81,9(56,'$'('(e925$
(6&2/$'(&,Ç1&,$6(7(&12/2*,$
'(3$57$0(172'(0(',&,1$9(7(5,1È5,$
Clínica Médica e Cirúrgica em Animais
de Companhia
3DQFUHDWLWHHP$QLPDLVGH&RPSDQKLD
Cátia Conceição da Encarnação Fernandes
2ULHQWDomR
'RXWRU5LFDUGR-RUJH3DOPHLUR5RPmR
&RRULHQWDomR
'RXWRU/XtV0LJXHO)RQWH0RQWHQHJUR
0HVWUDGRHP0HGLFLQD9HWHULQiULD ÈUHDGHHVSHFLDOL]DomR&LrQFLDV&OtQLFDV 5HODWyULRGHHVWiJLR eYRUDEste relatório de estágio não inclui as críticas e sugestões feitas pelo júri
81,9(56,'$'('(e925$
(6&2/$'(&,Ç1&,$6(7(&12/2*,$
'(3$57$0(172'(0(',&,1$9(7(5,1È5,$
Clínica Médica e Cirúrgica em Animais
de Companhia
3DQFUHDWLWHHP$QLPDLVGH&RPSDQKLD
Cátia Conceição da Encarnação Fernandes
2ULHQWDomR
'RXWRU5LFDUGR-RUJH3DOPHLUR5RPmR
&RRULHQWDomR
'RXWRU/XtV0LJXHO)RQWH0RQWHQHJUR
0HVWUDGRHP0HGLFLQD9HWHULQiULD ÈUHDGHHVSHFLDOL]DomR&LrQFLDV&OtQLFDV 5HODWyULRGHHVWiJLR eYRUD(VWDSiJLQDHVWiHPEUDQFRSURSRVLWDGDPHQWH
$JUDGHFLPHQWRV
$R PHX RULHQWDGRU 'U 5LFDUGR 5RPmR SHOD GLVSRQLELOLGDGH SHOD SDUWLOKD GH FRQKHFLPHQWRVDMXGDHFRQVHOKRVVREUHDHODERUDomRGHVWDWHVHGH0HVWUDGR
$R'U/XtV0RQWHQHJURSRUPHWHUFRQFHGLGRDRSRUWXQLGDGHGHDSUHQGHUFRQVLJRH FRPDVXDHTXLSDSRUWRGRVRVHVFODUHFLPHQWRVHKRVSLWDOLGDGH $WRGDDHTXLSDGR+RVSLWDOGH5HIHUrQFLD9HWHULQiULD0RQWHQHJURH&OtQLFDTXHPH UHFHEHUDPGXUDQWHRVVHLVPHVHVFRPVRUULVRVHERDGLVSRVLomRHSRUWRGRVRVHQVLQDPHQWRVH FRQVHOKRV $RVHVWDJLiULRVTXHVHWRUQDUDPJUDQGHVFRPSDQKHLURVGHVWDFDPLQKDGD6HPYRFrVD YLGDGHHVWDJLiULRQmRWHULDDPHVPDSLDGDGHVGHDVPDLVLQWHUQDFLRQDLV6DPDUDH5RVHOODj -XOLH9kQLD/LSD/LWD*RQoDOR$OH[DQGUD.DULQ+XJRHFODURDRVFRQWHUUkQHRVGHHVWXGR HERUHQVH(XULFR'LDQD0DUWDH6DUDSRUWHUHPVLGRXPJUDQGHDSRLR $WRGDDHTXLSDGR&HQWUR+RVSLWDO9HWHULQiULRSRUPHWHUDFHLWHGHEUDoRVDEHUWRVHSRU PHID]HUVHQWLUFUHVFHUSURILVVLRQDOPHQWH8PJUDQGHREULJDGRDR'U$QGUp3HUHLUDHDR'U &DUORV $GUHJD SRU WRGD D VLPSDWLD GHVGH R SULPHLUR GLD ERD GLVSRVLomR H FRQKHFLPHQWRV WUDQVPLWLGRV 2EULJDGD D WRGD D HTXLSD SHOD RSRUWXQLGDGH GHVDILRV ODQoDGRV VLPSDWLD H H[LJrQFLD(XPHVSHFLDODJUDGHFLPHQWRjHTXLSDGHHQIHUPDJHPSRUWRGDVDVULVDGDVSDFLrQFLD HGHGLFDomR)RUDPVHPG~YLGDGRLVPHVHVHQULTXHFHGRUHVHGLYHUWLGRV
¬HTXLSDGR/DERUDWyULR,112RQGHUHDOL]HLRPHXSULPHLURHVWiJLRH[WUDFXUULFXODUH DGTXLUL FRQKHFLPHQWRV EDVH TXH VH UHYHODUDP LPSRUWDQWHV QD FODULILFDomR GH FRQFHLWRV FLHQWtILFRVDGTXLULGRVDWpHQWmR
¬-RDQD9HQWXUDSHODH[FHOHQWHSHVVRDSRUWRGDDIRUoDHDPL]DGHLQFRQGLFLRQDO ¬/DUD6LOYD6DEULQD*XHUUHLUR'pERUD0DUWLQV6yQLD3HUHLUDH/HRQRU*DUFLDDPLJDV GHORQJDGDWDTXHPHVPRORQJHVHPSUHPHLQFHQWLYDUDPHHQFRUDMDUDPDLUPDLVDOpP2³c’est
la vie”QmRWHPRPHVPRVHQWLGRVHPYRFrV
¬ PLQKD WLD /tGLD 'XDUWH SHODV SDODYUDV FDORURVDV LQLQWHUUXSWDV DR ORQJR GR PHX SHUFXUVRDFDGpPLFR
$RV PHXV SDLV 0DULD +HOHQD )HUQDQGHV H -DLPH )HUQDQGHV SRU VHUHP XP DSRLR LQFRQGLFLRQDOHPWRGDVDVHWDSDVGDPLQKDYLGDHDMXGDUHPDFRQFUHWL]DURVPHXVREMHWLYRV SHODFRQILDQoDHHVIRUoRTXHIL]HUDPSDUDTXHWXGRLVWRIRVVHSRVVtYHOPXLWRREULJDGD2UJXOKR PHGRVYDORUHVWUDQVPLWLGRVGDSHUVHYHUDQoDHRSWLPLVPRTXHVmRRUHIOH[RGRTXHVRX0XLWR REULJDGD(VSHURFRQVHJXLUUHWULEXLUWXGRRTXHIL]HUDPHID]HPSRUPLP
$R5LFDUGR/RSHVSHODDPL]DGHLQFRQGLFLRQDOFRPSDQKHLULVPRGHDUPDVHVRUULVRVH PRPHQWRV SDUWLOKDGRV 2EULJDGD SRU WRGR R DSRLR e FRP JUDQGH RUJXOKR TXH FKHJDPRV LQYHQFtYHLVDRILQDOGHVWDHWDSD
¬'0DULD-RVp/RSHVH6U-RmR/RSHVSRUWRGDDVLPSDWLDHRSWLPLVPRWUDQVPLWLGRV ¬0DULDQD0DFLHOSRUWRGDDDPL]DGHULVDGDRWLPLVPRFRQWDJLDQWHHSDFLrQFLDPXLWD SDFLrQFLD«SDUDPHDWXUDUPHVPRHPWHUUDVIUDQFHVDV
$ WRGRV RV DQLPDLV TXH SHUGL DR ORQJR GHVWD FDPLQKDGD H TXH PH PRWLYDUDP HQFRUDMDUDPHLQVSLUDUDPDTXHUHUD0HGLFLQD9HWHULQiULDFRPRXPDGDVYHUWHQWHVLQWUtQVHFDV GDPLQKDYLGD
(DWL=pDY{-RVp5DPLUHVDSHVDUGHMiQmRHVWDUHVFiHVSHURTXHHVWHMDVRUJXOKRVR GHVWDSHTXHQLQDJUDQGHIDoDQKD23RUWRIRLXPDFRQTXLVWDTXHQmRFRQVHJXLVWHDVVLVWLU«QmR SRVVR DEUDoDUWH PDV HVSHUR TXH R PHX [LFRUDomR GH DJUDGHFLPHQWR HWHUQR FKHLR GH VDXGDGHVYiDWpWL
“Recomeça... se puderes, sem angústia e sem pressa e os passos que deres, nesse caminho duro do futuro, dá-os em liberdade, enquanto não alcances não descanses, de nenhum fruto queiras só metade.”
