclusão, elegeu-se 44 estudos para análise. A COVID-19 foi confirmada por RT-PCR e exames de imagem, foram identificadas manifestações gastrointestinais, alterações laboratoriais e achados de imagem primordialmente tomográfica. A maioria dos pacientes foi submetida à laparotomia. As explicações incluem lesão endotelial direta pela ligação do vírus ao receptor ECA-2, correlação entre hiperinflamação e hipercoagulabilidade, desregulação do sistema renina-angiotensina-aldosterona e fatores associados à gravidade do quadro. A IMA é uma emergência de alta morbimortalidade associada, nesses casos pode ser consequência principalmente do mecanismo tromboinflamatório associado ao SARS-CoV-2. Um alto nível de suspeita clínica, diagnóstico e tratamento precoces são cruciais diante dessa complicação; um regime de anticoagulação deve ser considerado conforme as evidências e diretrizes vigentes..

Acute abdomen in patients with covid-19: an integrative review / Abdômen agudo em pacientes com covid-19: uma revisão integrativa

ABSTRACT Introduction: upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. Methodology: this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. Results: the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. Conclusion: the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.

RESUMO Introdução: a partir da infecção com o SARS-CoV-2, os pacientes apresentaram sintomas não clássicos, como fenômenos gastrointestinais que incluem perda de apetite, náuseas, vômitos, diarréia e dores abdominais. Essas ocorrências, normalmente, foram encontradas em pacientes gravemente afetados pelo COVID-19. Com isso, o objetivo deste trabalho é analisar o conhecimento disponível sobre o desenvolvimento do abdome agudo em pacientes infectados pelo SARS-CoV-2. Metodologia: trata-se de uma Revisão Integrativa na base de dados PubMed, Web of Science e BVS. Foi utilizado os descritores: "Acute abdomen", "COVID-19", "Abdominal pain" e "SARS-CoV-2" com o operador booleano "AND", e selecionados artigos de relevância para o tema. Inicialmente, foram selecionados 331 artigos, todos publicados entre 2020 e 2023, em português e/ou inglês. Após análise, 11 artigos corresponderam ao objetivo proposto. Resultados: a relação entre a sensibilidade na região superior direita ou a presença do sinal de Murphy contribuiu na associação entre dor abdominal e as formas mais graves do COVID-19 em pacientes infectados. O número de diagnósticos para quadros agudos como colecistite, apendicite, diverticulite e pancreatite tiveram diminuição com a pandemia, mas ao mesmo tempo houve aumento na duração dos procedimentos cirúrgicos e nos períodos de internações. Esses quadros de abdome agudo foram resultados da procura tardia de assistência hospitalar que colaborou, inclusive no aumento da taxa de conversão para a cirurgia aberta e no número de quadros perfurativos. Conclusão: o desenvolvimento do abdome agudo em pacientes infectados pelo SARS-CoV-2 foi preditor de um prognóstico desfavorável.

Acute pancreatitis and COVID-19: an integrative review of the literature / Pancreatite aguda e COVID-19: uma revisão integrativa da literatura

ABSTRACT The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrapulmonary manifestations were reported worldwide. Acute pancreatitis concomitant with the diagnosis of SARS-CoV-2 infection has been observed in some patients, in the absence of the most common etiologies described in the literature. It is postulated that the presence of the ECA-2 viral receptor in the pancreas is responsible for the direct cellular damage and that the hyperinflammatory state of COVID-19 favors the development of pancreatitis through an immune-mediated mechanism. This study aimed to analyze the correlation between acute pancreatitis and COVID-19 disease as a probable causality factor. An integrative literature review was carried out, including studies published between January 2020 and December 2022 that brought data on patients diagnosed with acute pancreatitis according to the revised Atlanta Classification with a confirmed diagnosis of COVID-19 in the same period. A total of thirty studies were reviewed. Demographic, clinical, laboratory and imaging aspects were analyzed and discussed. It is believed that SARS-CoV-2 was responsible for the development of acute pancreatitis in these patients, due to the absence of other precipitating risk factors, as well as the close temporal relationship between both. Attention should be given to gastrointestinal manifestations in patients affected by COVID-19.

