Encefalopatia hepática: estudo de 50 casos

Resende, Luiz Antonio de Lima; Speciali, José Geraldo

doi:10.1590/S0004-282X1984000400002

Resumos

Os autores apresentam estudo retrospectivo de 50 pacientes com encefalopatia hepática atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto a partir de 1959 e discutem os aspectos clínicos, laboratoriais e anátomo-patológicos. Expõem os diagnósticos das hepatopatias, os fatores precipitantes dos episódios de coma e pré-coma hepático e enfatizam o papel da gasometria arterial no estabelecimento do diagnóstico.

The authors present a retrospective study of 50 patients with hepatic encephalopathy treated at the University Hospital, Faculty of Medicine of Ribeirão Preto since 1959 and discuss clinical, laboratory and anatomo-pathologic aspects. The diagnoses of the different types of liver disease as well as the factors that triggered the episodes of hepatic coma and pre-coma are reported and the role of the measurement of arterial blood gases in establishing the diagnosis is emphasized.

Encefalopatia hepática: estudo de 50 casos

Hepatic encephalopathy: a study of 50 cases

Luiz Antonio de Lima Resende^I; José Geraldo Speciali^II

^IAluno de Pós-Graduação. Departamento de Neuropsiquiatria e Psicologia Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

^IIProfessor Assistente-Doutor. Departamento de Neuropsiquiatria e Psicologia Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

RESUMO

Os autores apresentam estudo retrospectivo de 50 pacientes com encefalopatia hepática atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto a partir de 1959 e discutem os aspectos clínicos, laboratoriais e anátomo-patológicos. Expõem os diagnósticos das hepatopatias, os fatores precipitantes dos episódios de coma e pré-coma hepático e enfatizam o papel da gasometria arterial no estabelecimento do diagnóstico.

SUMMARY

The authors present a retrospective study of 50 patients with hepatic encephalopathy treated at the University Hospital, Faculty of Medicine of Ribeirão Preto since 1959 and discuss clinical, laboratory and anatomo-pathologic aspects. The diagnoses of the different types of liver disease as well as the factors that triggered the episodes of hepatic coma and pre-coma are reported and the role of the measurement of arterial blood gases in establishing the diagnosis is emphasized.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Departamento de Neuropsiquiatria e Psicologia Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo.

Agradecimento - Os autores agradecem ao Dr. Ulysses Meneghelli, Professor Adjunto da Disciplina de Gastroenterologia do Departamento de Clínica Médica da mesma Faculdade, pela grande colaboração prestada.

Departamento de Neuropsiquiatria e Psicologia Médica - Faculdade de Medicina de Ribeirão Preto, USP - 14100 Ribeirão Preto, SP - Brasil.

1. DAVIDSON, C.S. & GABUZDA, G.J. - Hepatic coma. In: Schiff, L. (ed.) - Diseases of the Liver. Ed. 4. Lippincott, Philadelphia, 1975.
2. FISCHER. J.E. & BALDESSARINI, R.J. - False neurotransmitters and hepatic failure. Lancet 2:75, 1971.
3. FISCHER, J.E.; YOSHIMURA, N.; AGUIRRE, A.; JAMES, J.H.; CUMMINGS, M.G.; ABEL, R.M. & DEINDOERFER, F. - Plasma amino acids in patients with hepatic encephalopathy. Amer. J. Surg. 127:40, 1974.
4 FISCHER, J.E.; FUNOVICS, J.M.; AGUIRRE, A.; JAMES, J.H.; KEANE, J.M.; WESDORP, R.I.C.; YOSHIMURA, N. & WESTMAN, T. - The role of plasma amino acids in hepatic encephalopathy. Surgery 78:276, 1975.
5 FISCHER, J.E.; ROSEN, H.M.; EBEID, A.M.; JAMES, H.; KEANE, J.M. & SOETERS, P.B. - The effect of normalization of plasma amino acids on hepatic encephalopathy in man. Surgery 80:77, 1976.
6. HURWITZ, L.J. & MONTGOMERY, D.A.D. - Persistent choreo-athetosis movements in liver disease. Arch. Neurol. (Chicago) 13:421, 1965.
7. MANGUM, J.; LAMONS, D. & FRIEDLANDER, W.J. - Neurologic changes in a patient with a portocaval shunt and the relationship to hepatic coma. Amer. J. Med. 21:306, 1956.
8. N1EDERMEYER, E. - Eletroencephalogram: Basic Principles, Clinical Applications and Related Fields. Urban & Schwartzenberg, Baltimore, 1982.
9 PHEAR. E.A.; RUEBNER, B.; SHERLOCK, S. & SUMMERSKILL. W.H.J. - Methionine toxicity in liver disease and its prevention by chlortetracycline. Clin. Sci. 15:93, 1956.
10. PLUM, F. & POSNER, J.B. - Diagnóstico de Estupor e Coma. Ed. 2 Guanabara Koogan, Rio de Janeiro, 1977.
11. SCOBIE, B. & SUMMERSKILL, W.H.J. - Permanent paraplegia with cirrosis. Arch. int. Med. 113:805, 1964.
12. SHERLOCK, S.; SUMMERSKILL, W.H.J.; SHITE, L.P. & PHEAR, E.A. - Portal-systemic encephalopathy. Neurological complication of liver disease. Lancet 2:453, 1954.
13. SHERLOCK, S.; SUMMERSKILL, W.H.J. & DAWSON, A.M. - The treatment and prognosis of hepatic coma. Lancet 2:689, 1956.
14. SHERLOCK, S. - Diseases of the Liver and Biliary System. Ed. 3. Blackwell, Oxford, 1975.
15. SMITH, A.; ROSSI-FANELLI, F.; ZIPARO, V.; JAMES, H.; PERELLE, B.A. & FISCHER, J.E. - Alterations in plasma and CSF amino acids, amine metabolites in hepatic coma. Ann. Surg. 187:343, 1978.
16. VICTOR, M.; ADAMS, R.D. & COLE, M. - The acquired (non-wilsonian) type of chronic hepatocerebral degeneration. Medicine 44:345, 1965.
17. WARE, A.J.; DAGOSTINO, A.N. & COMBES, B. - Cerebral edema: a major complication of massive hepatic necrosis. Gastroenterol. 61:877, 1971
18. ZIEVE, L - Pathogenesis of hepatic coma. Arch. int. Med. 118:211, 1966.

