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Clínica médica e cirúrgica em animais de companhia: pancreatite em animais de companhia

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VHYHUDPHQWHDXPHQWDGRGHYROXPHHKLSRHFyLFRURGHDGRSRUPHVHQWpULRKLSHUHFyLFRH%/RER HVTXHUGRGRSkQFUHDVLUUHJXODUHVSHVVRHKLSRHFyLFR(Washabau & Day, 2013 «««««

)LJXUD$LPDJHPHFRJUiILFDGHJDWRFRPOLSLGRVHKHSiWLFD%,PDJHPHFRJUiILFDGHMHMXQR

IHOLQRFRP,%'(Washabau & Day, 2013)……….………

)LJXUD   ,PDJHP GH 7& QRUPDO DR QtYHO GR FRUSR GH SkQFUHDV GH XP FmR $  )DVH SUp

FRQWUDVWH% )DVHHVWDFLRQiULD(Cáceres, 2011 «««««««««««««««««««

)LJXUD&mRDGXOWRFRPSDQFUHDWLWH$ ,PDJHP7&HPSUpFRQWUDVWH% ,PDJHP7&SyV

FRQWUDVWH(Cáceres, 2011)……….………..……

)LJXUD   7HVWH 61$3Š F3/ H D VXD LQWHUSUHWDomR (adaptado de Xenoulis & Steiner,

2012)……….……….. )LJXUD   3URWRFROR GH GLDJQyVWLFR GH SDQFUHDWLWH IHOLQD (adaptado de Roberston et al. 2008)………... )LJXUD   3kQFUHDV + ( ;  3DQFUHDWLWH DJXGD HP FmR FRP QHFURVH PDUFDGD 1  GDV

FpOXODV DFLQDUHV H LQILOWUDomR GR WHFLGR SDQFUHiWLFR FRP QHXWUyILORV 301  (Steiner,

2008)……….… )LJXUD   3kQFUHDV + ( ;  3DQFUHDWLWH FUyQLFD HP FmR FRP DWURILD DFLQDU PDUFDGD

HYLGHQFLDGD SHOD IDOWD GH FpOXODV DFLQDUHV SDQFUHiWLFDV H ILEURVH LQILOWUDWLYD DEXQGDQWH )  ,QILOWUDomR GH OLQIyFLWRV H SODVPyFLWRV (L/P  WDPEpP SRGHP VHU REVHUYDGRV (Steiner,

2008)………... )LJXUD  $ 3kQFUHDVGH JDWR DXPHQWDGR H GHDVSHWR QRGXODU(Caney, 2013) H% )LJXUD

LOXVWUDWLYDGHXPDGDVWpFQLFDVGHELySVLDSDQFUHiWLFDSRUFLUXUJLDDEHUWDGHVLJQDGDGHVXWXUD IUDWXUD(Langley-Hobbs et al. 2013)……….

)LJXUD  *DWR FRP WXER HVRIiJLFR$ FRORFDomR GH OLJDGXUD H % REVHUYDomR GR ORFDO GH

SHULVWRPLDHVXDSRVWHULRUDVVpSVLDSDUDUHPRomRGHFURVWDGHWULWRVHVHFUHo}HV(Grace Animal

Hospital, 2014)………...……….….. )LJXUD(FRJUDILDDEGRPLQDOHPIHOtGHRFRPLQVXILFLrQFLDUHQDOHDiabetes mellitus(Fonte: Autor. Cortesia de HRVM, 2014)«««««««««««««««««««««««««« )LJXUD(FRJUDILDDEGRPLQDOHPFDQtGHRFRPSDQFUHDWLWHVHFXQGiULDDLQGLVFULomRDOLPHQWDU (Fonte: Autor. Cortesia de HRVM, 2014)«««««««««««««««««««««««

(14)



ËQGLFHGH7DEHODV

 7DEHOD&DVXtVWLFDSRUÈUHDV&OtQLFDV 7DEHOD'LVWULEXLomRGDFDVXtVWLFDSHODVGLIHUHQWHViUHDVGH&OtQLFD0pGLFD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDODERUDWRULDO 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDHVWRPDWROyJLFRGHQWiULD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH*DVWURHQWHURORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH(PHUJrQFLDVHFXLGDGRVLQWHQVLYRV 7DEHOD'LVWULEXLomRGH)L)5H)LSGHSURFHGLPHQWRVGHXUJrQFLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH&DUGLRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH'HUPDWRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH(QGRFULQRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH1HXURORJLD 7DEHOD'LVWLEXLomRGH)L)5H)LSGH2QFRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH2IWDOPRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH2WRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH3QHXPRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH8URORJLDHQHIURORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH,QIHWRFRQWDJLRVDV 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDItVLFDHGHUHDELOLWDomR 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDGDUHSURGXomR 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDSUHYHQWLYD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH&LUXUJLDGHWHFLGRVPROHV 7DEHOD'LVWULEXLomRGH)L)5H)LSGH&LUXUJLDGHRUWRSHGLDHWUDXPDWRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH1HXURFLUXUJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH$QHVWHVLRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH,PDJLRORJLD 7DEHOD3URGXWRGDVFpOXODVDFLQDUHVSDQFUHiWLFDVHDVVXDVIXQo}HV(adaptado de Tobias & Johnston, 2011) 7DEHOD   3DSHO GDV HQ]LPDV H PHGLDGRUHV LQIODPDWyULRV QD ILVLRSDWRORJLD GD SDQFUHDWLWH (adaptado de Williams, 2005 & Mansfield, 2012) 7DEHOD6XEVWkQFLDVDVVRFLDGDVDRGHVHQYROYLPHQWRGHSDQFUHDWLWHFDQLQD(adaptado de Washabau & Day, 2013, William, 2006 & Etthinger, 2007) 7DEHOD   3ULQFLSDLV GLDJQyVWLFRV GLIHUHQFLDLV GH SDQFUHDWLWH DJXGD HP FmHV (adaptado de Schaer, 2009 & Plunkett, 2011) 7DEHOD3ULQFLSDLVGLDJQyVWLFRVGLIHUHQFLDLVGHSDQFUHDWLWHDJXGDHPJDWRV(adaptado de Schaer, 2009, Plunkett, 2011 & Linklater, 2014)

(15)

7DEHOD'LPHQV}HVXOWUDVVRQRJUiILFDVQRUPDLVGRSkQFUHDVIHOLQR(adaptado de Washabau & Day, 2013) 7DEHOD'URJDVDQHVWpVLFDVHDVVXDVLQGLFDo}HVHPGRHQWHVSDQFUHiWLFRV(adaptado de Tobias & Johnston, 2013) 7DEHOD'URJDVDQDOJpVLFDVIUHTXHQWHPHQWHDGPLQLVWUDGDVQDSDQFUHDWLWHIHOLQD(adaptado de Langley-Hobbs et al. 2013, Zoran, 2012 & Xenoulis et al. 2008) 7DEHOD3URWRFRORGHLQVXOLQDHIOXLGRWHUDSLDLQWUDYHQRVD ,9 DSOLFDGRQRFmRHJDWRFRP

'.$(Scott-Moncrieff, 2011)

7DEHOD   5HODomR GD GHVFREHUWD GH QRYRV HYHQWRV FHOXODUHV HQYROYLGRV QD SDQFUHDWLWH H

SRVVtYHLVDSOLFDo}HVWHUDSrXWLFDV(adaptado de Mansfield, 2012)

7DEHOD   &DUDFWHUtVWLFDV QXWULFLRQDLV GR PDQHLR DOLPHQWDU HP SDFLHQWHV FDQLQRV FRP 3& (adaptado de Watson, 2013) 7DEHOD   *HVWmR SUpFLU~UJLFD QD SDQFUHDWLWH FDQLQD (adaptado de Ruaux, 2014, Tobias & Johnston, 2011) 7DEHOD   (VFDOD GH VHYHULGDGH GD SDQFUHDWLWH DJXGD HVSRQWkQHD HP SDFLHQWHV FDQLQRV (adaptado de Holm et al. 2003) 7DEHOD6LVWHPDGHSRQWXDomRDVVRFLDGRDRSURJQyVWLFRHWD[DGHPRUWDOLGDGH  HPFmHV

FRPSDQFUHDWLWHDJXGD (adaptado de Kalli et al. 2009)

7DEHOD   6LQDLV FOtQLFRV GRV SDFLHQWHV GLDJQRVWLFDGRV FRP SDQFUHDWLWH QR +590 (Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD   )DWRUHV GH ULVFR DSUHVHQWDGRV SHORV SDFLHQWHV GLDJQRVWLFDGRV FRP SDQFUHDWLWH

DTXDQGRGDHQWUDGDQR+590(Fonte: Autor. Cortesia de HRVM, 2014)