RESUMO Os primeiros casos da doença COVID-19 foram identificados no final de 2019 na China, mas não foi necessário muito tempo para que se tornasse pandêmica. Acreditava-se, a princípio, que ela fosse restrita apenas a sintomas respiratórios, até que manifestações extrapulmonares fossem mundialmente relatadas. Quadros de pancreatite aguda concomitantes ao diagnóstico de infecção por SARS-CoV-2 vêm sendo observados em alguns pacientes, na ausência das etiologias mais comuns descritas na literatura. Postula-se que a presença do receptor viral ECA-2 no pâncreas seja responsável pelo dano celular direto e que o estado hiperinflamatório da COVID-19 favoreça o desenvolvimento da pancreatite por mecanismo imunomediado. Este estudo teve como objetivo analisar a correlação entre pancreatite aguda e a doença COVID-19 como um provável fator de causalidade. Realizou-se uma revisão integrativa da literatura, foram incluídos estudos publicados entre janeiro de 2020 e dezembro de 2022 que trouxessem dados acerca de pacientes diagnosticados com pancreatite aguda conforme a Classificação de Atlanta revisada com diagnóstico confirmado de COVID-19 no mesmo período. Um total de trinta estudos foram revisados. Aspectos demográficos, clínicos, laboratoriais e de imagem foram analisados e discutidos. Acredita-se que o SARS-CoV-2 foi o responsável pelo desenvolvimento de pancreatite aguda nestes pacientes, devido à ausência de demais fatores de risco precipitantes, bem como à estreita relação temporal entre ambos. Uma atenção deve ser dada às manifestações gastrointestinais em pacientes acometidos pela COVID-19.

Post-COVID-19 irritable bowel syndrome: an integrative review / Sindrome do intestino irritável pós-COVID-19: uma revisão integrativa

ABSTRACT Introduction: the persistence of long-term symptoms of COVID-19 represents a new challenge for the medical-scientific community, it is the condition called long-term COVID-19. Irritable Bowel Syndrome (IBS) is one of the most common Disorders of the Gut-Brain Interaction and its post-infection development is already validated. According to the Rome IV criteria, it is characterized by the presence of recurrent abdominal pain, on average, at least 1 day a week in the last 3 months with onset of symptoms at least 6 months before diagnosis, associated with 2 or more factors: related to defecation and/or associated with change in stool frequency and/or associated with change in stool form. This study aimed to review data on post-COVID-19 IBS. Methods: this is an integrative review of studies published between January 1, 2020 and April 30, 2023, which presented data on IBS with previously diagnosed COVID-19 disease. The PubMed database was used, the descriptors were "Irritable bowel syndrome" AND "COVID-19"; the reference list of the articles was also retrieved. Results: eight studies were reviewed, it was observed that 0.6% to 11.6% of patients had IBS again after a minimum period of 6 months of infection. Risk factors were female gender, severity of COVID-19, presence of acute-phase gastrointestinal symptoms, and depression/anxiety. Conclusion: the results obtained suggest that COVID-19 may be associated with the emergence of de novo IBS. Further studies are needed to investigate its long-term effects and clinical spectra.