Miguel Torga
5HVXPR
3DQFUHDWLWHHP$QLPDLVGH&RPSDQKLD
(VWHUHODWyULRDSUHVHQWDDFRQFOXVmRGHVHLVPHVHVGHHVWiJLRFXUULFXODULQFRUSRUDGRQR 0HVWUDGR ,QWHJUDGR HP 0HGLFLQD 9HWHULQiULD H GHVFUHYH DV DWLYLGDGHV PpGLFRYHWHULQiULDV UHDOL]DGDVHDVVLVWLGDVQXP+RVSLWDOH&OtQLFDGHUHIHUrQFLD7HPFRPRSDUWHLQWHJUDQWHXPD UHYLVmRELEOLRJUiILFDPpGLFDDWXDOGRestado de arteGD3DQFUHDWLWHHP$QLPDLVGH&RPSDQKLDH SRVWHULRUGLVFXVVmRGHFDVRVFOtQLFRV $SDQFUHDWLWHpXPDGRHQoDLQIODPDWyULDGHSDUWLFXODULPSRUWkQFLD2VHXFRPSRUWDPHQWR GLQkPLFR H DV HVSpFLHV DQLPDLV DWLQJLGDV GHWHUPLQDP D VXD LPSUHYLVLELOLGDGH 1RV JDWRV D SRVVtYHODVVRFLDomRGHRXWUDVFRPRUELOLGDGHVLQIODPDWyULDVWRUQDSRUYH]HVDSDQFUHDWLWHXP GHVDILR (VWXGRVUHFHQWHVFRQIHUHPXPDQRYDYLVmRVREUHHVWDGRHQoDTXHDWpHQWmRHUDWXUYD SRXFRFRPSUHHQGLGDHDVVHQWHHPDOJXQVDVSHWRVTXHKRMHVHFRQILUPDPWRWDOPHQWHSDUDGR[DLV HHUUiWLFRV2IRFRGLULJHVHSDUDDQXWULomRHQWHUDOSUHFRFHHjFRPELQDomRGDPHQVXUDomRGD OLSDVHSDQFUHiWLFDHHFRJUDILDFRPRRVPHLRVGHGLDJQyVWLFRGHHOHLomR 3DODYUDVFKDYHSkQFUHDVSDQFUHDWLWHFDQLQDSDQFUHDWLWHIHOLQDGLDJQyVWLFRGRHQoD FRQFRPLWDQWH
$EVWUDFW
3DQFUHDWLWLVLQ&RPSDQLRQ$QLPDOV
7KLV 5HSRUW SUHVHQWV WKH FRQFOXVLRQ RI D VL[ PRQWKV RI LQWHUQVKLS LQFRUSRUDWHG LQWR 9HWHULQDU\ 0HGLFLQH 0DVWHU¶V GHJUHH DQG LV LQWHQGHG WR GHVFULEH WKH PHGLFDO DQG YHWHULQDU\ DFWLYLWLHV GRQH DQG DVVLVWHG LQ D KRVSLWDO DQG UHIHUHQFH FOLQLF ,W LQFOXGHV D UHYLHZ RI FXUUHQW PHGLFDOOLWHUDWXUHRQstate of the scienceUHJDUGLQJ3DQFUHDWLWLVLQ&RPSDQLRQ$QLPDOVDQGIXUWKHU
GLVFXVVLRQRIFOLQLFDOFDVHV
3DQFUHDWLWLV LV DQ LQIODPPDWRU\ GLVHDVH RI SDUWLFXODU LPSRUWDQFH ,WV G\QDPLF EHKDYLRU DQG WKH DIIHFWHG DQLPDO VSHFLHV GHWHUPLQH LWV XQSUHGLFWDELOLW\ ,Q FDWV GXH WR WKH SRVVLEOH DVVRFLDWLRQ RI WKH RWKHU FRPRUELGLWLHV RI LQIODPPDWRU\ QDWXUH PDNH VRPHWLPHV SDQFUHDWLWLV D
FKDOOHQJH
5HFHQWVWXGLHVSURYLGHQHZLQVLJKWLQWRWKLVGLVHDVHZKLFKXQWLOQRZZDVEOXUUHGSRRUO\ XQGHUVWRRGDQGEDVHGRQVRPHDVSHFWVWKDWWRGD\DUHFRQVLGHUHGFRPSOHWHO\SDUDGR[LFDODQG HUUDWLF&XUUHQWO\ WKH IRFXV LV GLUHFWHG WR WKH HDUO\ HQWHUDO QXWULWLRQ DQG LQ ZKDW FRQFHUQV WKH GLDJQRVLV RI SDQFUHDWLWLV PHDVXUHPHQW RI SDQFUHDWLF OLSDVH DQG XOWUDVRXQG DUH SUHIHUUHG WRROVPHWKRGV .H\ZRUGVSDQFUHDVFDQLQHSDQFUHDWLWLVIHOLQHSDQFUHDWLWLVGLDJQRVLVFRQFRPLWDQWH GLVHDVH
ËQGLFH*HUDO
&DStWXOR5HODWyULRGHFDVXtVWLFD««««««««««««««««««««« ,QWURGXomR««««««««««««««««««««««««««««««««« 'HVFULomRGRORFDOGHHVWiJLR««««««««««««««««««««««««« &DVXtVWLFD«««««««««««««««««««««««««««««««««« &OtQLFD0pGLFD 0HGLFLQDODERUDWRULDO 0HGLFLQDHVWRPDWROyJLFRGHQWiULD *DVWURHQWHURORJLD (PHUJrQFLDVHFXLGDGRVLQWHQVLYRV &DUGLRORJLD 'HUPDWRORJLD (QGRFULQRORJLD 1HXURORJLD 2QFRORJLD«««««««««««««««««««««««««««« 2IWDOPRORJLD 2WRORJLD 3QHXPRORJLD 8URORJLDHQHIURORJLD 'RHQoDVLQIHWRFRQWDJLRVDV 0HGLFLQDItVLFDHGHUHDELOLWDomR 0HGLFLQDGDUHSURGXomR 0HGLFLQD3UHYHQWLYD &OtQLFD&LU~UJLFD &LUXUJLDGHWHFLGRVPROHV &LUXUJLDGHRUWRSHGLDHWUDXPDWRORJLD 1HXURFLUXUJLD $QHVWHVLRORJLDH,PDJLRORJLD 3DQFUHDWLWHHP$QLPDLVGH&RPSDQKLD 3UHIiFLR &DStWXOR&RQVLGHUDo}HVDQDWyPLFDVHIXQFLRQDLVSDQFUHiWLFDV ,QWURGXomR««««««««««««««««««««««««««««««««« $QDWRPLDSDQFUHiWLFDORFDOL]DomRHFDUDFWHUL]DomR 9DVFXODUL]DomRDUWHULDOHGUHQDJHPYHQRVD ,QHUYDomRHGUHQDJHPOLQIiWLFD&DStWXOR)LVLRORJLDSDQFUHiWLFD 3kQFUHDVH[yFULQRHHQGyFULQR 3kQFUHDVH[yFULQR &pOXODVGRVGXFWRV &pOXODVDFLQDUHV 5HJXODomRGDVHFUHomRSDQFUHiWLFDH[yFULQD ««««««««««««««« 3kQFUHDVHQGyFULQR +RUPRQDVHDVXDLQIOXrQFLDQRPHWDEROLVPRGDJOXFRVH«« &DStWXOR3DWRILVLRORJLDGDSDQFUHDWLWH 3DWRILVLRORJLD«««««««««««««««««««««««««««««««« (YHQWRVFHOXODUHV,QLFLDLV 'LDSHGHVHHPHGLDGRUHVLQIODPDWyULRV &RPSOLFDo}HVGDSDQFUHDWLWH &DStWXOR3DQFUHDWLWHHPDQLPDLVGHFRPSDQKLD 3UHYDOrQFLD««««««««««««««««««««««««««««««««« &ODVVLILFDomRKLVWRSDWROyJLFD /HV}HVSDQFUHiWLFDVQRFmRvsJDWR (WLRORJLD««««««««««««««««««««««««««««««««« )DWRUHVGHULVFR ,GDGHSUHGLVSRVLomRUDFLDOHJpQHUR« 'LHWDVULFDVHPJRUGXUD« 'RHQoDVHQGyFULQDVDVVRFLDGDVDKLSHUOLSLGpPLD« 'LDEHWHV 'LDEHWHVFHWRDFLGyWLFD'.$ 5HIOX[RGHIOXtGRGXRGHQDO« 2EVWUXomRGRGXFWRSDQFUHiWLFR« )iUPDFRV««««««««««««««««««««««««««««««« ,QIHomR««««««««««««««««««««««««««««««« ,VTXpPLDHWUDXPDSDQFUHiWLFR« +LSHUFDOFpPLD« ,QWR[LFDomRSRURUJDQRIRVIRUDGRV««««««««««««««««««« /LSRGLVWURILD« 'RHQoDGRWUDWRELOLDUFRQFRPLWDQWH 'RHQoDGRWUDWRJDVWURLQWHVWLQDOFRQFRPLWDQWH«««««««««««««« 'LDJQyVWLFRGHSDQFUHDWLWH 6LQDLVFOtQLFRV«
+HPDWRORJLD« %LRTXtPLFDVVpULFDV« 8ULDQiOLVH« 2XWURVDFKDGRVODERUDWRULDLV« 'LDJQyVWLFRGLIHUHQFLDO« 'LDJQyVWLFRLPDJLROyJLFR 5DGLRORJLD« 8OWUDVVRQRJUDILDDEGRPLQDO«««««««««««««««««««««««« 5HVVRQkQFLDPDJQpWLFD50 7RPRJUDILDFRPSXWRUL]DGD7&«««««««««««««««««««««« 8OWUDVVRQRJUDILDHQGRVFySLFDRXHFRHQGRVFRSLD &LQWLJUDILDSDQFUHiWLFD« 'LDJQyVWLFRVRUROyJLFR $WLYLGDGHGDDPLODVHHOLSDVH««««««««««««««««««««««« $YDOLDomRGDDWLYLGDGHGDOLSDVHQRIOXtGRSHULWRQHDO $WLYLGDGHLPXQRUUHDWLYDGDWULSVLQD7/,«««««««««««««««««« 'RVDJHPGRSpSWLGRDWLYDGRUGRWULSVLQRJpQLR7$3 $WLYLGDGHLPXQRUUHDWLYDjOLSDVHSDQFUHiWLFDFDQLQDF3/,HIHOLQDI3/,QRVRUR 3RWHQFLDLVWHVWHVGHGLDJQyVWLFR±SHUVSHFWLYDVIXWXUDV 'LDJQyVWLFRFHOXODUHWHFLGXODU &LWRORJLD %LRSVLDSDQFUHiWLFD« &RQVLGHUDo}HVDQHVWpVLFDV 7HUDSrXWLFDPpGLFD )OXLGRWHUDSLD« 7UDQVIXVmRGHSODVPD«««««««««««««««««««««««««« $QDOJHVLD 0DQHLRGRYyPLWR«««««««««««««««««««««««««««« *DVWURSURWHWRUHV« (VWLPXODQWHVGRDSHWLWH« *OXFRFRUWLFyLGHVH,PXQRPRGHODGRUHV $QWLELRWHUDSLD« ,QLELGRUHVGHSURWHDVHV« /DYDJHPSHULWRQHDO« 7UDWDPHQWRHSUHYHQomRGH&,'«««««««««««««««««««« 6XSOHPHQWDomRFRPFREDODPLQDYLWDPLQD% 7HUDSLDDQWLR[LGDQWH««««««««««««««««««««««««« 7HUDSLDLQVXOtQLFD«««««««««««««««««««««««««««
2XWURVWUDWDPHQWRV 1XWULomR 'RJPDMHMXP(“nil per os”)vs eVWLPXODomRSDQFUHiWLFD
9yPLWRFRPRIDWRUFRQGLFLRQDQWH««««««««««««««««««««« 1XWULomRHQWHUDO1( 7XERVGHDOLPHQWDomR«««««««««««««««««««««««« 1XWULomRSDUHQWHUDO13 'LHWD 7UDWDPHQWRFLU~UJLFR &XLGDGRVSyVFLU~UJLFRV««««««««««««««««««««««««« 0RQLWRUL]DomR««««««««««««««««««««««««««««««« 6LVWHPDVGHFODVVLILFDomRFOtQLFD ,QGLFDGRUHVGHSURJQyVWLFR« &DStWXOR&DVRVFOtQLFRV 6LQDLV&OtQLFRV«««««««««««««««««««««««««««««««« +LVWRULDOFOtQLFR««««« 3DWRORJLDFOtQLFD««««««««««««««««««««««««««««««« 0HLRVFRPSOHPHQWDUHVGHGLDJQyVWLFR 7HUDSrXWLFDHPRQLWRUL]DomR (YROXomRFOtQLFD««««««««««««««««««««««««««««««« 'LVFXVVmR««««««««««««««««««««««««««««««««« &DStWXOR&RQFOXVmR %LEOLRJUDILD
ËQGLFHGH)LJXUDV
)LJXUD'LODWDomRHWRUomRJiVWULFDHPFDQtGHR(Fonte: Autor. Cortesia de HRVM, 2014) )LJXUD&RUSRHVWUDQKRPHWiOLFRHPFDQtGHR(Fonte: Autor. Cortesia de HRVM, 2014) )LJXUD'HVFRPSUHVVmRJiVWULFDGHFDQtGHRFRPGLODWDomRYyOYXORJiVWULFD(Foto gentilmente cedida por Mariana Maciel. Cortesia de HRVM, 2014)««««««««««« )LJXUD)HOtGHRFRP~OFHUDHVWURPDOSURIXQGD (Fonte: Autor. Cortesia de HRVM, 2014) )LJXUD3DFLHQWHIHOLQRFRP~OFHUDFRUQHDOVXSHUILFLDOHVHTXHVWURFRUQHDOOHVmRUHGRQGD
FHQWUDOGHFRUDPDUHOD(Fonte: Autor. Cortesia de HRVM, 2014)
)LJXUD7&UHDOL]DGDjFROXQDWRUDFRORPEDUGHFDQtGHRFRP+pUQLDWLSR,,HP7/H
+pUQLDWLSR,HP//VXSHULRU(Fonte: Autor. Cortesia de HRVM, 2013)
)LJXUD5HODomRDQDWyPLFDHQWUHRSkQFUHDVHRVUHVWDQWHVyUJmRV(adaptado de Tobias & Johnston, 2013) )LJXUD9LVWDYHQWUDOGRDEGyPHQGHSkQFUHDVFDQLQR$HIHOLQR%HDVXDUHODomRFRPDV HVWUXWXUDVDGMDFHQWHV(adaptado de Washabau, 2013) )LJXUD5HSUHVHQWDomRHVTXHPiWLFDGRIOX[RELOLDUHPFmHVHJDWRV(QXPHUDomRSRURUGHP VLVWHPiWLFDGDVHVWUXWXUDVTXHUHDOL]DPDGUHQDJHPELOLDU0HPEUDQDVGRVKHSDWyFLWRV FDQDOtFXORVFDQDLVGH+HULQJGXFWRVELOLDUHVGXFWRVLQWHUOREXODUHVGXFWRVVHSWDLV GXFWRVKLODUHVGXFWRELOLDUFRPXPRXGXFWRFROpGRFRGXRGHQRSDSLODGH9DWHU YHVtFXODELOLDUHGXFWRFtVWLFR(Steiner, 2008) )LJXUD$,UULJDomRVDQJXtQHDGRSkQFUHDVGHFmR%'UHQDJHPYHQRVDGRSkQFUHDVGH FmR(adaptado de Cáceres, 2011)
)LJXUD 'LDJUDPD HVTXHPiWLFR OREXODU TXH GHPRQVWUD D UHODomR HQWUH DV LOKRWDV GH
/DQJHUKDQVSkQFUHDVHQGyFULQRHFpOXODVDFLQDUHVSkQFUHDVH[yFULQR(adaptado de Goldfine
& Williams, 1983) )LJXUD 2UJDQL]DomR HVWUXWXUDO GR SkQFUHDV H[yFULQR H HQGyFULQR (Adaptado de Efrat & Russ, 2012)«««««««««««««««««««««««««««««««««««« )LJXUD,PDJHPKLVWROyJLFDGHSkQFUHDV+ ([(Monteiro & Faísca, 2007)««« )LJXUD$EVRUomRGHFREDODPLQDQDGLHWD(Washabau & Day, 2013)««««««««« )LJXUD'HPRQVWUDomRGDWHRULDGHFRORFDOL]DomR(adaptado de Mansfield, 2012)……….. )LJXUD3kQFUHDVFRPQHFURVHQDJRUGXUDSHULSDQFUHiWLFD(Steiner, 2008)«««««« )LJXUD $ ,QWHVWLQR GHOJDGR VDXGiYHO FRP HQ]LPDV GLJHVWLYDV VtPERORV D]XLV TXH
GHJUDGDP R DOLPHQWR QR LQWHULRU GR O~PHQ GR LQWHVWLQR GHOJDGR % DXWRGLJHVWmR GR LQWHVWLQR LQtFLR GR HVWDGR GH FKRTXH FRP OLEHUWDomR GH HQ]LPDV GLJHVWLYDV SDQFUHiWLFDV DWUDYpV GR SHULWRQHX YHLD SRUWD H YDVRV OLQIiWLFRV GR LQWHVWLQR FRP FRQVHTXHQWH GHJUDGDomR WHFLGXDO H 02'6(adaptado de DeLano et al. 2013)««««««««««««««««««««
)LJXUD 5DGLRJUDILD DEGRPLQDO FRP SHUGD GH FRQWUDVWH QR DEGyPHQ FUDQLDO DVVRFLDGR D
)LJXUD$(L[RORQJRGRORERHVTXHUGRGHSkQFUHDVFDQLQRFRPHGHPDSDQFUHiWLFR%
,PDJHPWUDQVYHUVDOGRDEGyPHQFUDQLDO/RERGLUHLWRGRSkQFUHDVFRPOHVmRFDYLWiULDVHWDV FRP PDWHULDO HFRJpQLFR H UHPDQHVFHQWH GR ORER GLUHLWR SDQFUHiWLFR FRUSR SDQFUHiWLFR FRP VLQDLVGHSDQFUHDWLWHVHYHUD(Washabau & Day, 2013)……….... ………….……….
