1 ABDOME AGUDO

INTRODUO
Abdome agudo todo quadro abdominal de instalao sbita com reao inflamatria peritoneal,
caracterizado por uma srie de sinais e sintomas. afeco comum, principalmente em emergncia
intraabdominal que s resolvida cirurgicamente .
As doenas abdominais so, na maioria, associadas a dor em algum momento de sua evoluo.
BASES FISIOLGICAS
O trato gastrintestinal pode ser dividido em intestino proximal, mdio e distal, cada um com inervao e
vascularizao prprias.
Intestino proximal vai do orofaringe at o duodeno, ao nvel da implantao da papila, e inclui
pncreas, fgado, rvore biliar e bao.
Intestino mdio se estende desde a poro distal do duodeno at os 2/3 proximais do clon transverso.
Intestino distal compreende o restante do clon at a linha denteada.
De um modo geral, a dor originada no ( ver fig. 1):
intestino proximal sentida na regio epigstrica;
a do intestino mdio, no mesogstrio e;
a do intestino distal, no hipogstrio.
O peritneo, por sua vez, pode ser dividido em visceral e parietal
peritneo visceral aquele que recobre todos os rgos intra-abdominais, sendo inervado pelo sistema
nervoso autnomo (simptico e parassimptico) atravs de fibras no-mielinizadas do tipo "C". Essas
fibras so encontradas na parede de vsceras ocas e na cpsula de rgos macios (bem como no msculo,
peristeo e peritneo parietal), sendo responsveis pela transmisso da dor surda, mal - localizada, de
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424242424242424242424242424242424242424242424242424242424242424242424242424242424242
424242424242424242424242424242424242424242424242424242424242424242424242424242424242
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42424242424242424242424242424242424 mais importantes na avaliao da dor abdominal. Entretanto
os exames complementares so de grande utilidade para a confirmao da hiptese diagnstica e para o
embasamento da indicao cirrgicaLaboratrio
Vrios exames laboratoriais auxiliam a avaliao da dor abdominal. Eles devem ser utilizados nas
situaes em que seu resultado pode alterar a conduo do caso. Por exemplo, nas gastroenterites bvias
eles no so de nenhuma utilidade.
Basicamente solicitamos:
- Hemograma;
- EAS;
- Amilase e beta-HCG (para mulheres em idade frtil com dor abdominal baixa).
- Dosagem de eletrlitos, uria, creatinina e glicose, para avaliao mais acurada da hidratao, funo
renal e estado metablico bsico do paciente.
- A dosagem de transaminases e da atividade de protrombina pode ser til nos casos de dor no andar
superior do abdome.
- Outros exames mais especficos so indicados em situaes particulares - teste de afoiamento (anemia
falciforme), CPK-MB (isquemia miocrdica), dosagens hormonais (doena de Addison), pesquisa de
drogas etc.
Eletrocardiograma
- Indicado nos pacientes com dor no andar superior onde h suspeita de isquemia miocrdica, assim como
nos cardiopatas com possibilidade de indicao cirrgica e nos casos de alterao ritmo cardaco para
apoiar a hiptese de embolia mesentrica.
- Na suspeita de embolia mesentrica, cabe tambm a realizao de ecocardiograma, para pesquisa de
trombos intracardacos.
Mtodos de Imagem
- A rotina para abdome agudo (radiografia de trax PA e perfil, abdome em p e deitado) essencial no
paciente sem diagnstico bvio, apesar de s mostrar alteraes em cerca de 10% dos pacientes.
- de grande utilidade para demonstrar:
Pneumoperitneo;
Distenso de ala;
Nveis hidroareos;
Fecalitos;
Clculos biliares e urinrios;
Ascite e apagamento do psoas.
- Serve tambm para excluir patologias pulmonares (pneumonia, derrame pleural).
- Sua maior serventia na avaliao de patologias de vsceras ocas, pela possibilidade de evidenciar
claramente 24242424 p24 24 24 24
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