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Causas de hepatomegalia e/ou esplenomegalia em doentes internados no Hospital Universitário Américo Boavida, Luanda, Angola
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Atendendo à elevada frequência de doentes com hepatomegalia (HM) e/ ou esplenomegalia (SM) observada nos serviços de Medicina e Gastroenterologia do Hospital Américo Boavida, em Luanda, Angola, o presente estudo teve como objetivo identificar os principais fatores causais destes sinais e os potenciais fatores de risco, de modo a serem implementadas as medidas mais adequadas à sua prevenção. Foi efetuado um estudo retrospetivo, transversal, com base nos processos clínicos referentes ao período compreendido entre 2013 a 2015. Os dados foram obtidos nos processos dos doentes após autorização da direção do hospital (dados demográficos, dados relativos à sintomatologia do doente, exame físico, fatores de risco para hepatomegalia e/ ou esplenomegalia, dados dos exames complementares de diagnóstico e estado dos doentes à saída). Os dados foram analisados com apoio do programa SPSS, versão 23.
Foram analisados 804 processos de doentes com hepatomegalia e/ou esplenomegalia, com idade média de 37,2 anos, metade do género masculino e 41,5% naturais de Luanda.
Destes doentes, 42,4% tinham iniciado sintomas até uma semana antes do internamento e 30% entre uma e quatro semanas antes. Os sintomas mais referidos foram dor abdominal (66,9%), febre (56,1%), emagrecimento (43,8%); ao exame objetivo observou-se mucosas descoradas (69,3%), hepatomegalia (49,8%), esplenomegalia (18,5%), hepatoesplenomegalia (5,8%); A maioria dos doentes apresentava anemia e provas de função hepática alteradas. Três quartos realizou exames imagiológicos e um quarto realizou endoscopia digestiva alta.
Das principais causas de hepatomegalia e/ ou esplenomegalia encontradas, salientam-se a malária (13,3%), schistosomose (13,2%), insuficiência cardíaca congestiva (12,2%), doença hepática crónica alcoólica (10,3%), hepatocarcinoma (8,8%). Em relação à mortalidade ocorrida nestes doentes, no total de 122, verificou-se que o hepatocarcinoma, síndrome de imunodeficiência adquirida associada a tuberculose e doença hepática alcoólica foram as principais causas de morte, com 36%, 10,7% e 10,7%, respetivamente.
Considerando o mecanismo fisiopatológico das doenças, o grupo etário dos 30-39 anos apresentou a maior percentagem de casos de doença inflamatória (25%) e doença congestiva (22%) e o grupo etário dos 50-59 anos apresentou a maior percentagem (25%) de casos de doença infiltrativa, refletindo, provavelmente, doença oncológica.
A maioria dos doentes era originária das províncias de Luanda, Uíge e Malange, sendo a schistosomose hepatoesplénica predominante nos doentes do Uíge, devendo ser um diagnóstico a considerar nos doentes oriundos desta região. Quanto aos potenciais fatores de risco, salientam-se os hábitos etílicos, banho no rio e hemotransfusão.
Será importante reforçar a prevenção destas doenças através de, por exemplo, medidas de controlo de mosquitos vetores, saneamento básico e água tratada, educação para saúde, aumento da literacia em saúde na população e maior acesso a serviços de saúde.
