Caracteristicas clinicas, laboratoriais e ultra-sonograficas de pacientes com trombose de veia porta na faixa etaria pediatrica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Portal vein thrombosis (PVT) is relatively rare disease that affects adults and children, consisting of a blockage of the portal vein, and portal hypertension (PH) is the most frequent development problem. The knowledge regarding to the clinical manifestations and diagnostics are not yet been used into the routine of the general pediatrician, pediatric gastroenterologist and ultrasonographic (USG) specialists. Due to this, the objective of this study was to analyze the clinical, laboratorial and USG characteristics of the pediatric patients with PVT. 22 children with clinical and USG diagnosis of PVT participated in the study. A paired sex and age group was used as control. A chart with identification data, presence of any etiopathogenic antecedent for PVT, symptom or sign of PH and laboratorial values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltranferase (GGT), alkaline phosphatase (AP), prothrombin activity (PA), hemoglobin (Hb), leucocytes and platelets was filled up. At the USG examinations it was observed liver features such as surface, edge, parenchyma together with longitudinal and antero-posterior dimensions, studies of the gallbladder (GB) contractility and PH signs (thickness of the venous ligament, lesser omentum/aorta ratio, presence of GB varices, size of the spleen and splenorenal shunt). In order to compare both groups by categorical variables, Fisher?s exact test or chi square test was used and by means of the continuous variables the Mann Whitney test was performed. The age of the patients varied from 1 year old and 5 months to 20 years old and 10 months (average of 11 years old and 7 months). Differences in relation to gender were not observed and also the hematemesis was the most frequent form of initial clinical presentation 13/22 (59%) of the patient. The implied etiopathogenic factor was the umbilical catheterism 8/22, (36%) patients. Within the laboratorial examinations, aminotransferases, GGT and AP had no significant changes. Hypersplenism was represented mainly by thrombocytopenia presented in 15/22 (68%) of the patients. At USG study, it was observed that, mainly the left lobe of the liver was diminished in the patients with TVP. The most frequent ecographic signals of PH were splenomegaly that was presented in all patients followed by an increased thickness of the GB walls in 20/22 (91%) patients, and the thickness of the venous ligament in 16/18 (89%) patients and splenorenal shunt in 15/20 (75%) of patients. Biliary lithiasis was observed in 3/22 patients (13,6%). Varices in the GB were observed in 13/22 patients (59%) and the contractility of the GB was lower in the group of patients with TVP. It was concluded that hematemesis was the most frequent form of presentation and that the umbilical catheterism is an important ethiopathogenic factor. The measurements of the spleen, the thickness of the venous ligament and of the wall of the GB are good indicators of PH. The liver, mainly the left lobe, is shown with reduced dimension in TVP patients and the varices of the GB are frequent complications in the patients with portal vein thrombosis

ASSUNTO(S)

veia porta esplenomegalia crianças trombose hipertensão portal

ACESSO AO ARTIGO

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