)LJXUD ,PDJHP HFRJUiILFD GH JDWR FRP SDQFUHDWLWH DJXGD QHFURWL]DQWH $ SkQFUHDV
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$3 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)«««««««««««««««««««««««
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$QHVWHVLRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH,PDJLRORJLD 7DEHOD3URGXWRGDVFpOXODVDFLQDUHVSDQFUHiWLFDVHDVVXDVIXQo}HV(adaptado de Tobias & Johnston, 2011) 7DEHOD 3DSHO GDV HQ]LPDV H PHGLDGRUHV LQIODPDWyULRV QD ILVLRSDWRORJLD GD SDQFUHDWLWH (adaptado de Williams, 2005 & Mansfield, 2012) 7DEHOD6XEVWkQFLDVDVVRFLDGDVDRGHVHQYROYLPHQWRGHSDQFUHDWLWHFDQLQD(adaptado de Washabau & Day, 2013, William, 2006 & Etthinger, 2007) 7DEHOD 3ULQFLSDLV GLDJQyVWLFRV GLIHUHQFLDLV GH SDQFUHDWLWH DJXGD HP FmHV (adaptado de Schaer, 2009 & Plunkett, 2011) 7DEHOD3ULQFLSDLVGLDJQyVWLFRVGLIHUHQFLDLVGHSDQFUHDWLWHDJXGDHPJDWRV(adaptado de Schaer, 2009, Plunkett, 2011 & Linklater, 2014)7DEHOD'LPHQV}HVXOWUDVVRQRJUiILFDVQRUPDLVGRSkQFUHDVIHOLQR(adaptado de Washabau & Day, 2013) 7DEHOD'URJDVDQHVWpVLFDVHDVVXDVLQGLFDo}HVHPGRHQWHVSDQFUHiWLFRV(adaptado de Tobias & Johnston, 2013) 7DEHOD'URJDVDQDOJpVLFDVIUHTXHQWHPHQWHDGPLQLVWUDGDVQDSDQFUHDWLWHIHOLQD(adaptado de Langley-Hobbs et al. 2013, Zoran, 2012 & Xenoulis et al. 2008) 7DEHOD3URWRFRORGHLQVXOLQDHIOXLGRWHUDSLDLQWUDYHQRVD,9DSOLFDGRQRFmRHJDWRFRP
'.$(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[DGHPRUWDOLGDGHHPFmHV
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 $OWHUDo}HV FOtQLFRSDWROyJLFDV DSUHVHQWDGDV SHORV SDFLHQWHV GLDJQRVWLFDGRV FRP
SDQFUHDWLWHQR+590(Fonte: Autor. Cortesia de HRVM, 2014)
7DEHOD5HVXOWDGRVREWLGRVGHXULDQiOLVHWLSR,UHODWLYRVDRSDFLHQWHIHOLQRFRP(+%2(Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD9DORUHVGRVSDUkPHWURVELRTXtPLFRVGHJDWRQmRHVWDELOL]DGRFRP(+%2(Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD9DORUHVGHJDVRPHWULDYHQRVDYHLDMXJXODUGHJDWRQmRHVWDELOL]DGRFRP(+%2 (Fonte: Autor. Cortesia de HRVM, 2014) 7DEHOD (YROXomR GRV QtYHLV GH ELOLUUXELQD WRWDO DR ORQJR GR LQWHUQDPHQWR (Fonte: Autor. Cortesia de HRVM, 2014)
ËQGLFHGH*UiILFRV
*UiILFR&DVXtVWLFDVHJXQGRÈUHDV&OtQLFDV *UiILFR&DVXtVWLFDGDVGLIHUHQWHViUHDVGH&OtQLFD0pGLFD *UiILFR5HSUHVHQWDomRGDVHFUHomRGHFORURHELFDUQRQDWRHPEDL[DVHHOHYDGDVWD[DVGHVHFUHomRREVHUYDGDVQXPSkQFUHDVFDQLQR(Washabau & Day, 2013)
*UiILFR )UHTXrQFLDV GH OHV}HV KLVWRSDWROyJLFDV GR SkQFUHDV GH FmHV (adaptado de Steiner, 2008) *UiILFR )UHTXrQFLD GH OHV}HV KLVWRSDWROyJLFDV GR SkQFUHDV GH JDWRV (adaptado de Steiner, 2008) *UiILFR(OLPLQDomRGDOLSDVHSDQFUHiWLFDFDQLQDHPFDQtGHRVDXGiYHO(Dossin, 2011) *UiILFR5HSUHVHQWDomRJUiILFDGRVYDORUHVGHJOLFHPLDDSUHVHQWDGRVQRVGRLVSULPHLURVGLDV
DSyVDKRVSLWDOL]DomR(Fonte: Autor. Cortesia de HRVM, 2014)
/LVWDGH$EUHYLDWXUDV6LJODVH6tPERORV
0DUFDUHJLVWDGD
$%&±9LDVDpUHDVUHVSLUDomRHFLUFXODomRAirway, breathing and circulation) $,1(V±$QWLLQIODPDWyULRVQmRHVWHUyLGHV $/7±$ODQLQDDPLQRWUDQVIHUDVH $67±$VSDUWDWRDPLQRWUDQVIHUDVH %,'±'XDVYH]HVSRUGLD(Bis in Die) %81±8UHLDQLWURJHQDGDVDQJXtQHD &$09±&HQWURGHDWHQGLPHQWRPpGLFRYHWHULQiULR &&.±&ROHFLVWRTXLQLQD &,'±&RDJXODomRLQWUDYDVFXODUGLVVHPLQDGD &.'±'RHQoDUHQDOFUyQLFD(Chronic Kidney Disease)
&/±&RODQJLWHOLQIRFtWLFD
&O±,mRFORUR
&1$±&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
'.$–'LDEHWHVFHWRDFLGyWLFDDiabetic Ketoacidosis)
'/$±$QWLJpQLRVGRVOHXFyFLWRVFDQLQRVDog Leukocyte Antigen)
'0±Diabetes mellitus
(&2±(FRJUDILD
(+%'2±2EVWUXomRH[WUDKHSiWLFDGRGXFWRELOLDUExtrahepatic Bile Duct Obstruction) (+%2±2EVWUXomRELOLDUH[WUDKHSiWLFDExtrahepatic Biliary Tract Obstruction)
)$±)RVIDWDVHDOFDOLQD
)'0±)DWRUGHSUHVVRUGRPLRFiUGLR
)H/9±9tUXVGDOHXFHPLDIHOLQDfeline Leukemia Virus)
)L±)UHTXrQFLDUHODWLYD
),9±9tUXVGDLPXQRGHILFLrQFLDIHOLQD
I3/,±,PXQRUUHDWLYLGDGHjOLSDVHSDQFUHiWLFDIHOLQD (feline Pancreatic Lipase Immunoreactivity)
)5±)UHTXrQFLDDEVROXWD
(2±(VItQFWHUGHOddi
**7±*DPD*OXWDPLO7UDQVIHUDVH
*+,+ ± )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±$GPLQLVWUDomRLQWUDYHQRVD .±,mRSRWiVVLR /3(±(QWHULWHOLQIRFtWLFDSODVPRFLWiULDLymphocytic-Plasmacytic Enteritis)
0+&±&RPSOH[RPDLRUGHKLVWRFRPSDWLELOLGDGHMajor Histocompatibility Complex)
02'6±(VWDGRGHIDOKDPXOWLRUJkQLFDMultiorgan Dysfunction Syndrome)