Considering the high frequency of patients with hepatomegaly and/or splenomegaly observed in the Medicine and Gastroenterology departments of Américo Boavida Hospital, in Luanda, Angola, the present study aimed to identify the main causal factors of these signs and the potential risk factors, to be implemented the most appropriate measures for their prevention. A cross-sectional retrospective study was carried out based on the clinical processes during the period from 2013 to 2015. Data were obtained from patients' files following hospital authorization (demographic data, patient symptoms, physical examination, risk factors, data from complementary diagnostic tests, and status of outgoing patients). The data were analysed with the support of the SPSS program, version 23. We analysed 804 cases of patients with hepatomegaly, splenomegaly or hepatosplenomegaly, with a mean age of 37.2 years, almost half of the patients were male and 41.5% from Luanda. Of these patients, 42.4% started symptoms up to one week before admission and 30% between one and four weeks before. The most commonly reported symptoms were abdominal pain (66.9%), fever (56.1%), weight loss (43.8%); discoloured mucous membranes was observed in 69.3%, hepatomegaly (55.5%), splenomegaly (24.5%) and hepatosplenomegaly (20%); Most patients had anemia and abnormal liver function tests. About 75% performed imaging exams and almost 25% performed upper endoscopy. The main causes of hepatomegaly, splenomegaly or hepatosplenomegaly were malaria (13.3%), schistosomiasis (13.2%), congestive heart failure (12.2%), chronic alcoholic liver disease (10.3%) and hepatic cancer (8.8%). In relation to the mortality in these patients, in a total of 122, hepatic cancer, acquired immunodeficiency syndrome associated with tuberculosis and alcoholic liver disease were the main causes of death, with 36%, 10.7% and 10.7% %, respectively. Considering the pathophysiological mechanism of the diseases, the 30-39 years’ age group presented the highest percentage of cases of inflammatory disease (25%) and congestive disease (22%) whereas the 50-59 age group had the highest percentage (25 %) of cases of infiltrative disease, probably reflecting oncological disease. Most of the patients came from the provinces of Luanda, Uíge and Malange, and hepatosplenic schistosomiasis was predominant in patients from Uíge and should be further considered in patients from this region. Potential risk factors include ethylic habits, bathing in the river and blood transfusion. Reinforcement of preventive measures are highly recommended through, for example, vector control measures, improvement of sanitation and treated water, health education and literacy in the population and increased access to health service
Considering the high frequency of patients with hepatomegaly and/or splenomegaly observed in the Medicine and Gastroenterology departments of Américo Boavida Hospital, in Luanda, Angola, the present study aimed to identify the main causal factors of these signs and the potential risk factors, to be implemented the most appropriate measures for their prevention. A cross-sectional retrospective study was carried out based on the clinical processes during the period from 2013 to 2015. Data were obtained from patients' files following hospital authorization (demographic data, patient symptoms, physical examination, risk factors, data from complementary diagnostic tests, and status of outgoing patients). The data were analysed with the support of the SPSS program, version 23. We analysed 804 cases of patients with hepatomegaly, splenomegaly or hepatosplenomegaly, with a mean age of 37.2 years, almost half of the patients were male and 41.5% from Luanda. Of these patients, 42.4% started symptoms up to one week before admission and 30% between one and four weeks before. The most commonly reported symptoms were abdominal pain (66.9%), fever (56.1%), weight loss (43.8%); discoloured mucous membranes was observed in 69.3%, hepatomegaly (55.5%), splenomegaly (24.5%) and hepatosplenomegaly (20%); Most patients had anemia and abnormal liver function tests. About 75% performed imaging exams and almost 25% performed upper endoscopy. The main causes of hepatomegaly, splenomegaly or hepatosplenomegaly were malaria (13.3%), schistosomiasis (13.2%), congestive heart failure (12.2%), chronic alcoholic liver disease (10.3%) and hepatic cancer (8.8%). In relation to the mortality in these patients, in a total of 122, hepatic cancer, acquired immunodeficiency syndrome associated with tuberculosis and alcoholic liver disease were the main causes of death, with 36%, 10.7% and 10.7% %, respectively. Considering the pathophysiological mechanism of the diseases, the 30-39 years’ age group presented the highest percentage of cases of inflammatory disease (25%) and congestive disease (22%) whereas the 50-59 age group had the highest percentage (25 %) of cases of infiltrative disease, probably reflecting oncological disease. Most of the patients came from the provinces of Luanda, Uíge and Malange, and hepatosplenic schistosomiasis was predominant in patients from Uíge and should be further considered in patients from this region. Potential risk factors include ethylic habits, bathing in the river and blood transfusion. Reinforcement of preventive measures are highly recommended through, for example, vector control measures, improvement of sanitation and treated water, health education and literacy in the population and increased access to health service
Descrição
Palavras-chave
Saúde tropical Doenças tropicais Hepatomegalia Esplenomegalia Doenças do fígado Doenças do baço Luanda Angola
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical