Orientador: Ilka de Fatima Ferreira Santana Boin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T16:27:50Z (GMT). No. of bitstreams: 1
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Previous issue date: 2003 / Resumo: o autor apresenta um estudo descritivo, retrospectivo, realizado a partir da análise dos prontuários de 769 pacientes com HDA, dos quais 220 tinham, como motivo do atendimento no setor de urgência do HC-UNICAMP, quadro clínico de lIDA por varizes esofagogástricas no período de 1995 a 2000. As varizes esofagogástricas, presente em 28,6% dos casos, foram a segunda causa de hemorragia digestiva alta (lIDA). Observou-se prevalência entre a terceira e quinta décadas de vida, com pico na quarta década (29,2%), sendo 76,8% deles do sexo masculino. Houve associação de hematêmese e melena na admissão em 57,7% dos pacientes, com ascite presente em 48,2% dos mesmos. A maioria deles foram classificados como Child B na admissão (40%). O exame endoscópico, em até 24 horas, foi realizado em 96,8% dos casos, tendo evidenciado, segundo a classificação de Osaka (1979), varizes F3 (38,5%), CB (25,1%), RCS (12,6%), sendo 41,5% localizadas no terço médio do esôfago. O tratamento farmacológico mais utilizado foi o octreotida em 45,9% dos casos, com eficácia em 74,2% dos pacientes. O tamponamento com balão de Sengstaken-Blakemore, foi realizado em 30,5% dos pacientes, tendo sido observado que 69,7% daqueles com resposta insatisfatória evoluíram para óbito. O tratamento endoscópico foi efetuado em 41,8% dos casos com eficácia de 81,5%. A escleroterapia foi utilizada em 60,9%, sendo o oleato de etanolamina o esclerosante mais utilizado. A cirurgia de emergência foi realizada em apenas 8,6% dos pacientes, controlando a hemorragia em 78,9% dos casos. A mortalidade durante o período de admissão foi de 2,3%, subindo para 14,6% na fase de internação. Houve um significante número de óbitos naqueles pacientes que apresentaram ineficácia no tratamento aplicado. A sobrevida após o primeiro ano foi de 85% para Child A, 55% para Child B e 47% para Child C, com diferença significativa de sobrevida ao final do primeiro ano. Pode se concluir que as VEG são importante causa de lIDA, havendo diferença significativa de sobrevida de acordo com a classificação de Child- Turcotte-Pugh na admissão / Abstract: The aim of this work was to evaluate (by a retrospective) the prevalence, clinic and evolution of bleeding by gastroesophageal varices in the patients treated the emergency room of the Hospital State University of Campinas (Brazil) ITom 1995 until 2000. The method used here consisted ofa descriptive and retrospective study carried out byanalyzing the medical records of 769 patients with upper gastrointestinal bleeding of which 220 of them were admitted to this Hospital because of upper gastrointestinal bleeding caused by gastroesophageal varices during this same period. The results showed that the gastroesophageal varices appeared in 28,6% of the patients and they were the second most common cause of upper gastrointestinal bleeding. While evaluating factors such as age, sex and the common individual records, it was shown that this disease occurs mainly among people between the forth and the sixth decade of life, with the great majority of cases occurring in the fifth decade (29,2%), ofwhich 76,8% were male. There was an association ofhematemesis and melena in the admission of 57,7% ofthe patients and even ascites was a common diagnosis in 48,2% of them. Most of these patients (40%) were classified as child class B at admission. The early endoscopic exam was applied in 96,8% of them and it showed the presence of F3 varices in 38,5%, CB varices in 25,1% and RCS varices in 12,6%, most ofthese varices (41,5% ofthe cases studied) were situated in the third part of the medium esophagus. The most used pharmacological treatment was based on octreotida in 45,9% of the patients. They received the dose of 0,05mg of octreotida in pills and maintenance of lmg a day in 98,6% of the cases, with efficacy in 74,2% of the patients. The tamponade with Sengstaken-Blakemore tube was applied in 30,5% of the patients, but it was observed that 69,7% of them did not present any considerable progress and this situation led them to death. The endoscopic treatment was performed in 41,8% of the patients with efficacy in 81,5% of them. The sclerotherapy was used in 60,9% of the studied cases and the medicine called Ethamolin was the most used for sclerosing. Emergency surgery was used in just 8,6% of the patients studied and it controlled the bleeding in only 78,9"/Ó ofthe cases. During admission to the Emergency Room of the State University Hospital of Campinas on1y 2,3% ofthe patients died, and this index went up to 14,6% during hospital intemment. A significant number of patients died when the treatment rea1ized was not effective, in comparison with treatment which had succeeded in controlling bleeding.The survival rate after one year was 85% for Child ~ 55% for Child B and 47% for Child C. We could conclude that gastroesophageal varices are an important cause of upper gastrointestinal bleeding, and there is a significant difference of survival rate after one-year when Child- Turcotte-Pugh classification was utilized at admission / Mestrado / Medicina Interna / Mestre em Ciências Médicas
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unicamp.br:REPOSIP/313548 |
| Date | 27 February 2003 |
| Creators | Silva, Elio Rodrigues da |
| Contributors | UNIVERSIDADE ESTADUAL DE CAMPINAS, Boin, Ilka de Fatima Santana Ferreira, 1953-, Silva, Rita de Cassia Martins Alves da, Lopes, Luiz Roberto |
| Publisher | [s.n.], Universidade Estadual de Campinas. Faculdade de Ciências Médicas |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | 128 p. : il., application/pdf |
| Source | reponame:Repositório Institucional da Unicamp, instname:Universidade Estadual de Campinas, instacron:UNICAMP |
| Rights | info:eu-repo/semantics/openAccess |
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