1D±,mRVyGLR 1D&O±&ORUHWRGHVyGLR 1(±1XWULomRHQWHUDO 1)N%±)DWRUQXFOHDUNDSSD% 1*±1DVRJiVWULFR 12±Ï[LGRQtWULFR 13±1XWULomRSDUHQWHUDO
2637±7HPSRGHSURWURPELQD (One-Stage Prothrombin Time)
3$±3DQFUHDWLWHDJXGD
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/$±)RVIROLSDVH$
33±3ROLSpSWLGRSDQFUHiWLFR
331±1XWULomRSDUHQWHUDOSDUFLDO (Partial Parenteral Nutrition)
367,±,QLELGRUGDVHFUHomRSDQFUHiWLFDGHWULSVLQD (Pancreatic Secretor Trypsin Inhibitor) 37±7HPSRGHSURWURPELQDProtrombine Time
377±7HPSRGHWURPERSODVWLQDSDUFLDOPartialThromboplastin Time) 4,'±$GPLQLVWUDomRTXDWURYH]HVDRGLDquater in die four times a day) 50±5HVVRQkQFLDPDJQpWLFD
526±(VSpFLHVGHR[LJpQLRUHDWLYDV (Reactive Oxygen Species)
6&±9LDVXEFXWkQHD
6,%2±6REUHFUHVFLPHQWREDFWHULDQRSmall Intestinal Bacterial Overgrowth 6,'±8PDYH]SRUGLD(Semel in Die)
6,56 ± 6tQGURPH GD UHVSRVWD LQIODPDWyULD VLVWpPLFD (Systemic Inflammatory Response Syndrome)
61$±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$3FUHDWLQLQD (Urinary TAP-Creatinine Ratio) 9,3±3pSWLGRYDVRDWLYRLQWHVWLQDO (Vasoactiveintestinalpeptide)
96)&9 - (VWLUSHYLUXOHQWDGRFDOLFLYtUXVIHOLQRVirulentSystemic Feline Calicivirus) 9/'/±/LSRSURWHtQDVGHEDL[DGHQVLGDGH (Very Low Density Lipoproteins
&DStWXOR5HODWyULRGHFDVXtVWLFD
,QWURGXomR
2HVWiJLRGHFRUUHXHQWUHRGLDGH2XWXEURGHHGH$EULOGHWHQGRVLGR XPJUDQGHSDVVRQDWUDQVLomRGDYLGDDFDGpPLFDSDUDRLQtFLRGDYLGDSURILVVLRQDO3HUPLWLXTXH DWpQXHEDUUHLUDGHDSOLFDomRSUiWLFDGRVFRQKHFLPHQWRVWHyULFRVDGTXLULGRVDRORQJRGRFXUVR IRVVHTXHEUDGDHQRYDVSRUWDVUXPRjUHDOLGDGHYHWHULQiULDIRVVHPFRORFDGDVDGHVFREHUWR 2V REMHWLYRV GHOLQHDGRV IRUDP DWLQJLGRV HQXPHUDQGRVH R GHVHQYROYLPHQWR GH UDFLRFtQLRFOtQLFRH RDXPHQWR QD SHUtFLD GHSURFHGLPHQWRV PpGLFRYHWHULQiULRV EHP FRPR D LQWHJUDomRQRWUDEDOKRGHHTXLSDFKDYHVIXQGDPHQWDLVQDSUiWLFDFOtQLFD
$VVLPHPVHJXLGDVHUiUHODWDGDDFDVXtVWLFDDVVLVWLGDHDVXDUHSUHVHQWDWLYLGDGHFRP GHVWDTXHSDUDDOJXQVFDVRVFOtQLFRVHQWLGDGHVFOtQLFDVGHLQWHUHVVH1XPDVHJXQGDSDUWHVHUi DERUGDGDXPDUHYLVmRELEOLRJUiILFDPpGLFDDWXDOGRestado de arteGD³3DQFUHDWLWHHP$QLPDLV GH &RPSDQKLD´ H SRVWHULRU GLVFXVVmR GH FDVRV FOtQLFRV SUHWHQGHQGR GHPRQVWUDU XPD QRYD DERUGDJHPVREUHHVWDWHPiWLFDRQGHDLPSUHYLVLELOLGDGHHDVguidelinesUHFHQWHVUHYROXFLRQDP GHFHUWRPRGRDIRUPDGHDWXDomRQRGRHQWHSDQFUHiWLFR
'HVFULomRGRORFDOGHHVWiJLR
2 +RVSLWDO GH 5HIHUrQFLD 9HWHULQiULD 0RQWHQHJUR +590 p XP GRV &HQWURV GH DWHQGLPHQWRPpGLFRYHWHULQiULR&$09GHUHIHUrQFLDGR3RUWRFRPVHUYLoRSHUPDQHQWHGXUDQWH KHDSUHVHQWDSROLYDOrQFLDFOtQLFDHPWRGDVDVHVSHFLDOLGDGHV 2+590pFRQVWLWXtGRSHODUHFHomRWUrVFRQVXOWyULRVVHQGRXPGHXVRH[FOXVLYRSDUD SDFLHQWHVIHOLQRVVDODGH5DLRV[VDODGHWRPRJUDILDFRPSXWRUL]DGD7&VDODGHHFRJUDILD SDUWLOKDGDMXQWDPHQWHFRPDiUHDGHUHDOL]DomRGHKHPRGLiOLVHHGLiOLVHSHULWRQHDOGXDVVDODV GHFLUXUJLDVDODGHLQWHUQDPHQWRQRUPDOHRXWUDGHLQWHUQDPHQWRGHVWLQDGRDSDFLHQWHVFRP GRHQoDVLQIHWRFRQWDJLRVDVHILQDOPHQWHXPSHTXHQRODERUDWyULR1RSLVRVXSHULRUH[LVWHDLQGD XPDVDODGHIRUPDomRGHVWLQDGDjUHDOL]DomRGHFXUVRVSDUD0pGLFRV9HWHULQiULRVEHPFRPR GHSDOHVWUDVUHDOL]DGDVSHORVHVWDJLiULRV
$&OtQLFD9HWHULQiULD0RQWHQHJURUHSUHVHQWDDLQVWDODomRPDLVDQWLJDRQGHDWpKiSRXFR WHPSRHVWDYDPFHQWUDOL]DGRVWRGRVRVVHUYLoRVHSURILVVLRQDLVeFRQVWLWXtGDSHODUHFHomRXP LQWHUQDPHQWRQRUPDOHXPGHVWLQDGRDSDFLHQWHVLQIHWRFRQWDJLRVRVVDODGH5DLRV[SDUWLOKDGD FRP D GH HFRJUDILD VDOD GHVWLQDGD D FLUXUJLDV GH URWLQD H XPD SHTXHQD VDOD SDUD DQiOLVHV ODERUDWRULDLVVHQGRTXHRVFDVRVGHRIWDOPRORJLDVmRUHSRUWDGRVSDUDHVWDLQVWDODomR
&DVXtVWLFD
$SDUWLFLSDomRDWLYDHPFRQVXOWDVGHSURILOD[LDHGH3DWRORJLD0pGLFDH[DPHVItVLFRV JHUDLV H GLULJLGRV TXDOLGDGH QD PRQLWRUL]DomR DQHVWpVLFD H D DTXLVLomR GH FRQKHFLPHQWRV SUiWLFRVQDTXDOLGDGHGHDMXGDQWHGHFLUXUJLmRHPFLUXUJLDVGHWHFLGRVPROHVHGHRUWRSHGLDEHP FRPRDSUiWLFDHPSURFHGLPHQWRVFOtQLFRVFRPXQVFRPVXSHUYLVmRPpGLFDHDGLVFXVVmRGH
FDVRVFOtQLFRVHPWRGDVDVUHXQL}HVPDWLQDLVIRUDPDOJXPDVGDVDWLYLGDGHVUHDOL]DGDVDRORQJR GRHVWiJLRFXUULFXODU