RESUMO Introdução: a persistência de sintomas a longo prazo da COVID-19 representa um novo desafio à comunidade médico-científica, é a condição denominada COVID-19 longo. A Síndrome do Intestino Irritável (SII) é um dos Distúrbios da Interação Intestino Cérebro mais comuns e seu desenvolvimento pós-infecção já é validado. Segundo os critérios de Roma IV, caracteriza-se por presença de dor abdominal recorrente, em média, pelo menos 1 dia por semana nos últimos 3 meses com início dos sintomas pelo menos 6 meses antes do diagnóstico, associada a 2 ou mais fatores: relacionada à defecação e/ou associada com mudança na frequência das fezes e/ou associada com mudança na forma das fezes. Este estudo teve como objetivo revisar dados acerca de SII pós-COVID-19. Métodos: trata-se de uma Revisão Integrativa de estudos publicados entre 1º de janeiro de 2020 a 30 de abril de 2023, que apresentassem dados acerca de SII com a doença COVID-19 previamente diagnosticada. Utilizou-se a base de dados PubMed, os descritores foram "Irritable bowel syndrome" AND "COVID-19"; a lista de referência dos artigos também foi recuperada. Resultados: oito estudos foram revisados, observou-se que 0,6% a 11,6% pacientes cursaram com SII de novo após um período mínimo de 6 meses da infecção. Os fatores de risco foram sexo feminino, gravidade da COVID-19, presença de sintomas gastrointestinais de fase aguda e depressão/ansiedade. Conclusão: os resultados obtidos permitem crer que a COVID-19 pode estar associada ao surgimento de SII de novo. São necessários outros estudos para investigar seus efeitos a longo prazo e espectros clínicos..

Combined liver-kidney transplant in polycystic diseases: a case report

ABSTRACT Polycystic liver disease, a hereditary pathology, usually manifests as autosomal dominant polycystic kidney disease. The many cysts in the liver cause massive hepatomegaly, majorly affecting the patient's quality of life. In cases of refractory symptoms, liver transplantation is the only treatment choice. A 43-year-old woman was followed up as a hepatology outpatient in August 2020, with a progressive increase in abdominal volume, lower limb edema, and cachexia. The patient was diagnosed with polycystic renal and liver disease with massive hepatomegaly in March 2021, a combined kidney-liver transplant. Liver size represented 13% of the patient's corporal composition, weighing 8.6kg. The patient was discharged on the 7th postoperative day with no complications. Only 10-20% of patients with polycystic liver disease have clinical manifestations, most of which result from hepatomegaly. An increase in liver volume deteriorates liver function until the condition becomes end-stage liver disease, as kidney function is already compromised; liver-kidney transplantation remains the only treatment choice. The case described drew significant attention to the massive hepatomegaly presented in the patient, with the liver representing over 10% of the patient's body weight, approximately five to six times larger than a normal-sized liver.

Intraabdominal hypertension and Abdominal Compartment Syndrome in patients with COVID-19: an integrative review / Hipertensão Intra-abdominal/Síndrome Compartimental Abdominal em pacientes com COVID-19: uma revisão integrativa

ABSTRACT The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory distress syndrome, requiring support in Intensive Care Units. Intra-abdominal Hypertension and Abdominal Compartment Syndrome are characterized by increased intra-abdominal pressure, and are subject to several predisposing factors, such as mechanical ventilation assistance, extracorporeal membrane oxygenation, elevated PEEP, intestinal obstructions, excessive fluid replacement, major burns and coagulopathies. Hence, for the management of patients with severe COVID-19, there are numerous risk factors for the development of intra-abdominal hypertension and abdominal compartment syndrome. Therefore, this study proposes to analyze the variables that directly interfere with the increase in intra-abdominal pressure in patients with COVID-19, as well as the changes in the organic systems caused, through an integrative literature review.

RESUMO Os primeiros casos de COVID-19 foram diagnosticados na China, evoluindo rapidamente com uma disseminação a nível mundial, transformando-se em uma pandemia. Uma porcentagem desses pacientes desenvolve a forma grave da doença e evolui com Síndrome do Desconforto Respiratório, necessitando de suporte em Unidades de Terapia Intensiva. A Hipertensão Intra-abdominal e a Síndrome Compartimental Abdominal são caracterizadas pelo aumento da pressão intra-abdominal, e estão sujeitas a diversos fatores predisponentes, como assistência por ventilação mecânica, oxigenação por membrana extracorpórea, PEEP elevada, obstruções intestinais, reposição excessiva de fluidos, grandes queimados e coagulopatias. Com isso, para o manejo dos pacientes com COVID-19 grave, numerosos são os fatores de risco para o desenvolvimento da Hipertensão intraabdominal e da Síndrome Compartimental Abdominal. Por isso, esse estudo se propõe a analisar as variáveis que interferem diretamente no aumento da pressão intra-abdominal em pacientes com COVID-19, assim como as alterações nos sistemas orgânicos provocadas, por meio de uma revisão integrativa da literatura.

