<div id="pf1" class="pf w0 h0" data-page-no="1"><div class="pc pc1 w0 h0"><img class="bi x0 y0 w0 h0" alt="" src="https://files.passeidireto.com/2e5848d1-314e-4838-84e2-598f98ea6d0b/bg1.png"><div class="c x1 y1 w1 h1"><div class="t m0 x2 h2 y2 ff1 fs0 fc0 sc0 ls1 ws3"> </div><div class="t m0 x2 h3 y3 ff2 fs1 fc0 sc0 ls1 ws3">A <span class="blank _0"> </span>apendicite <span class="blank _0"> </span>não <span class="blank _0"> </span>tende <span class="blank _0"> </span>a <span class="blank _0"> </span>se <span class="blank _0"> </span>generalizar<span class="blank _1"></span>. <span class="blank _0"> </span>Ou <span class="blank _0"> </span>ela </div><div class="t m0 x2 h3 y4 ff2 fs1 fc0 sc0 ls1 ws3">começa <span class="blank _2"> </span>per<span class="blank _2"> </span>furada, <span class="blank _2"> </span>gerando <span class="blank _2"> </span>clínica <span class="blank _2"> </span>de <span class="blank _2"> </span>peritonite </div><div class="t m0 x2 h3 y5 ff2 fs1 fc0 sc0 ls1 ws3">difusa <span class="blank"> </span>ou <span class="blank _3"> </span>produz <span class="blank"> </span>uma <span class="blank _3"> </span>peritonite <span class="blank"> </span>circunscrita/lo-</div><div class="t m0 x2 h3 y6 ff2 fs1 fc0 sc0 ls1 ws3">cal, <span class="blank _0"> </span>gerando <span class="blank _0"> </span>dor<span class="blank _4"></span>, <span class="blank _0"> </span>defesa, <span class="blank _0"> </span>contratura <span class="blank _0"> </span>e <span class="blank _0"> </span>DBD <span class="blank _0"> </span>+ <span class="blank _0"> </span>no </div><div class="t m0 x2 h3 y7 ff2 fs1 fc0 sc0 ls1 ws3">quadrante <span class="blank _2"> </span>inferior <span class="blank _5"> </span>direito <span class="blank _2"> </span>e <span class="blank _5"> </span>sinal <span class="blank _2"> </span>de <span class="blank _5"> </span>Blumberg <span class="blank _2"> </span>+.<span class="ls0"> A<span class="blank _6"></span> </span></div><div class="t m0 x2 h3 y8 ff2 fs1 fc0 sc0 ls1 ws3">apendicite <span class="blank _3"> </span>aguda <span class="blank _3"> </span>circunscrita <span class="blank _3"> </span>não <span class="blank _3"> </span>tende <span class="blank _3"> </span>a <span class="blank _3"> </span>se </div><div class="t m0 x2 h3 y9 ff2 fs1 fc0 sc0 ls1 ws3">generalizar<span class="blank _4"></span>, <span class="blank _7"> </span>porque <span class="blank _7"> </span>o <span class="blank _7"> </span>processo <span class="blank _7"> </span>inflamatório <span class="blank _7"> </span>fica </div><div class="t m0 x2 h3 ya ff2 fs1 fc0 sc0 ls1 ws3">bloqueado <span class="blank"> </span>pelo <span class="blank _3"> </span>omento, <span class="blank"> </span>o <span class="blank _3"> </span>máximo <span class="blank"> </span>que <span class="blank"> </span>pode </div><div class="t m0 x2 h3 yb ff2 fs1 fc0 sc0 ls1 ws3">acontecer é um abscesso local. </div><div class="t m0 x3 h4 yc ff3 fs2 fc0 sc0 ls2 ws0">INTRODUÇÃO<span class="ff2 ls1 ws3"> </span></div><div class="t m0 x2 h3 yd ff2 fs1 fc0 sc0 ls1 ws3">A <span class="blank _0"> </span>apendicite <span class="blank _0"> </span>aguda <span class="blank _0"> </span>tem <span class="blank _0"> </span>uma <span class="blank _0"> </span>incidência <span class="blank _0"> </span>de <span class="blank _0"> </span>7%, </div><div class="t m0 x2 h3 ye ff2 fs1 fc0 sc0 ls1 ws3">sendo <span class="blank _2"> </span>muito <span class="blank _2"> </span>frequente. <span class="blank _5"> </span>Ocorre <span class="blank _2"> </span>especialmente <span class="blank _2"> </span>na </div><div class="t m0 x2 h5 yf ff3 fs1 fc0 sc0 ls3 ws3">faixa <span class="blank _8"> </span>etária <span class="blank _8"> </span>de <span class="blank _8"> </span>10 <span class="blank _8"> </span>- <span class="blank _8"> </span>30 <span class="blank _8"> </span>anos<span class="ff2 ls1">, <span class="blank _8"> </span>correspondendo <span class="blank _8"> </span>a </span></div><div class="t m0 x2 h3 y10 ff2 fs1 fc0 sc0 ls1 ws3">75% <span class="blank _8"> </span>dos <span class="blank _7"> </span>casos. <span class="blank _8"> </span>Responsável <span class="blank _8"> </span>por <span class="blank _7"> </span>60% <span class="blank _8"> </span>dos <span class="blank _8"> </span>abdo-</div><div class="t m0 x2 h5 y11 ff2 fs1 fc0 sc0 ls1 ws3">mes <span class="blank _5"> </span>agudos, <span class="blank _5"> </span><span class="ff3 ls4">sem <span class="blank _0"> </span>predileção <span class="blank _2"> </span>por <span class="blank _0"> </span>gênero<span class="ff2">. <span class="blank _2"> </span>Nos <span class="blank _0"> </span>ex</span></span>-</div><div class="t m0 x2 h3 y12 ff2 fs1 fc0 sc0 ls1 ws3">tremos <span class="blank _5"> </span>de <span class="blank _5"> </span>idades <span class="blank _5"> </span>o <span class="blank _5"> </span>diagnóstico <span class="blank _5"> </span>é <span class="blank _5"> </span>muito <span class="blank _5"> </span>difícil, <span class="blank _5"> </span>na </div><div class="t m0 x2 h3 y13 ff2 fs1 fc0 sc0 ls1 ws3">criança <span class="blank _0"> </span>por<span class="blank _6"></span>que <span class="blank _0"> </span>ela <span class="blank _5"> </span>não <span class="blank _0"> </span>fala, <span class="blank _5"> </span>só <span class="blank _0"> </span>chora <span class="blank _5"> </span>e <span class="blank _0"> </span>nos <span class="blank _9"> </span>ido-</div><div class="t m0 x2 h3 y14 ff2 fs1 fc0 sc0 ls1 ws3">sos <span class="blank _8"> </span>porque <span class="blank _8"> </span>eles <span class="blank _a"> </span>não <span class="blank _8"> </span>fazem <span class="blank _a"> </span>leucocitose, <span class="blank _8"> </span>não <span class="blank _8"> </span>fa-</div><div class="t m0 x2 h3 y15 ff2 fs1 fc0 sc0 ls1 ws3">zem <span class="blank _b"> </span>reação <span class="blank _b"> </span>peritoneal, <span class="blank _b"> </span>ou <span class="blank _b"> </span>seja, <span class="blank _b"> </span>eles <span class="blank _b"> </span>têm <span class="blank _b"> </span>dificul-</div><div class="t m0 x2 h3 y16 ff2 fs1 fc0 sc0 ls1 ws3">dade <span class="blank _c"> </span>de <span class="blank _c"> </span>apresentar <span class="blank _c"> </span>dor<span class="blank _4"></span>, <span class="blank _c"> </span>defesa, <span class="blank _c"> </span>contratura <span class="blank _c"> </span>e </div><div class="t m0 x2 h3 y17 ff2 fs1 fc0 sc0 ls1 ws3">DBD <span class="blank _d"> </span>+. <span class="blank _d"> </span>A <span class="blank _d"> </span>mortalidade <span class="blank _d"> </span>não <span class="blank _d"> </span>é <span class="blank _d"> </span>desprezível, <span class="blank _d"> </span>no </div><div class="t m0 x2 h3 y18 ff2 fs1 fc0 sc0 ls1 ws3">apêndice <span class="blank _5"> </span>não <span class="blank _9"> </span>per<span class="blank _5"> </span>furado <span class="blank _9"> </span>atinge <span class="blank _9"> </span>0,5% <span class="blank _5"> </span>e <span class="blank _9"> </span>no <span class="blank _9"> </span>apên-</div><div class="t m0 x2 h3 y19 ff2 fs1 fc0 sc0 ls1 ws3">dice per<span class="blank _2"> </span>furado 2,5%. </div><div class="t m0 x4 h3 y1a ff2 fs1 fc0 sc0 ls1 ws3">Menino de 15 anos que começa com dor abdo-</div><div class="t m0 x5 h3 y1b ff2 fs1 fc0 sc0 ls1 ws3">minal em cólica (dor visceral) e que 8-12horas </div><div class="t m0 x2 h3 y1c ff2 fs1 fc0 sc0 ls1 ws3">depois essa dor adquire o caráter migratório para </div><div class="t m0 x4 h3 y1d ff2 fs1 fc0 sc0 ls1 ws3">FID com sinais de dor (dor parietal), defesa, con-</div><div class="t m0 x2 h3 y1e ff2 fs1 fc0 sc0 ls1 ws3">tratura e descompressão brusca dolorosa positiva </div><div class="t m0 x6 h3 y1f ff2 fs1 fc0 sc0 ls1 ws3">é apendicite aguda. </div><div class="t m0 x7 h4 y20 ff3 fs2 fc0 sc0 ls5 ws1">ANATOMIA<span class="ls1 ws3"> </span></div><div class="t m0 x2 h3 y21 ff2 fs1 fc0 sc0 ls1 ws3"> </div><div class="t m0 x2 h3 y22 ff2 fs1 fc0 sc0 ls1 ws3"><span class="fc3 sc0"> </span><span class="fc3 sc0"> </span></div><div class="t m0 x2 h3 y23 ff2 fs1 fc0 sc0 ls1 ws3"> </div><div class="t m0 x2 h3 y24 ff2 fs1 fc0 sc0 ls1 ws3">A ponta do <span class="blank _2"> </span>apêndice pode se <span class="blank _2"> </span>situar em qualquer </div><div class="t m0 x2 h3 y25 ff2 fs1 fc0 sc0 ls1 ws3">lugar <span class="blank"> </span>da <span class="blank _7"> </span>cavidade <span class="blank"> </span>abdominal, <span class="blank _7"> </span>tornando <span class="blank"> </span>a <span class="blank"> </span>do-</div><div class="t m0 x2 h3 y26 ff2 fs1 fc0 sc0 ls1 ws3">ença <span class="blank _0"> </span>pleomór<span class="blank _5"> </span>fica. <span class="blank _0"> </span>Na <span class="blank _b"> </span>grande <span class="blank _0"> </span>maioria <span class="blank _b"> </span>das <span class="blank _0"> </span>vezes </div><div class="t m0 x8 h3 y27 ff2 fs1 fc0 sc0 ls1 ws3">situa-se <span class="blank _9"> </span>na <span class="blank _0"> </span>fossa <span class="blank _9"> </span>ilíaca <span class="blank _0"> </span>direita <span class="blank _9"> </span>(70-80% <span class="blank _0"> </span>das <span class="blank _0"> </span>vezes), </div><div class="t m0 x8 h3 y28 ff2 fs1 fc0 sc0 ls1 ws3">mas <span class="blank _2"> </span>pode situar-se <span class="blank _2"> </span>na <span class="blank _2"> </span>pelve <span class="blank _2"> </span>e <span class="blank _2"> </span>simular <span class="blank _2"> </span>as <span class="blank _2"> </span>doenças </div><div class="t m0 x8 h3 y29 ff2 fs1 fc0 sc0 ls1 ws3">ginecológicas, <span class="blank"> </span>como <span class="blank"> </span>também <span class="blank"> </span>pode <span class="blank"> </span>ser <span class="blank"> </span>subce-</div><div class="t m0 x8 h3 y2a ff2 fs1 fc0 sc0 ls1 ws3">cal, <span class="blank _3"> </span>retrocecal, <span class="blank _3"> </span>retroileal, <span class="blank _3"> </span>sub-hepático <span class="blank _c"> </span>e <span class="blank _3"> </span>pode </div><div class="t m0 x8 h3 y2b ff2 fs1 fc0 sc0 ls1 ws3">ser <span class="blank"> </span>dentro <span class="blank"> </span>de <span class="blank _3"> </span>uma <span