7DEHOD   $OWHUDo}HV FOtQLFRSDWROyJLFDV DSUHVHQWDGDV SHORV SDFLHQWHV GLDJQRVWLFDGRV FRP

SDQFUHDWLWHQR+590(Fonte: Autor. Cortesia de HRVM, 2014)

7DEHOD5HVXOWDGRVREWLGRVGHXULDQiOLVHWLSR,UHODWLYRVDRSDFLHQWHIHOLQRFRP(+%2(Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD9DORUHVGRVSDUkPHWURVELRTXtPLFRVGHJDWRQmRHVWDELOL]DGRFRP(+%2(Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD9DORUHVGHJDVRPHWULDYHQRVD YHLDMXJXODU GHJDWRQmRHVWDELOL]DGRFRP(+%2 (Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD   (YROXomR GRV QtYHLV GH ELOLUUXELQD WRWDO DR ORQJR GR LQWHUQDPHQWR (Fonte: Autor. Cortesia de HRVM, 2014)

(16)



ËQGLFHGH*UiILFRV

 *UiILFR&DVXtVWLFDVHJXQGRÈUHDV&OtQLFDV *UiILFR&DVXtVWLFDGDVGLIHUHQWHViUHDVGH&OtQLFD0pGLFD *UiILFR5HSUHVHQWDomRGDVHFUHomRGHFORURHELFDUQRQDWRHPEDL[DVHHOHYDGDVWD[DVGH

VHFUHomRREVHUYDGDVQXPSkQFUHDVFDQLQR(Washabau & Day, 2013)

*UiILFR   )UHTXrQFLDV GH OHV}HV KLVWRSDWROyJLFDV GR SkQFUHDV GH  FmHV (adaptado de Steiner, 2008) *UiILFR   )UHTXrQFLD GH OHV}HV KLVWRSDWROyJLFDV GR SkQFUHDV GH  JDWRV (adaptado de Steiner, 2008) *UiILFR(OLPLQDomRGDOLSDVHSDQFUHiWLFDFDQLQDHPFDQtGHRVDXGiYHO(Dossin, 2011) *UiILFR5HSUHVHQWDomRJUiILFDGRVYDORUHVGHJOLFHPLDDSUHVHQWDGRVQRVGRLVSULPHLURVGLDV

DSyVDKRVSLWDOL]DomR(Fonte: Autor. Cortesia de HRVM, 2014)                

(17)

/LVWDGH$EUHYLDWXUDV6LJODVH6tPERORV



Š0DUFDUHJLVWDGD

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&/±&RODQJLWHOLQIRFtWLFD        

&O±,mRFORUR        

&1$±&RODQJLWHQHXWURItOLFDDJXGD      

&1&± &RODQJLWHQHXWURItOLFDFUyQLFD       

F3/, ± ,PXQRUUHDWLYLGDGH j OLSDVH SDQFUHiWLFD FDQLQD (canine Pancreatic Lipase Immunoreactivity)  

&5,±7D[DGHLQIXVmRFRQWtQXD(Continuous Rate Infusion)  

&57= ± =RQD TXLPLRUHFHSWRUD QD PHGXOD REORQJDWD Chemoreceptor Trigger Zone) &6,±&RFNHU6SDQLHO,QJOrV     

'.$–'LDEHWHVFHWRDFLGyWLFD Diabetic Ketoacidosis)     

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'0±Diabetes mellitus       

(&2±(FRJUDILD       

(+%'2±2EVWUXomRH[WUDKHSiWLFDGRGXFWRELOLDU Extrahepatic Bile Duct Obstruction)  (+%2±2EVWUXomRELOLDUH[WUDKHSiWLFD Extrahepatic Biliary Tract Obstruction) 

)$±)RVIDWDVHDOFDOLQD        

)'0±)DWRUGHSUHVVRUGRPLRFiUGLR       

)H/9±9tUXVGDOHXFHPLDIHOLQD feline Leukemia Virus)    

)L±)UHTXrQFLDUHODWLYD        

),9±9tUXVGDLPXQRGHILFLrQFLDIHOLQD      

I3/,±,PXQRUUHDWLYLGDGHjOLSDVHSDQFUHiWLFDIHOLQD (feline Pancreatic Lipase Immunoreactivity)

)5±)UHTXrQFLDDEVROXWD       

(2±(VItQFWHUGHOddi       

**7±*DPD*OXWDPLO7UDQVIHUDVH      

(18)