'XUDQWHHVWHSHUtRGRQmRKRXYHDSRVVLELOLGDGHGHDFRPSDQKDPHQWRGHQHQKXPFDVR FOtQLFRGHDQLPDLVH[yWLFRVXPDYH]TXHDPpGLFDYHWHULQiULDGHVWDiUHDFOtQLFDQmRpPHPEUR SHUPDQHQWHGDHTXLSD$PDLRULDGDVFRQVXOWDVIRUDPDVVLVWLGDVQDVSUySULDVLQVWDODo}HVVHQGR UDUDVDVFRQVXOWDVDRGRPLFtOLRGHYLGRDRHOHYDGRIOX[RGHWUDEDOKRQRLQWHUQDPHQWRHFRQVXOWDV 4XDQWR jV iUHDV FOtQLFDV DSUHVHQWDGDV R Q~PHUR GH RFRUUrQFLDV REVHUYDGDV QmR FRUUHVSRQGH DR Q~PHUR JOREDO GH DQLPDLV DVVLVWLGRV GHYLGR jV VLWXDo}HV GH SDWRORJLDVFRQGLo}HV FRQFRPLWDQWHV QXP PHVPR DQLPDO 2 Q~PHUR GH FDVRV FLWDGRV QmR FRUUHVSRQGHDRQ~PHURWRWDOGHDQLPDLVDVVLVWLGRVWDQWRQRKRVSLWDOFRPRQDFOtQLFDGHYLGRDR IXQFLRQDPHQWRGDVLQVWDODo}HVHPKRUiULRFRQWtQXRHWHUHPQRVVLGRDWULEXtGRGLYHUVRVKRUiULRV DOWHUQDGRVHQWUHHVWDVLQVWDODo}HV 2VGDGRVHVWDWtVWLFRVDVHJXLUPHQFLRQDGRVHVWmRVREDIRUPDGHIUHTXrQFLDDEVROXWD )LHUHODWLYD)5RXVHMDFRUUHVSRQGHPDRQ~PHURWRWDOGHSURFHGLPHQWRVRXFDVRVDVVLVWLGRV )L H DR YDORU SHUFHQWXDO GD RFRUUrQFLD GD HQWLGDGH FOtQLFD HP UHODomR DR Q~PHUR WRWDO GH RFRUUrQFLDVWRWDLVGDiUHDFOtQLFD)5
3RUREVHUYDomRGR*UiILFRH7DEHODpSRVVtYHOFRQVWDWDUTXHDiUHDFOtQLFDFRPPDLRU Q~PHUR GH FDVRV REVHUYDGRV SHUWHQFH j &OtQLFD 0pGLFD VHJXLGD SHOD ,PDJLRORJLD SHOD&OtQLFD&LU~UJLFDSHOD0HGLFLQD3UHYHQWLYDHSRU~OWLPRSHOD $QHVWHVLRORJLD'HDFRUGRFRPD7DEHODpSRVVtYHOSHUFHEHUTXHRVSDFLHQWHVFDQLQRV IRUDP D HVSpFLH PDLV REVHUYDGD UHSUHVHQWDQGR Q HP UHODomR DRV SDFLHQWHV IHOLQRVTXHDSUHVHQWDYDPQ GRVSDFLHQWHVREVHUYDGRV'DGDDHOHYDGDUHOHYkQFLD GD$QHVWHVLRORJLDHQTXDQWRVXSRUWHSDUDSURFHGLPHQWRVFLU~UJLFRVFDGDYH]PDLVFRPSOH[RVH HVSHFLDOLGDGHGHDSRLRDWRGDVDVRXWUDVHVSHFLDOLGDGHVPpGLFDVIH]VHQWLGRFRQVLGHUiODFRPR iUHDFOtQLFDDSDUGD&OtQLFD0pGLFDGD&OtQLFD&LU~UJLFDHGD0HGLFLQD3UHYHQWLYD *UiILFR&DVXtVWLFDVHJXQGRÈUHDV&OtQLFDV 393 29 90 133 39 0 100 200 300 400 500 ClínicaMédica Medicina Preventiva
ClínicaCirúrgica Imagiologia Anestesiologia
Percentagem/valor
absoluto
CasuísticaporÁreasClínicas
7DEHOD&DVXtVWLFDSRUÈUHDV&OtQLFDV ÈUHDV&OtQLFDV )UHTXrQFLD $EVROXWD)L )UHTXrQFLD 5HODWLYD )LS &DQLQD )LS )HOLQD )LS ([yWLFRV &OtQLFD0pGLFD 0HGLFLQD3UHYHQWLYD &OtQLFD&LU~UJLFD ,PDJLRORJLD $QHVWHVLRORJLD 7RWDOGH&DVRV $FUyQLPRVQDWDEHODFiIUHTXrQFLDDEVROXWDFRIUHTXrQFLDUHODWLYDFipIUHTXrQFLDDEVROXWDSDUFLDO 2HOHYDGRQ~PHURGHDWLYLGDGHVDVVLVWLGDVQRkPELWRGD,PDJLRORJLDMXVWLILFDVHSHOR IXQFLRQDPHQWR GR &HQWUR GH ,PDJHP HP LQWHUOLJDomR GLUHWD FRP R PHLR LQWHUQR KRVSLWDODU 3DFLHQWHVGHRXWURV&$09VmRUHHQFDPLQKDGRVSDUDHVWH&HQWURPXLWDVYH]HVDSHQDVSDUD UHDOL]DURSURFHGLPHQWRDQHVWpVLFRHSRVWHULRU7&
&OtQLFD0pGLFD
(P VHJXLGD DSUHVHQWDPVH JUiILFRV H WDEHODV FRP SDWRORJLDV H HQWLGDGHV FOtQLFDV UHIHUHQWHV jV GLIHUHQWHV iUHDV FOtQLFDV RQGH FRQVWDP DV DWLYLGDGHV PpGLFRYHWHULQiULDV GHVHQYROYLGDVHDVVLVWLGDV±7DEHODH*UiILFR 7DEHOD'LVWULEXLomRGDFDVXtVWLFDSHODVGLIHUHQWHViUHDVGH&OtQLFD0pGLFD ÈUHD0pGLFD )UHTXrQFLD $EVROXWD)L )UHTXrQFLD 5HODWLYD )L3DUFLDO &DQLQD )L3DUFLDO )HOLQD &DUGLRORJLD 'HUPDWRORJLD 'RHQoDVLQIHWRFRQWDJLRVDV (PHUJrQFLDVHFXLGDGRVLQWHQVLYRV (QGRFULQRORJLD *DVWURHQWHURORJLD 0HGLFLQDGDUHSURGXomR 0HGLFLQDGHDQLPDLVH[yWLFRV 0HGLFLQDHVWRPDWROyJLFRGHQWiULD 0HGLFLQDItVLFDHGHUHDELOLWDomR 0HGLFLQDODERUDWRULDO 1HXURORJLD 2IWDOPRORJLD 2QFRORJLD 2WRORJLD 3QHXPRORJLD 8URORJLDHQHIURORJLD 7RWDOGH&DVRV $FUyQLPRVQDWDEHODFiIUHTXrQFLDDEVROXWDFRIUHTXrQFLDUHODWLYDFipIUHTXrQFLDDEVROXWDSDUFLDO
*UiILFR±&DVXtVWLFDGDVGLIHUHQWHViUHDVGH&OtQLFD0pGLFD
$V HVSHFLDOLGDGHV PDLV UHSUHVHQWDWLYDV IRUDP D *DVWURHQWHURORJLD VHJXLGD SHOD 1HXURORJLD H 0HGLFLQD GDV GRHQoDV LQIHWRFRQWDJLRVDV $ *DVWURHQWHURORJLDpGDViUHDVPDLVUHTXLVLWDGDVQDVFRQVXOWDVFOtQLFDVSHODIiFLOSHUFHomRGH DOJRDQRUPDORXGHVLQDLVLQFRPRGDWLYRVDRVSURSULHWiULRV$SDUGHVWDViUHDVVXUJHD8URORJLD H1HIURORJLDH(PHUJrQFLDVH&XLGDGRV,QWHQVLYRV
1mR IRL SRVVtYHO DVVLVWLU D FRQVXOWDV GD iUHD GH 1XWULomR FRQWXGR p XPD iUHD HP GHVHQYROYLPHQWRFUHVFHQWHSRLVDREHVLGDGHpXPDSUREOHPiWLFDFDGDYH]PDLVSUHVHQWHQRV DQLPDLV GH FRPSDQKLD R TXH FRQGX]LX DR GHVHQYROYLPHQWR GH SURJUDPDV GH SHUGD GH SHVRFRQWURORQXWULFLRQDOQR+590 0HGLFLQDODERUDWRULDO 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDODERUDWRULDO 10 23 39 35 15 68 9 0 21 18 4 53 15 19 8 19 37 0 10 20 30 40 50 60 70 80
CasuísticaporáreasdeClínicaMédica
FrequênciaAbsoluta(Fi) FrequênciaRelativa(%) FiParcialCanina FiParcialFelina
(QWLGDGHFOtQLFD )UHTXrQFLD$EVROXWD )L )UHTXrQFLD 5HODWLYD )LS &DQLQD )HOLQD)LS $QHPLD+HPROtWLFD,PXQRPHGLDGD 7URPERFLWRSpQLD6HYHUD