class="blank"> </span>hér<span class="blank _2"> </span>nia <span class="blank"> </span>inguinal <span class="blank"> </span>(nesse <span class="blank _3"> </span>caso </div><div class="t m0 x8 h3 y2c ff2 fs1 fc0 sc0 ls1 ws3">recebe <span class="blank _2"> </span>o <span class="blank _5"> </span>nome <span class="blank _5"> </span>de <span class="blank _5"> </span>hérnia <span class="blank _5"> </span>de <span class="blank _5"> </span>amyand). <span class="blank _5"> </span>Além <span class="blank _5"> </span>dis-</div><div class="t m0 x8 h3 y2d ff2 fs1 fc0 sc0 ls1 ws3">so, <span class="blank _8"> </span>pode <span class="blank _8"> </span>situar-se <span class="blank _8"> </span>em <span class="blank _8"> </span>cima <span class="blank _8"> </span>da <span class="blank _8"> </span>bexiga <span class="blank _8"> </span>e <span class="blank _a"> </span>simular </div><div class="t m0 x8 h3 y2e ff2 fs1 fc0 sc0 ls1 ws3">sinais de cistite. </div><div class="t m0 x8 h3 y2f ff2 fs1 fc0 sc0 ls1 ws3">De <span class="blank _0"> </span>acordo <span class="blank _9"> </span>com <span class="blank _0"> </span>a <span class="blank _0"> </span>anatomia, <span class="blank _0"> </span>a <span class="blank _0"> </span>base <span class="blank _b"> </span>do <span class="blank _9"> </span>apêndi-</div><div class="t m0 x8 h3 y30 ff2 fs1 fc0 sc0 ls1 ws3">ce <span class="blank _b"> </span>está <span class="blank _0"> </span>sempre <span class="blank _b"> </span>no <span class="blank _0"> </span>mesmo <span class="blank _b"> </span>lugar<span class="blank _4"></span>, <span class="blank _0"> </span>situada <span class="blank _b"> </span>na <span class="blank _0"> </span>jun-</div><div class="t m0 x8 h3 y31 ff2 fs1 fc0 sc0 ls1 ws3">ção <span class="blank _2"> </span>das <span class="blank _5"> </span>três <span class="blank _5"> </span>tênias <span class="blank _2"> </span>colônicas <span class="blank _5"> </span>e <span class="blank _5"> </span>na <span class="blank _2"> </span>bissetriz <span class="blank _5"> </span>do <span class="blank _2"> </span>ân-</div><div class="t m0 x8 h3 y32 ff2 fs1 fc0 sc0 ls1 ws3">gulo <span class="blank _5"> </span>for<span class="blank _2"> </span>mado <span class="blank _9"> </span>entre <span class="blank _5"> </span>o <span class="blank _9"> </span>íleo <span class="blank _5"> </span>ter<span class="blank _2"> </span>minal <span class="blank _9"> </span>e <span class="blank _9"> </span>o <span class="blank _5"> </span>ceco <span class="blank _9"> </span>está </div><div class="t m0 x8 h3 y33 ff2 fs1 fc0 sc0 ls1 ws3">situado o apêndice. </div><div class="t m0 x8 h6 y34 ff4 fs3 fc0 sc0 ls1 ws3"> </div><div class="t m0 x9 h4 y35 ff3 fs2 fc0 sc0 ls1 ws3">ETIOLOGIA </div><div class="t m0 x8 h3 y36 ff2 fs1 fc0 sc0 ls1 ws3">Na <span class="blank _a"> </span>criança, <span class="blank"> </span>o <span class="blank _a"> </span>apêndice <span class="blank _7"> </span>é <span class="blank _a"> </span>um <span class="blank"> </span>órgão <span class="blank _a"> </span>bursa-de-</div><div class="t m0 x8 h3 y37 ff2 fs1 fc0 sc0 ls1 ws3">pendente <span class="blank"> </span>ou <span class="blank _a"> </span>timo-independente <span class="blank"> </span>e <span class="blank _7"> </span>tem <span class="blank"> </span>função </div><div class="t m0 x8 h3 y38 ff2 fs1 fc0 sc0 ls1 ws3">semelhante <span class="blank _a"> </span>a <span class="blank _7"> </span>amígdala <span class="blank _a"> </span>no <span class="blank _7"> </span>sistema <span class="blank _a"> </span>adenoidea-</div><div class="t m0 x8 h3 y39 ff2 fs1 fc0 sc0 ls1 ws3">no, <span class="blank _a"> </span>ou <span class="blank _7"> </span>seja, <span class="blank _a"> </span>é <span class="blank"> </span>produtor <span class="blank _8"> </span>de <span class="blank"> </span>imunoglobulinas. <span class="blank _a"> </span>No </div><div class="t m0 x8 h3 y3a ff2 fs1 fc0 sc0 ls1 ws3">adulto, <span class="blank _b"> </span>o <span class="blank _b"> </span>apêndice <span class="blank _b"> </span>funciona <span class="blank _b"> </span>como <span class="blank _b"> </span>depósito <span class="blank _b"> </span>da </div><div class="t m0 x8 h3 y3b ff2 fs1 fc0 sc0 ls1 ws3">flora intestinal <span class="blank _2"> </span>nor<span class="blank _2"> </span>mal, se <span class="blank _2"> </span>por <span class="blank _2"> </span>exemplo, o <span class="blank _2"> </span>indivíduo </div><div class="t m0 x8 h3 y3c ff2 fs1 fc0 sc0 ls1 ws3">toma <span class="blank"> </span>antibiótico <span class="blank"> </span>e <span class="blank"> </span>esteriliza <span class="blank"> </span>a <span class="blank"> </span>flora <span class="blank"> </span>intestinal, <span class="blank"> </span>o </div><div class="t m0 x8 h3 y3d ff2 fs1 fc0 sc0 ls1 ws3">apêndice <span class="blank _b"> </span>recoloniza <span class="blank _0"> </span>a <span class="blank _b"> </span>microbiota, <span class="blank _0"> </span>especialmen-</div><div class="t m0 x8 h3 y3e ff2 fs1 fc0 sc0 ls1 ws3">te as bactérias saprófitas. </div><div class="t m0 x8 h3 y3f ff2 fs1 fc0 sc0 ls1 ws3">A <span class="blank _5"> </span>causa <span class="blank _5"> </span>de <span class="blank _5"> </span>apendicite <span class="blank _5"> </span>aguda <span class="blank _5"> </span>na <span class="blank _5"> </span>criança <span class="blank _9"> </span>é <span class="blank _5"> </span>dife-</div><div class="t m0 x8 h3 y40 ff2 fs1 fc0 sc0 ls1 ws3">rente <span class="blank _8"> </span>do <span class="blank _a"> </span>adulto. <span class="blank _a"> </span>Na <span class="blank _a"> </span>criança <span class="blank _a"> </span>é <span class="blank _a"> </span>secundária <span class="blank _8"> </span>a <span class="blank _a"> </span><span class="ls4 ws2">hi</span>-</div><div class="t m0 x8 h3 y41 ff2 fs1 fc0 sc0 ls1 ws3">perplasia <span class="blank _8"> </span>linfoide <span class="blank _8"> </span>(ocorreu <span class="blank _8"> </span>um <span class="blank _a"> </span>estímulo <span class="blank _8"> </span>viral, <span class="blank _8"> </span>por </div><div class="t m0 x8 h3 y42 ff2 fs1 fc0 sc0 ls1 ws3">exemplo, <span class="blank _9"> </span>IV<span class="blank _4"></span>AS <span class="blank _5"> </span><span class="ff5">\u2192</span> <span class="blank _0"> </span>1 <span class="blank _9"> </span>semana <span class="blank _9"> </span>depois <span class="blank _9"> </span>a <span class="blank _0"> </span>criança <span class="blank _9"> </span>co-</div><div class="t m0 x8 h3 y43 ff2 fs1 fc0 sc0 ls1 ws3">meça <span class="blank _b"> </span>com <span class="blank _0"> </span>dor <span class="blank _b"> </span>periumbilical <span class="blank _b"> </span>e <span class="blank _0"> </span>sinais <span class="blank _b"> </span>de <span class="blank _b"> </span>irritação </div><div class="t