Colangite aguda: da tríade de Charcot aos critérios de Tóquio / Acute cholangitis: from Charcot's triad to Tokyo guidelines

O objetivo deste estudo foi revisar as ferramentas diagnósticas e de manejo da colangite aguda, da tríade de Charcot aos critérios de Tóquio. Foi realizada revisão da literatura no PubMed® utili- zando a combinação dos descritores "Tokyo Guideline", "Char- cot's triad" e "Acute cholangitis". A tríade de Charcot foi a pri- meira ferramenta diagnóstica da colangite aguda. Apesar de sua contribuição, foram os critérios de Tóquio a primeira diretriz com evidência clínica para diagnóstico, classificação de severidade e estratégia para o manejo da colangite aguda. A literatura atual busca identificar marcadores de mau prognóstico do paciente, como a procalcitonina, assim como o tempo ideal para a terapia antibiótica e a drenagem biliar. É bem estabelecido o quanto a tríade de Charcot, juntamente dos critérios de Tóquios, contri- buiu para o melhor diagnóstico e manejo da colangite aguda. Todavia, mais estudos são necessários para validação científica dessas diretrizes na prática clínica-cirúrgica.

The objective of this study was to review acute cholangitis diag- nostic and management tools, from Charcot's triad to Tokyo guidelines. The keywords "Tokyo guideline", "Charcot's triad", and "Acute cholangitis" were searched in PUBMED® and used to review the literature. Charcot's triad was the first diagnostic tool in acute cholangitis. Despite its contribution, Tokyo guidelines were the first evidence-based parameters for diagnosis, severity assessment, and strategy for acute cholangitis management. The current literature searches for biomarkers of patient's bad prognostic, such as procalcitonin, as well the optimal timing of antibiotic therapy and biliary drainage. The good contribution Charcot's triad and Tokyo guidelines has made to improved diagnosis and management of acute cholangitis is well-esta- blished. However, further studies are required for scientific vali- dation of these guidelines in clinical-surgical practice.

Alterações hidroeletrolíticas em pessoas com cirrose / Hydroelectrolytic alterations in cirrhotic patients

O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)

The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)

Hipertensão intra-abdominal e síndrome compartimental abdominal: repercussões e tratamento clínico no paciente crítico / Intra-abdominal hypertension and abdominal compartment syndrome: repercussions and clinical treatment in critically ill patients

A hipertensão intra-abdominal e a síndrome compartimental abdominal foram durante muitas décadas mal compreendidas e dissociadas de suas repercussões clínicas. Trata-se de um distúrbio que pode levar à disfunção de múltiplos órgãos devido ao desequilíbrio circulatório desencadeado pelo aumento de pressão no compartimento abdominal. As manifestações envolvem os sistemas cardiovascular, respiratório, renal, nervoso e gastrintestinal e estão largamente relacionadas com o fator de morbimortalidade no paciente crítico. A despeito da importância clínica, a hipertensão intra-abdominal e à síndrome compartimental abdominal ainda são temas pouco dominados pelos médicos, e fazem-se necessários o reconhecimento precoce e o estabelecimento de estratégias clínicas objetivas no contexto de uma síndrome com desfecho tão desfavorável. Portanto, foi realizada uma revisão da literatura não sistematizada com objetivo de compreender os principais pontos sobre definições, prevalência, fatores de risco, fisiopatologia, diagnóstico e tratamento acerca da hipertensão intra-abdominal e a síndrome compartimental abdominal.