1HVWD iUHD REVHUYRXVH PDLV IUHTXHQWHPHQWH WURPERFLWRSHQLD VHYHUD HP GRV SDFLHQWHV FRPSDUDWLYDPHQWH DRV REVHUYDGRV FRP DQHPLD KHPROtWLFD LPXQRPHGLDGD $ WURPERFLWRSHQLD p D GHVRUGHP SODTXHWiULD PDLV FRPXP HP FmHV H JDWRV H D DOWHUDomR PDLV FRPXPGDFRDJXODomRSULPiULD3RGHVXUJLUSRUGLPLQXLomRGDSURGXomRGHSODTXHWDVFDXVDV KHUHGLWiULDV GRHQoDV LPXQRPHGLDGDV DJHQWHV LQIHFLRVRV RX GURJDV SRU DXPHQWR GR VHX VHTXHVWUR GHVRUGHQV DVVRFLDGDV D HVSOHQRPHJiOLD FRQVXPR VHFXQGiULR D &,' YDVFXOLWH VtQGURPH KHPROtWLFRXUpPLFR DQWDJRQLVPR GD 9LWDPLQD . RX WURPERVH ORFDO SRU GHVWUXLomR DXPHQWDGDDVVRFLDGDDGRHQoDVLPXQRPHGLDGDVRXVHFXQGiULDDQHRSODVLDDJHQWHVLQIHFLRVRV Anaplasma VSS Bartonella VSS RX SURFHVVRV LQIODPDWyULRV RX SRU ~OWLPR SRU DXPHQWR GD SHUGD GH SODTXHWDV DTXDQGR GH KHPRUUDJLD VHYHUD SDUWLFXODUPHQWH SRU WUDXPD RX HQYHQHQDPHQWR SRU URGHQWLFLGDV FDVR GRV SDFLHQWHV REVHUYDGRV (VWDV GXDV ~OWLPDV FRQGLo}HVVmRDVPDLVYXOJDUPHQWHDVVRFLDGDVDJUDXVGHWURPERFLWRSHQLDPDLVVHYHURV 0HGLFLQDHVWRPDWROyJLFRGHQWiULD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH0HGLFLQDHVWRPDWROyJLFRGHQWiULD
2 WUDWDPHQWR SHULRGRQWDO IRL R SURFHGLPHQWR RGRQWROyJLFR PDLV REVHUYDGR UHSUHVHQWDQGRGRVFDVRVTXDVHDSDUGDH[WUDomRGHQWiULDFRP(PFDVRGH GRHQoD SHULRGRQWDO JUDYH RX GH HVWRPDWLWH D H[WUDomR GHQWiULD SDUHFH HYLGHQFLDU UHVXOWDGRV PDLV SURPLVVRUHV GR TXHD WHUDSLD PpGLFD LVRODGD QHFHVViULD DR FRQWUROR GH VLQDLVFOtQLFRV UD]mR SHOD TXDO SDFLHQWHV FRP HVWRPDWLWH UHIUDWiULD DRV FRUWLFRHVWHURLGHV VHUHP IRUWHV FDQGLGDWRVDH[WUDomRGHQWiULD
*DVWURHQWHURORJLD
7DEHOD'LVWULEXLomRGH)L)5H)LSGH*DVWURHQWHURORJLD
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
&ROLWH
'RHQoDLQIODPDWyULDLQWHVWLQDO,%'
)HFDORPD
*DVWURHQWHULWHSDUDVLWiULD
*DVWURHQWHULWHYLUDOEDFWHULDQD
(QWLGDGHFOtQLFD )UHTXrQFLD$EVROXWD )L )UHTXrQFLD 5HODWLYD )LS &DQLQD )LS )HOLQD 7UDWDPHQWRSHULRGRQWDO ([WUDomRGHQWiULD (VWRPDWLWH~OFHUD *UDQXORPDHRVLQRItOLFR 7RWDO
+HPDWHPHVH +HPDWRTXpVLD +HSDWRSDWLD ,PSDFWDomRGRVVDFRVDQDLV /LSLGRVHKHSiWLFD 0HJDHVyIDJR 0HOHQD 0XFRFHOR 2EVWUXomRGRGXFWRELOLDU 3DQFUHDWLWH Shunt SRUWRVLVWpPLFRH[WUDKHSiWLFR 7RWDO
$V PDQLIHVWDo}HV JDVWURLQWHVWLQDLV GH YyPLWR H GLDUUHLD IRUDP IUHTXHQWHPHQWH REVHUYDGDVQRHQWDQWRDVXDHWLRORJLDpFRPSOH[DGDGRTXHH[LVWHPYiULDVFDXVDVHDOLPLWDomR ILQDQFHLUDSRUYH]HVLPSHGHRDOFDQFHGRGLDJQyVWLFRGHILQLWLYR1HVWDVFRQGLo}HVUHDOL]DVH WUDWDPHQWR VLQWRPiWLFR GH DFRUGR FRP DV HWLRORJLDV PDLV SURYiYHLV ± D PDLRULD GRV FDVRV GLUHFLRQDUDPSDUDHWLRORJLDEDFWHULDQDYtULFDRXSDUDVLWiULD±HDFKDGRVGHDQDPQHVHH[DPH FOtQLFRHH[DPHVFRPSOHPHQWDUHV (PHUJrQFLDVHFXLGDGRVLQWHQVLYRV 7DEHOD'LVWULEXLomRGH)L)5H)LSGH(PHUJrQFLDVHFXLGDGRVLQWHQVLYRV
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
$QJLRHGHPD &RODSVR&KRTXH 'LODWDomR*iVWULFD 'LVWyFLD (OHFWURFXVVmR ,QWR[LFDomRSRUOtULRV
)LJXUD &RUSR HVWUDQKR PHWiOLFR HP FDQtGHR )RQWH Autor. &RUWHVLD GH +590
)LJXUD 'LODWDomR H WRUomR JiVWULFD HP FDQtGHR )RQWH Autor &RUWHVLD GH +590
,QWR[LFDomRSRUSDUDFHWDPRO ,QWR[LFDomRSRUURGHQWLFLGDV 2EVWUXomRXUHWUDO 3URODSVRUHFWDO 3URSWRVHRFXODU 5XWXUDGHEH[LJD 6tQGURPHGLODWDomRWRUomRJiVWULFD 7RWDO
$ FRQGLomR GH FKRTXH QRUPDOPHQWH FRQVHTXrQFLD GH RXWUDV GHVRUGHQV IRL D PDLV REVHUYDGDHPSHUtRGRVGHXUJrQFLD7RUQDVHLPSRUWDQWHUHFRQKHFHURVVLQDLVFOtQLFRVGHIRUPD LPHGLDWD$QmRSDOSDomRGHSXOVRIHPRUDOHDSUHVVmRDUWHULDOPpGLDLQIHULRUDPP+JH[LJH XPDSURQWLGmRQDDGPLQLVWUDomRGHFROyLGHVEyOXV
GH P/NJ QR Pi[LPR DGPLQLVWUDGR WUrV YH]HV QXP SHUtRGR GH PLQ HP FmHV H P/NJ HP JDWRV FRPR WHUDSLD GH UHSRVLomR HILFD] SDUD D KLSRWHQVmR H KLSRYROpPLD 2V VLQDLV FOtQLFRV H[DPH ItVLFR H KLVWyULD SUHJUHVVD GHYHP SHUPLWLU GLVWLQJXLUFKRTXHKLSRYROpPLFRGHFDUGLRJpQLFR $V VLWXDo}HV GH FKRTXH RFRUUHUDP FRP PDLRU IUHTXrQFLD HP JDWRV QD VHTXrQFLD GH FLVWLWH H REVWUXomRXUHWUDOSRUFiOFXORVHQRVFmHVGHYLGRD WDPSRQDPHQWRFDUGtDFRFRPRULJHPHPPDVVDQDEDVHGRFRUDomRHDWHOHFWDVLDLQGX]LGDSRU PRUGHGXUD 'RVSURFHGLPHQWRVPpGLFRVUHDOL]DGRVQHVWDiUHDFOtQLFDGHVWDFDPVHDUHVVXVFLWDomR FDUGLRSXOPRQDU H D SHULFDUGLRFHQWHVH D WRUDFRFHQWHVH H D WURFDUWHUL]DomRGHVFRPSUHVVmR FRPR IRUPD GH LQWHUYHQomR LPHGLDWD 4XDQGR QHFHVViULR VmR WUDQVPLWLGRV YLD WHOHIRQH SURFHGLPHQWRV GH DVVLVWrQFLD DRV SDFLHQWHV HQTXDQWR QmR FKHJDP DR &$09 7RGRV RV SDFLHQWHVVmRVXEPHWLGRVDSURWRFROR$%&HVHPSUHTXHQHFHVViULRpDSOLFDGRR[LJHQRWHUDSLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGHSURFHGLPHQWRVGHXUJrQFLD