Datas de Publicação

Publicação nesta coleção
13 Ago 2012
Data do Fascículo
Dez 1984

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. DAVIDSON, C.S. & GABUZDA, G.J. - Hepatic coma. In: Schiff, L. (ed.) - Diseases of the Liver. Ed. 4. Lippincott, Philadelphia, 1975.

[2] 2. FISCHER. J.E. & BALDESSARINI, R.J. - False neurotransmitters and hepatic failure. Lancet 2:75, 1971.

[3] 3. FISCHER, J.E.; YOSHIMURA, N.; AGUIRRE, A.; JAMES, J.H.; CUMMINGS, M.G.; ABEL, R.M. & DEINDOERFER, F. - Plasma amino acids in patients with hepatic encephalopathy. Amer. J. Surg. 127:40, 1974.

[4] 4 FISCHER, J.E.; FUNOVICS, J.M.; AGUIRRE, A.; JAMES, J.H.; KEANE, J.M.; WESDORP, R.I.C.; YOSHIMURA, N. & WESTMAN, T. - The role of plasma amino acids in hepatic encephalopathy. Surgery 78:276, 1975.

[5] 5 FISCHER, J.E.; ROSEN, H.M.; EBEID, A.M.; JAMES, H.; KEANE, J.M. & SOETERS, P.B. - The effect of normalization of plasma amino acids on hepatic encephalopathy in man. Surgery 80:77, 1976.

[6] 6. HURWITZ, L.J. & MONTGOMERY, D.A.D. - Persistent choreo-athetosis movements in liver disease. Arch. Neurol. (Chicago) 13:421, 1965.

[7] 7. MANGUM, J.; LAMONS, D. & FRIEDLANDER, W.J. - Neurologic changes in a patient with a portocaval shunt and the relationship to hepatic coma. Amer. J. Med. 21:306, 1956.

[8] 8. N1EDERMEYER, E. - Eletroencephalogram: Basic Principles, Clinical Applications and Related Fields. Urban & Schwartzenberg, Baltimore, 1982.

[9] 9 PHEAR. E.A.; RUEBNER, B.; SHERLOCK, S. & SUMMERSKILL. W.H.J. - Methionine toxicity in liver disease and its prevention by chlortetracycline. Clin. Sci. 15:93, 1956.

[10] 10. PLUM, F. & POSNER, J.B. - Diagnóstico de Estupor e Coma. Ed. 2 Guanabara Koogan, Rio de Janeiro, 1977.

[11] 11. SCOBIE, B. & SUMMERSKILL, W.H.J. - Permanent paraplegia with cirrosis. Arch. int. Med. 113:805, 1964.

[12] 12. SHERLOCK, S.; SUMMERSKILL, W.H.J.; SHITE, L.P. & PHEAR, E.A. - Portal-systemic encephalopathy. Neurological complication of liver disease. Lancet 2:453, 1954.

[13] 13. SHERLOCK, S.; SUMMERSKILL, W.H.J. & DAWSON, A.M. - The treatment and prognosis of hepatic coma. Lancet 2:689, 1956.

[14] 14. SHERLOCK, S. - Diseases of the Liver and Biliary System. Ed. 3. Blackwell, Oxford, 1975.

[15] 15. SMITH, A.; ROSSI-FANELLI, F.; ZIPARO, V.; JAMES, H.; PERELLE, B.A. & FISCHER, J.E. - Alterations in plasma and CSF amino acids, amine metabolites in hepatic coma. Ann. Surg. 187:343, 1978.

[16] 16. VICTOR, M.; ADAMS, R.D. & COLE, M. - The acquired (non-wilsonian) type of chronic hepatocerebral degeneration. Medicine 44:345, 1965.

[17] 17. WARE, A.J.; DAGOSTINO, A.N. & COMBES, B. - Cerebral edema: a major complication of massive hepatic necrosis. Gastroenterol. 61:877, 1971

[18] 18. ZIEVE, L - Pathogenesis of hepatic coma. Arch. int. Med. 118:211, 1966.