m0 x8 h3 y44 ff2 fs1 fc0 sc0 ls1 ws3">peritoneal <span class="blank _5"> </span><span class="ff5">\u2192</span> <span class="blank _9"> </span>o <span class="blank _9"> </span>que <span class="blank _9"> </span>ocorreu <span class="blank _5"> </span>foi <span class="blank _9"> </span>que <span class="blank _9"> </span>as <span class="blank _5"> </span>placas <span class="blank _9"> </span>de </div><div class="t m0 x8 h3 y45 ff2 fs1 fc0 sc0 ls1 ws3">Peyer <span class="blank _9"> </span>\u2013 <span class="blank _0"> </span>órgãos <span class="blank _9"> </span>linfoides <span class="blank _0"> </span>da <span class="blank _9"> </span>submucosa <span class="blank _0"> </span>do <span class="blank _9"> </span>apên-</div><div class="t m0 x8 h3 y46 ff2 fs1 fc0 sc0 ls1 ws3">dice <span class="blank _b"> </span>\u2013 <span class="blank _b"> </span>se <span class="blank _b"> </span>hipertrofiaram <span class="blank _b"> </span>em <span class="blank _b"> </span>resposta <span class="blank _b"> </span>a <span class="blank _b"> </span>esse <span class="blank _b"> </span>estí-</div><div class="t m0 x8 h3 y47 ff2 fs1 fc0 sc0 ls1 ws3">mulo <span class="blank _b"> </span>viral <span class="blank _8"> </span>e <span class="blank _8"> </span>causam <span class="blank _b"> </span>uma <span class="blank _8"> </span>semi-oclusão <span class="blank _b"> </span>ou <span class="blank _8"> </span>oclu-</div><div class="t m0 x8 h3 y48 ff2 fs1 fc0 sc0 ls1 ws3">são <span class="blank _0"> </span>do <span class="blank _b"> </span>apêndice <span class="blank _0"> </span>ver<span class="blank _2"> </span>mifor<span class="blank _2"> </span>me). <span class="blank _b"> </span>No <span class="blank _0"> </span>adulto, <span class="blank _b"> </span>não <span class="blank _0"> </span>é </div><div class="t m0 x8 h3 y49 ff2 fs1 fc0 sc0 ls1 ws3">a mesma etiologia, porque as placas de Peyer do </div><div class="t m0 x8 h3 y4a ff2 fs1 fc0 sc0 ls1 ws3">apêndice <span class="blank _9"> </span>atrofiam <span class="blank _9"> </span>por <span class="blank _0"> </span>volta <span class="blank _9"> </span>dos <span class="blank _0"> </span>20 <span class="blank _9"> </span>anos <span class="blank _9"> </span>de <span class="blank _0"> </span>ida-</div><div class="t m0 x8 h3 y4b ff2 fs1 fc0 sc0 ls1 ws3">de. <span class="blank _0"> </span>No <span class="blank _0"> </span>adulto, <span class="blank _b"> </span>a <span class="blank _9"> </span>principal <span class="blank _b"> </span>etiologia <span class="blank _9"> </span>é <span class="blank _b"> </span>fecalito <span class="blank _9"> </span>ou </div><div class="t m0 x8 h3 y4c ff2 fs1 fc0 sc0 ls1 ws3">apendicolito, <span class="blank _b"> </span>fragmento <span class="blank _b"> </span>de <span class="blank _b"> </span>fezes <span class="blank _b"> </span>espesso, <span class="blank _0"> </span>extre-</div><div class="t m0 x8 h3 y4d ff2 fs1 fc0 sc0 ls1 ws3">mamente <span class="blank _c"> </span>endurecido, <span class="blank _c"> </span>que <span class="blank _c"> </span>simula <span class="blank _c"> </span>uma <span class="blank _c"> </span>pedra, </div><div class="t m0 x8 h3 y4e ff2 fs1 fc0 sc0 ls1 ws3">adentra <span class="blank _9"> </span>a <span class="blank _9"> </span>luz <span class="blank _0"> </span>apendicular <span class="blank _9"> </span>e <span class="blank _0"> </span>obstrui <span class="blank _9"> </span>a <span class="blank _9"> </span>luz <span class="blank _0"> </span>apendi-</div><div class="t m0 x8 h3 y4f ff2 fs1 fc0 sc0 ls1 ws3">cular<span class="blank _1"></span>. </div><div class="t m0 x8 h3 y50 ff2 fs1 fc0 sc0 ls1 ws3">Outras <span class="blank _b"> </span>possíveis <span class="blank _8"> </span>causas <span class="blank _8"> </span>são: <span class="blank _b"> </span>T<span class="blank _6"></span>umores <span class="blank _b"> </span>(por <span class="blank _8"> </span>exem-</div><div class="t m0 x8 h3 y51 ff2 fs1 fc0 sc0 ls1 ws3">plo, <span class="blank _b"> </span>tumor <span class="blank _0"> </span>da <span class="blank _b"> </span>vertente <span class="blank _b"> </span>do <span class="blank _0"> </span>ceco), <span class="blank _b"> </span>sementes, <span class="blank _b"> </span>ver-</div><div class="t m0 x8 h3 y52 ff2 fs1 fc0 sc0 ls1 ws3">mes, <span class="blank _8"> </span>Y<span class="blank _1"></span>ersinia <span class="blank _a"> </span>Enterocolitica. <span class="blank _8"> </span>T<span class="blank _6"></span>odas <span class="blank _a"> </span>essas <span class="blank _8"> </span>possibili-</div><div class="t m0 x8 h3 y53 ff2 fs1 fc0 sc0 ls1 ws3">dades <span class="blank _9"> </span>possuem <span class="blank _9"> </span>a <span class="blank _0"> </span>mesma <span class="blank _9"> </span>fisiopatologia, <span class="blank _0"> </span>que <span class="blank _9"> </span>é <span class="blank _0"> </span>a </div><div class="t m0 x8 h3 y54 ff2 fs1 fc0 sc0 ls1 ws3">obstrução do óstio apendicular<span class="blank _1"></span>. </div><div class="t m0 xa h4 y55 ff3 fs2 fc0 sc0 ls1 ws3">FISIOPATOLOGIA </div><div class="t m0 x8 h3 y56 ff2 fs1 fc0 sc0 ls1 ws3">Com <span class="blank _9"> </span>a <span class="blank _9"> </span>alimentação <span class="blank _9"> </span>ocidental, <span class="blank _0"> </span>as <span class="blank _9"> </span>fezes <span class="blank _9"> </span>se <span class="blank _9"> </span>tor<span class="blank _2"> </span>na-</div><div class="t m0 x8 h3 y57 ff2 fs1 fc0 sc0 ls1 ws3">ram <span class="blank _2"> </span>mais <span class="blank _5"> </span>endurecidas, <span class="blank _5"> </span>logo <span class="blank _2"> </span>há <span class="blank _5"> </span>fragmentos <span class="blank _5"> </span>fecais </div><div class="t m0 x8 h3 y58 ff2 fs1 fc0 sc0 ls1 ws3">(fecalito) <span class="blank _3"> </span>endurecidos <span class="blank _c"> </span>na <span class="blank _3"> </span>luz <span class="blank _3"> </span>cecal. <span class="blank _c"> </span>Por <span class="blank _3"> </span>algum </div></div><div class="c x1 y59 w2 h7"><div class="t m0 xb h8 y5a ff6 fs0 fc1 sc0 ls1 ws3">Amanda Viol</div></div><div class="c xc y5b w3 h9"><div class="t m0 x2 h3 y5c ff2 fs1 fc0 sc0 ls1 ws3">Retrocecal - Pélvico - Retroileal - </div><div class="t m0 x2 h3 y5d ff2 fs1 fc0 sc0 ls1 ws3">Sub-hepático - FIE - Hérnia Inguinal<span class="fc2">l</span></div></div><div class="c xc y5e w4 ha"><div class="t m0 xd hb y5f ff7 fs4 fc0 sc0 ls1">APENDICITE\ue601</div><div class="t m0 xd hb y60 ff7 fs4 fc0 sc0 ls1">AGUDA</div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf2" class="pf w0 h0" data-page-no="2"><div class="pc pc2 w0 h0"><img class="bi x0 y0 w0 h0" alt="" src="https://files.passeidireto.com/2e5848d1-314e-4838-84e2-598f98ea6d0b/bg2.png"><div class="c x1 y61 w5 hc"><div class="t m0 x2 h3 y62 ff2 