Intra-abdominal hypertension and abdominal compartment syndrome have been, for many decades, poorly understood and dissociated from their clinical repercussions. It is a disorder that can lead to organ dysfunction due to circulatory impairment triggered by increased pressure in the abdominal compartment. The manifestations involve cardiovascular, respiratory, renal, nervous, and gastrointestinal systems, and are widely associated with significant morbidity and mortality in critically ill patients. Despite their clinical importance, intra-abdominal hypertension and abdominal compartment syndrome are still not sufficiently known by physicians and, early recognition and the establishment of objective clinical strategies for managing these highly morbid syndromes are required. Therefore, a non-systematized review was carried out to understand the main points about definitions, prevalence, risk factors, pathophysiology, diagnosis, and treatment of intra-abdominal hypertension and abdominal compartment syndrome.

Dor torácica na emergência: quando pensar em síndrome de Takotsubo? / Emergency chest pain: when to think about Takotsubo syndrome?

A síndrome de Takotsubo é uma cardiomiopatia induzida por estresse, caracterizada por disfunção transitória do ventrículo esquerdo. Essa disfunção pode ser confundida com infarto agudo miocárdio na sala de emergência por ter características clínicas semelhantes ­ principalmente a dor torácica. A fisiopatologia ainda não é bem definida, mas está associada à deficiência de estrogênio e ao aumento de catecolaminas que estimulam o acoplamento dos receptores beta-2 do coração, o que resulta em atividade inotrópica negativa, levando à disfunção contrátil do ventrículo esquerdo. As enzimas cardíacas alteradas dificultam ainda mais o diagnóstico da síndrome de Takotsubo. O exame padrão-ouro, que diferencia a síndrome de Takotsubo do infarto agudo do miocárdio, é a angiografia coronariana. Uma das opções na emergência é o ecocardiograma na beira do leito. Além disso, os critérios de Mayo devem ser usados para diagnosticar a síndrome de Takotsubo. É importante, para o profissional que trabalha no pronto-socorro, ter a síndrome de Takotsubo como diagnóstico diferencial na dor torácica.

Takotsubo syndrome is a stress-induced cardiomyopathy characterized by a transient left ventricular dysfunction. This dysfunction can be confused with acute myocardial infarction in the emergency room as it has similar clinical characteristics, especially chest pain. Its pathophysiology is not yet well defined, but is associated with estrogen deficiency and increased catecholamines that stimulate the coupling of cardiac beta-2 receptors, resulting in negative inotropic activity and leading to contractile dysfunction of the left ventricle. Altered cardiac enzymes make the diagnosis of Takotsubo syndrome even more difficult. The gold standard exam that will differentiate Takotsubo syndrome from acute myocardial infarction is coronary angiography. One of the options in the emergency room is bedside echocardiography. In addition, Mayo criteria should be used to diagnose Takotsubo syndrome. Professionals working in the emergency room shall have Takotsubo syndrome as a differential diagnosis in chest pain.

Use of Liver Grafts From Deceased Organ Donors With Infectious Diseases.

INTRODUCTION: Liver transplant is the only option in reversing liver insufficiency and its complications. It is very important to realize the quality control of organs and tissues used in transplant, as well as to develop diagnostic, treatment, and prophylaxis techniques to prevent other comorbidities and to increase the survival of transplanted patients. OBJECTIVES: The study describes the characteristics of liver transplant using organs with infectious diseases realized by Liver Transplantation Unit (LTU) of the University Hospital Oswaldo Cruz (UHOC). METHODS: The methodology is a descriptive, cross-sectional, and retrospective study, with a quantitative approach of all patients submitted for liver transplantation between 2013 and 2017. The research was realized at LTU ambulatory of the UHOC from the analysis of medical records using a semistructured collect instrument for the information acquisition. RESULTS: Researchers analyzed 127 medical records, 85% of which had transmissible diseases and 15% of which had infectious diseases. Of the infectious diseases, it was observed that 85% were syphilis (16 cases), followed by 10% with Chagas disease and 5% with cytomegalovirus (CMV). The transplant outcomes showed that 68% of organ receptors with infectious diseases achieved good recovery. CONCLUSION: Organ transplant for those with infectious diseases is a treatment option to improve the life quality of people at any age who present with a chronic disease, where its use has been an alternative well accepted due to the shortage of livers for transplants.