3URFHGLPHQWR $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
$EGRPLQRFHQWHVH $OJDOLDomR 3HULRFDUGLRFHQWHVH 3OHXURFHQWHVH 5HVVXVFLWDomRFDUGLRSXOPRQDU 7RUDFRFHQWHVH )LJXUD 'HVFRPSUHVVmRJiVWULFDGHFDQtGHRFRP GLODWDomR YyOYXORJiVWULFD )RWR JHQWLOPHQWH FHGLGD SRUMariana Maciel&RUWHVLDGH+590
7UDQVIXVmRVDQJXtQHD 7URFDUWHUL]DomRGHVFRPSUHVVmR 7RWDO &DUGLRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH&DUGLRORJLD &RPRGHPRQVWUDGRDFDUGLRPLRSDWLDKLSHUWUyILFDIRLD~QLFDGRHQoDFDUGtDFDREVHUYDGD HP JDWRV UHSUHVHQWDGR GR WRWDO GH SDFLHQWHV REVHUYDGRV SHQVDVH TXH VHFXQGiULD D KLSHUWLUHRLGLVPR2VSDFLHQWHVFDQLQRVDSUHVHQWDUDPXPDYDULHGDGHGHGRHQoDVFDUGtDFDVH IRUDPUHSRUWDGRVSDUDUHDOL]DomRGHHFRFDUGLRJUDILDHPYLUWXGHGHDSUHVHQWDUHPVLQDLVFRPR FDQVDoRGLVSQHLDHDOWHUDo}HVjDXVFXOWDomR 'HUPDWRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH'HUPDWRORJLD
$GHUPDWLWHDOpUJLFDjSLFDGDGDSXOJD'$33pDDOHUJLDPDLVFRPXPHPSHTXHQRV DQLPDLVHRFRUUHGHYLGRDUHDomRDOpUJLFDSURYRFDGDSHODVDOLYDGDSXOJD2EVHUYDUDP VH VLQDLV FRPR SUXULGR VHERUUHLD FURVWDV HVFRULDo}HV HULWHPD DORSpFLD DXWRLQIOLJLGD EHP
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
&DUGLRPLRSDWLDGLODWDGD &DUGLRPLRSDWLDKLSHUWUyILFD 'RHQoDYDOYXODUGHJHQHUDWLYD )LEULOKDomRDWULDO +LSHUWURILDGRYHQWUtFXORGLUHLWR ,QVXILFLrQFLDFDUGtDFDGLUHLWD 7RWDO
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
'HUPDWLWHDOpUJLFDjSLFDGDGDSXOJD'$33 &HOXOLWHMXYHQLO 'HUPDWLWHDOpUJLFDRXDWRSLD 'HUPDWRILWRVH )OHLPmR *UDQXORPDLVTXpPLFR 2WLWHSRUMalasseziaVS 3LRGHUPDWLWHVXSHUILFLDO 7RWDO
FRPR OHV}HV VHFXQGiULDV SRU LQIHo}HV EDFWHULDQDV H Malassezia VS $ ORFDOL]DomR WtSLFD GDV OHV}HVpGRUVRORPEDUEDVHGDFDXGDHSRUomRFDXGDOGDVFR[DV2VJDWRVSRGHPDSUHVHQWDU DLQGDGHUPDWLWHPLOLDUSiSXODVFRPFURVWDVQDFDEHoDHWURQFRHSODFDHRVLQRItOLFD2VH[DPHV UHFRUUHQGRjOkPSDGDGH:RRGWULFRJUDPDHFXOWXUDI~QJLFDIRUDPLPSRUWDQWHVSDUDHOLPLQDU RXWUDVGRHQoDVGHUPDWROyJLFDVGDOLVWDGHGLDJQyVWLFRVGLIHUHQFLDLV (QGRFULQRORJLD 7DEHOD'LVWULEXLomRGH)L)5H)LSGH(QGRFULQRORJLD
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
+LSRWLURLGLVPR Diabetes Mellitus &HWRDFLGRVH'LDEpWLFD +LSRDGUHQRFRUWLFLVPR +LSHUWLURLGLVPR +LSHUSDUDWLURLGLVPRVHFXQGiULRQXWULFLRQDO 7RWDO
$ diabetes mellitus IRL VHP G~YLGD D GRHQoD HQGyFULQD PDLV IUHTXHQWH HP FmHV UHSUHVHQWDQGRGRWRWDOGHSDFLHQWHVHQGyFULQRVHFXMRREMHWLYRGHWUDWDPHQWRQRVJDWRVWHP YLQGRUHFHQWHPHQWHDGLVWDQFLDUVHGDHVSpFLHFDQLQDSDVVDQGRVHGDSULRULGDGHQRFRQWUROR GRVVLQDLVFOtQLFRVHGHHYLWDUKLSRJOLFpPLDSDUDRGHUHPLVVmRFOtQLFDQmRQHFHVVLWDUGHLQVXOLQD SRUPDLVGHXPPrV6DEHVHDLQGDTXHGRVSDFLHQWHVIHOLQRVTXHDWLQJHPDUHPLVVmR UHFLGLYDP VHQGR GH JUDQGH LPSRUWkQFLD QHVWHV FDVRV R LQtFLR GR WUDWDPHQWR FRP LQVXOLQD H
FRQWURORJOLFpPLFR
2KLSHUWLUHRLGLVPRVXUJHDSDUGD '0FRPRGDVSDWRORJLDVHQGyFULQDVPDLVIUHTXHQWHV QRVSDFLHQWHVIHOLQRV$IHWDIUHTXHQWHPHQWHJDWRVJHULiWULFRVHRVVLQDLVFOtQLFRVPDLVFRPXQV VmRSROLIDJLDDQRUH[LDKLSHUDWLYLGDGHRXLUULWDELOLGDGHWDTXLFDUGLDGLDUUHLDHFHUFDGHGRV SDFLHQWHV SRGHP DSUHVHQWDUVH DSiWLFRV $ DERUGDJHP WHUDSrXWLFD QR +590 FRQVLVWH QD DGPLQLVWUDomRGHPHWLPD]ROPJPJJDWR%,'QXQFDHVTXHFHQGRDPRQLWRUL]DomRGRTXDGUR FOtQLFRDWUDYpVGHHFRFDUGLRJUDILDHPHGLomRGDSUHVVmRDUWHULDOGHYLGRDRVSRVVtYHLVHIHLWRV VLVWpPLFRVGHFDUGLRPLRSDWLDKLSHUWUyILFDHKLSHUWHQVmRDUWHULDOUHVSHWLYDPHQWH 1HXURORJLD 7DEHOD±'LVWULEXLomRGH)L)5H)LSGH1HXURORJLD (QWLGDGHFOtQLFD )UHTXrQFLD $EVROXWD)L )UHTXrQFLD 5HODWLYD )LS &DQLQD )LS )HOLQD +pUQLDFHUHEHODU +pUQLDFHUYLFDO +pUQLDWRUDFRORPEDU
6tQGURPHGHWobbler Status epilépticus (GHPDFHUHEUDO $WD[LDLGLRSiWLFD 6tQGURPHYHVWLEXODU +LGURFHIDOLD 0HQLQJLWHUHVSRQVLYDDHVWHUyLGHV 7RWDO
$V KpUQLDV GLVFDLV IRUDP D HQWLGDGH QHXUROyJLFD REVHUYDGD FRP PDLRU IUHTXrQFLD DR ORQJRGRHVWiJLRUHSUHVHQWDQGRFHUFDGHGRVFDVRVVHJXLQGRVHRstatus epilépticusH DDWD[LDFRPRRXWUDVGDVFRQGLo}HVFOtQLFDVPDLVIUHTXHQWHV
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 KHSiWLFDFRPROLSLGRVHKHSiWLFD6HJXHVHRXVRGHIHQREDUELWDOOLQKDRXSURSRIROOLQKD 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]DomRSRUSURWHtQDVVpULFDVHRXWURVyUJmRVH[WUDKHSiWLFRV
2QFRORJLD
7DEHOD'LVWLEXLomRGH)L)5H)LSGH2QFRORJLD
(QWLGDGHFOtQLFD $EVROXWD)L)UHTXrQFLD 5HODWLYD)UHTXrQFLD &DQLQD)LS )HOLQD)LS
&DUFLQRPDGDWLUyLGH
&DUFLQRPDGDVFpOXODVHVFDPRVDV
&DUFLQRPDSXOPRQDU
+HPDQJLRVVDUFRPDHVSOpQLFR