Colecistite aguda: critérios diagnósticos e epidemiologia
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Tipo
TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Melo, Bernardo Huçulak
Oliveira, Maria Eduarda Barcik de
Oliveira, Maria Eduarda Barcik de
Orientador
Coelho, Guilherme Andrade
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Introdução: A colecistite aguda (CA) caracteriza-se pela inflamação aguda da vesícula biliar, geralmente causada pela obstrução das vias biliares por cálculos. Como sintomas, tem-se dor abdominal, náuseas, vômitos e febre. Ademais, podem estar presentes sinais clínicos como sensibilidade à palpação do quadrante superior direito do abdômen (QSD) e sinal de Murphy, que é um indicativo de colecistite caracterizado pela parada brusca da inspiração durante a palpação profunda da vesícula. O diagnóstico é frequentemente baseado nos Critérios de Tóquio, que levam em consideração indicadores clínicos, laboratoriais e de imagem. Objetivo: Avaliar a sensibilidade, especificidade e acurácia dos Critérios de Tóquio de 2018 (CT18) para o diagnóstico de CA através da coleta de dados de pacientes com abdome agudo em hospital de referência. A análise se concentra na epidemiologia da CA, objetivando avaliar o desempenho dos critérios diagnósticos propostos pelos CT18. Método: Foi conduzida uma análise retrospectiva de 825 prontuários de pacientes submetidos à colecistectomia no Hospital Universitário Evangélico Mackenzie entre janeiro de 2019 e janeiro de 2021. Foram analisados os sinais e sintomas na admissão, exames laboratoriais e de imagem. Além disso, foram coletados dados relacionados ao procedimento cirúrgico, tempo de internamento, uso de antibióticos, presença de intercorrências e exame anatomopatológico (AP) do espécime cirúrgico. Resultados: A maioria da amostra foi composta por mulheres (73,40%) entre 31-59 anos. O sinal mais comum foi dor no QSD. Leucocitose esteve presente em 35,70% dos casos e elevação da PCR em 69,70%. A ultrassonografia foi o exame mais solicitado e a colelitíase foi o achado mais comum. Quanto à cirurgia, a via de acesso mais utilizada foi a convencional na técnica retrógrada. O tempo de internamento teve média de 3,2 dias, antibióticos foram utilizados em 42,10% dos pacientes e segundo o AP, 19,90% dos casos eram de colecistite aguda e 80,10% de colecistite crônica. Os CT18 demonstraram sensibilidade de 77,40%, especificidade de 58,40% e acurácia de 66,10% para o diagnóstico de CA. Conclusão: O estudo conclui que a Guideline de Tóquio de 2018 é relevante para o diagnóstico de CA. Os critérios demonstram uma sensibilidade razoável na identificação da maioria dos casos, porém, a especificidade indica alguma imprecisão na exclusão de casos que não são de CA. A acurácia global é aceitável para a classificação da presença ou ausência da condição.
Introduction: Acute cholecystitis (AC) is characterized by the acute inflammation of the gallbladder, typically caused by obstruction of the biliary ducts by gallstones. This condition presents with symptoms including abdominal pain, nausea, vomiting, and fever. Additionally, clinical signs may be present, such as tenderness upon palpation of the right upper quadrant of the abdomen (RUQ) and Murphy's sign, an indicative sign of cholecystitis characterized by sudden inspiratory arrest upon deep palpation of the gallbladder. The diagnosis is often based on the Tokyo Guidelines, which take into account clinical, laboratory, and imaging indicators. Objective: To evaluate the sensitivity, specificity, and accuracy of the 2018 Tokyo Criteria (CT18) for the diagnosis of AC through the collection of data from patients with acute abdomen in a reference hospital. The analysis focuses on the epidemiology of AC and aims to evaluate the performance of the diagnostic criteria proposed by TG18. Methodology: A retrospective analysis was conducted with 825 medical records of patients who underwent cholecystectomy at the Evangelical Mackenzie University Hospital between January 2019 and January 2021. The following were analyzed: signs and symptoms upon admission, laboratory and imaging tests. Furthermore, data related to the surgical procedure, length of hospitalization, use of antibiotics, presence of complications, and anatomopathological examination (AP) of the surgical specimen were collected. Results: The majority of the sample was composed of women (73.40%) between 31-59 years old. The most common sign was pain in the RUQ. Leukocytosis was present in 35.70% of patients and elevated CRP in 69.70%. Abdominal ultrasound was the most requested test and cholelithiasis was the most common finding. Regarding surgery, the most commonly used access route was the conventional retrograde technique. The average length of hospitalization was 3.2 days, antibiotics were used in 42.10% of patients, and according to the AP, 19.90% of cases were acute cholecystitis and 80.10% were chronic cholecystitis. The CT18 demonstrated sensitivity of 77.40%, specificity of 58.40%, and accuracy of 66.10% for the diagnosis of CA. Conclusion: The study concludes that the 2018 Tokyo Guideline is relevant for the diagnosis of AC. The criteria demonstrate reasonable sensitivity in identifying most cases, however, specificity indicates some inaccuracy in excluding cases that are not AC. Overall accuracy is acceptable for classifying the presence or absence of the condition.
Introduction: Acute cholecystitis (AC) is characterized by the acute inflammation of the gallbladder, typically caused by obstruction of the biliary ducts by gallstones. This condition presents with symptoms including abdominal pain, nausea, vomiting, and fever. Additionally, clinical signs may be present, such as tenderness upon palpation of the right upper quadrant of the abdomen (RUQ) and Murphy's sign, an indicative sign of cholecystitis characterized by sudden inspiratory arrest upon deep palpation of the gallbladder. The diagnosis is often based on the Tokyo Guidelines, which take into account clinical, laboratory, and imaging indicators. Objective: To evaluate the sensitivity, specificity, and accuracy of the 2018 Tokyo Criteria (CT18) for the diagnosis of AC through the collection of data from patients with acute abdomen in a reference hospital. The analysis focuses on the epidemiology of AC and aims to evaluate the performance of the diagnostic criteria proposed by TG18. Methodology: A retrospective analysis was conducted with 825 medical records of patients who underwent cholecystectomy at the Evangelical Mackenzie University Hospital between January 2019 and January 2021. The following were analyzed: signs and symptoms upon admission, laboratory and imaging tests. Furthermore, data related to the surgical procedure, length of hospitalization, use of antibiotics, presence of complications, and anatomopathological examination (AP) of the surgical specimen were collected. Results: The majority of the sample was composed of women (73.40%) between 31-59 years old. The most common sign was pain in the RUQ. Leukocytosis was present in 35.70% of patients and elevated CRP in 69.70%. Abdominal ultrasound was the most requested test and cholelithiasis was the most common finding. Regarding surgery, the most commonly used access route was the conventional retrograde technique. The average length of hospitalization was 3.2 days, antibiotics were used in 42.10% of patients, and according to the AP, 19.90% of cases were acute cholecystitis and 80.10% were chronic cholecystitis. The CT18 demonstrated sensitivity of 77.40%, specificity of 58.40%, and accuracy of 66.10% for the diagnosis of CA. Conclusion: The study concludes that the 2018 Tokyo Guideline is relevant for the diagnosis of AC. The criteria demonstrate reasonable sensitivity in identifying most cases, however, specificity indicates some inaccuracy in excluding cases that are not AC. Overall accuracy is acceptable for classifying the presence or absence of the condition.
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Palavras-chave
colecistite aguda , epidemiologia , diagnóstico , epidemiology , cholecystitis , acute , diagnosis