*+,+ ± )DWRU LQLELWyULR GD KRUPRQD GH FUHVFLPHQWR Growth hormone-inhibiting hormone) *,±*DVWURLQWHVWLQDO        

+±,mRKLGURJpQLR       

+&2±,mRELFDUERQDWR        

+590±+RVSLWDO5HIHUrQFLD9HWHULQiULD0RQWHQHJUR   

,%'±'RHQoDLQIODPDWyULDLQWHVWLQDO (Inflammatory Bowel Disease) ,&$0±0ROpFXODGHDGHVmRLQWHUFHOXODU      ,/±,QWHUOHXFLQD   ,0±YLDLQWUDPXVFXODU        ,3(±,QVXILFLrQFLDSDQFUHiWLFDH[yFULQD  ,5±,QVXILFLrQFLDUHQDO  ,5$±,QVXILFLrQFLDUHQDODJXGD        ,5&±,QVXILFLrQFLDUHQDOFUyQLFD       ,9±$GPLQLVWUDomRLQWUDYHQRVD        .±,mRSRWiVVLR          /3(±(QWHULWHOLQIRFtWLFDSODVPRFLWiULD Lymphocytic-Plasmacytic Enteritis) 

0+&±&RPSOH[RPDLRUGHKLVWRFRPSDWLELOLGDGH Major Histocompatibility Complex) 

02'6±(VWDGRGHIDOKDPXOWLRUJkQLFD Multiorgan Dysfunction Syndrome)  

1D±,mRVyGLR          1D&O±&ORUHWRGHVyGLR        1(±1XWULomRHQWHUDO          1)N%±)DWRUQXFOHDUNDSSD%      1*±1DVRJiVWULFR          12±Ï[LGRQtWULFR 13±1XWULomRSDUHQWHUDO        

2637±7HPSRGHSURWURPELQD (One-Stage Prothrombin Time) 

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3$)±)DWRUGHDJUHJDomRSODTXHWiULD (Platelet-Activating Factor)   

3$0±3UHVVmRDUWHULDOPpGLD 3$1±3DQFUHDWLWHDJXGDQHFURWL]DQWH   3$1,±3UHVVmRDUWHULDOQmRLQYDVLYD       3$6±3DQFUHDWLWHDJXGDVXSXUDWLYD        3&± 3DQFUHDWLWHFUyQLFD 3,)±3HULWRQLWHLQIHFLRVDIHOLQD        

3,9.$ ± )DWRUHV GH FRDJXODomR GHSHQGHQWHV GH 9LWDPLQD . Proteins Induced by Vitamin K Antagonism)

3/$±)RVIROLSDVH$       

(19)

33±3ROLSpSWLGRSDQFUHiWLFR      

331±1XWULomRSDUHQWHUDOSDUFLDO (Partial Parenteral Nutrition)

367,±,QLELGRUGDVHFUHomRSDQFUHiWLFDGHWULSVLQD (Pancreatic Secretor Trypsin Inhibitor) 37±7HPSRGHSURWURPELQD Protrombine Time 

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526±(VSpFLHVGHR[LJpQLRUHDWLYDV (Reactive Oxygen Species)

6&±9LDVXEFXWkQHD         

6,%2±6REUHFUHVFLPHQWREDFWHULDQR Small Intestinal Bacterial Overgrowth  6,'±8PDYH]SRUGLD(Semel in Die)

6,56 ± 6tQGURPH GD UHVSRVWD LQIODPDWyULD VLVWpPLFD (Systemic Inflammatory Response Syndrome)

61$±6LVWHPDQHUYRVRDXWyQRPR 61&±6LVWHPDQHUYRVRFHQWUDO

6SHFF3/±/LSDVHHVSHFtILFDSDQFUHiWLFDFDQLQD(canine pancreatic-specific lipase) 6SHFI3/±/LSDVHHVSHFtILFDSDQFUHiWLFDIHOLQD(feline pancreatic-specific lipase) 63,1.±6LQyQLPRGH367, (Serine protéase Inhibitor Kazal-type 1 

65$±6LVWHPDUHQLQDDQJLRWHQVLQD

7$3±3pSWLGRDWLYDGRUGRWULSVLQRJpQLR (Trypsinogen Activation Peptide)  

7&±7RPRJUDILDFRPSXWRUL]DGD      

7,'7UrVYH]HVDRGLD(three times a day)

7/,±$WLYLGDGHLPXQRUUHDWLYDGDWULSVLQD (Serum Trypsin-like Immunoreactivity  71)±)DWRUGHQHFURVHWXPRUDO

731±1XWULomRSDUHQWHUDOWRWDO (Total Parenteral Nutrition) 735±7HPSHUDWXUDSXOVRHUHVSLUDomR

8,±8QLGDGHVLQWHUQDFLRQDLV

87&5±5iFLRXULQiULR7$3FUHDWLQLQD (Urinary TAP-Creatinine Ratio) 9,3±3pSWLGRYDVRDWLYRLQWHVWLQDO (Vasoactiveintestinalpeptide)

96)&9 - (VWLUSHYLUXOHQWDGRFDOLFLYtUXVIHOLQR VirulentSystemic Feline Calicivirus) 9/'/±/LSRSURWHtQDVGHEDL[DGHQVLGDGH (Very Low Density Lipoproteins 

(20)



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(21)

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(22)

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(23)

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(24)



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(25)

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(26)

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 2V SDFLHQWHV FRP FRQYXOV}HV ± status epilepticus ± H[LJLUDP UiSLGD LQWHUYHQomR H PRQLWRUL]DomR DSHUWDGD GH IRUPD D PDQWHU D WHPSHUDWXUD FRUSRUDO QRUPDO GLPLQXLU D SUREDELOLGDGH GH GHVHQYROYLPHQWR GH HGHPD FHUHEUDO H SDUDU D DWLYLGDGH FRQYXOVLYD FRQWLQXDGD(VWDFRQGLomRDWULEXLVHjHSLOHSVLDLGLRSiWLFDFRQWXGRVmRPXLWDVDVFDXVDVTXH SRGHPVHUFRQVLGHUDGDVWDQWR±H[WUDFUDQLDQDV±FRPRGLVW~UELRVPHWDEyOLFRVSRUH[HPSOR KLSRJOLFHPLD VLWXDomR GH KLSRFDOFpPLD HQFHIDORSDWLD KHSiWLFD RX Wy[LFRV FRPR RUJDQRVIRVIRUDGRV H FKXPER DVVLP FRPR ± FDXVDV LQWUDFUDQLDQDV (PERUD FRQWURYHUVR D SULPHLUD OLQKD GH WUDWDPHQWR FRQVLVWH QD DGPLQLVWUDomR GH EHQ]RGLD]HSLQDV QmR VHQGR UHFRPHQGDGDVHPFDVRGHKLSRJOLFpPLDRXKLSHUDPRQLpPLD2PLGD]RODPSRGHVHUXVDGRHP SURO GR GLD]HSDP GHYLGR j VXD PHWDEROL]DomR H H[FLSLHQWH SURSLOHQRJOLFRO  GHYHQGR R GLD]HSDP VHU UHVWULQJLGR HP VLWXDo}HV GH HQFHIDORSDWLD KHSiWLFD SRU LQGX]LU LQVXILFLrQFLD KHSiWLFDFRPROLSLGRVHKHSiWLFD6HJXHVHRXVRGHIHQREDUELWDO OLQKD RXSURSRIRO OLQKD  HVWH~OWLPRGHXVRFRQWURYHUVRGHYLGRjH[LVWrQFLDGHHVWXGRVTXHHYLGHQFLDPDLQGXomRGH FRQYXOV}HV SRU VL Vy 2XWURV IiUPDFRV FRPR LPHSLWRtQD OHYHWLUDFHWDP EURPHWR GH SRWiVVLR QXQFD HP JDWRV  H EURPHWR GH VyGLR LQWUDYHQRVR  SRGHP VHU DGPLQLVWUDGRV DTXDQGR GD SHUPDQrQFLDGRHVWDGRFRQYXOVLYR&RQWXGRUHFHQWHPHQWHR/HYHWLUDFHWDPWRUQRXVHR DQWLFRQYXOVLYRGHSULPHLUDOLQKDHVSHFLDOPHQWHHPSDFLHQWHVFRPHQFHIDORSDWLDKHSiWLFDGHYLGR jVXDPHWDEROL]DomRSRUSURWHtQDVVpULFDV  HRXWURVyUJmRVH[WUDKHSiWLFRV

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Imagem

Tabela 30 - 3ULQFLSDLVGLDJQyVWLFRVGLIHUHQFLDLVGHSDQFUHDWLWHDJXGDHPJDWRV (adaptado de  Schaer, 2009, Plunkett, 2011 & Linklater, 2014)

Referências

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