Distúrbios ácido-base nas doenças hepáticas / Acid-base disorders in liver diseases

O objetivo deste artigo foi abordar as controvérsias científicas acerca dos distúrbios ácido-base nas doenças hepáticas. Nos estágios avançados da doença hepática, os distúrbios ácido-base atuam de forma complexa, comprometendo a qualidade de vida do paciente e desafiando o manejo clínico. A literatura apresenta a alcalose respiratória como uma das principais alterações, porém há uma longa discussão sobre o mecanismo fisiopatológico; em especial, citam-se a hipóxia, a hipocapnia e o nível de progesterona. Nas desordens metabólicas, com destaque para a acidose, os estudos apontam principalmente o lactato, os unmeasured ions ou íons não medidos e as alterações hidroeletrolíticas, mas cada componente desse sobressai-se dependendo da fase da doença estudada, compensada ou descompensada. As controvérsias dos distúrbios ácido-base nas doenças hepáticas devem-se ora à complexidade da fisiopatologia da própria doença, ora à necessidade de mais estudos esclarecedores.

The aim of this study is to address the scientific controversy about acid-base disorders in liver diseases. In the end stage of liver diseases, the acid-base disorder has a complex performance, impairing the patient's quality of life and challenging the clinic management. Although the literature shows respiratory alkalosis as one of the main alterations, there is a long discussion about the pathophysiological mechanism, specially regarding hypoxia, hypocapnia, and progesterone level. In metabolic disorders, especially acidosis, the studies mainly indicate the lactate, unmeasured ions, and hydroelectrolytic alterations, but, depending on the disease phase, either compensated or decompensated, each element has a particular action. The controversy about acid-base disorders in liver diseases is associated with the complexity of this condition, as well as with the necessity of more specialized research.

Arritmias e alterações cardíacas no paciente cirrótico / Arrhythmias and cardiac alterations in the cirrhotic patient

No Brasil, a cirrose é um problema de saúde pública, que afeta aproximadamente 2 milhões de pessoas. As causas mais comuns são a doença hepática alcoólica, as hepatites virais e a doença hepática não alcoólica. A relação entre desordens cardíacas e hepatopatias é descrita na literatura, e a mais importante delas é o prolongamento do intervalo QT. A cirrose, independente de sua causa, é uma patologia frequentemente encontrada na população brasileira. Por este motivo, elucidar dados referentes às arritmias cardíacas em pacientes cirróticos é de grande importância dentro do estudo desta subpopulação. O objetivo deste artigo é fazer uma revisão de literatura com as informações referentes a epidemiologia, fisiopatologia, fatores de risco e prognóstico para as arritmias cardíacas em portadores de cirrose. (AU)

In Brazil, cirrhosis is a public health problem affecting approximately 2 million people. The most common causes are alcoholic liver disease, viral hepatitis, and non-alcoholic liver disease. The relationship between cardiac disorders and liver diseases is described in the literature, and the most important one is the QT interval prolongation. Cirrhosis, regardless of its causes, is a pathology that is frequently found in the Brazilian population. For this reason, elucidating data regarding cardiac arrhythmias in cirrhotic patients is of great importance within the study of this subpopulation. The aim of this article is to review the literature with information on the epidemiology, pathophysiology, risk factors, and prognosis for cardiac arrhythmias in patients with cirrhosis. (AU)