fs1 fc0 sc0 ls1 ws3">estímulo <span class="blank _0"> </span>ainda <span class="blank _b"> </span>não <span class="blank _0"> </span>explicado, <span class="blank _0"> </span>um <span class="blank _b"> </span>fragmento <span class="blank _0"> </span>fe-</div><div class="t m0 x2 h3 y63 ff2 fs1 fc0 sc0 ls1 ws3">cal, <span class="blank _b"> </span>chamado <span class="blank _8"> </span>fecalito <span class="blank _8"> </span>ou <span class="blank _8"> </span>apendicolito, <span class="blank _8"> </span>adentra </div><div class="t m0 x2 h3 y64 ff2 fs1 fc0 sc0 ls1 ws3">a <span class="blank _5"> </span>luz <span class="blank _9"> </span>apendicular<span class="blank _4"></span>, <span class="blank _9"> </span>que <span class="blank _9"> </span>é <span class="blank _9"> </span>muito <span class="blank _9"> </span>estreita. <span class="blank _9"> </span>Com <span class="blank _5"> </span>isso, </div><div class="t m0 x2 h5 y65 ff2 fs1 fc0 sc0 ls1 ws3">passa <span class="blank _3"> </span>a <span class="blank _c"> </span>ter <span class="blank _3"> </span>uma <span class="blank _c"> </span><span class="ff3 ls6">obstrução <span class="blank _3"> </span>em <span class="blank _c"> </span>alça <span class="blank _3"> </span>fechada</span><span class="ls4">, </span></div><div class="t m0 x2 h3 y66 ff2 fs1 fc0 sc0 ls1 ws3">porque <span class="blank _9"> </span>a <span class="blank _9"> </span>ponta <span class="blank _0"> </span>do <span class="blank _9"> </span>apêndi<span class="blank _2"> </span>ce <span class="blank _9"> </span>é <span class="blank _0"> </span>fechada. <span class="blank _9"> </span>A <span class="blank _0"> </span>obs-</div><div class="t m0 x2 h5 y67 ff2 fs1 fc0 sc0 ls1 ws3">trução <span class="blank _8"> </span>em <span class="blank _8"> </span>alça <span class="blank _a"> </span>fechada <span class="blank _8"> </span>é <span class="blank _8"> </span>o <span class="blank _a"> </span><span class="ff3 ls3">fator <span class="blank _8"> </span>de <span class="blank _a"> </span>predição</span> </div><div class="t m0 x2 h3 y68 ff2 fs1 fc0 sc0 ls1 ws3">mais <span class="blank"> </span>importante <span class="blank _3"> </span>de <span class="blank _3"> </span>que <span class="blank"> </span>essa <span class="blank _3"> </span>alça <span class="blank _3"> </span>entrará <span class="blank"> </span>em </div><div class="t m0 x2 h3 y69 ff2 fs1 fc0 sc0 ls1 ws3">necrose. </div><div class="t m0 x2 h3 y6a ff2 fs1 fc0 sc0 ls1 ws3">O <span class="blank _c"> </span>apêndice <span class="blank _c"> </span>começará <span class="blank _c"> </span>a <span class="blank _c"> </span>contrair <span class="blank _c"> </span>para <span class="blank _c"> </span>tentar </div><div class="t m0 x2 h3 y6b ff2 fs1 fc0 sc0 ls1 ws3">devolver <span class="blank _0"> </span>ao <span class="blank _b"> </span>ceco <span class="blank _0"> </span>esse <span class="blank _b"> </span>fragmento, <span class="blank _0"> </span>se <span class="blank _b"> </span>ele <span class="blank _0"> </span>conse-</div><div class="t m0 x2 h3 y6c ff2 fs1 fc0 sc0 ls1 ws3">guir<span class="blank _4"></span>, <span class="blank _2"> </span>a <span class="blank _2"> </span>apendicite <span class="blank _2"> </span>aguda <span class="blank _5"> </span>será <span class="blank _2"> </span>abortada; <span class="blank _2"> </span>caso <span class="blank _2"> </span>ele </div><div class="t m0 x2 h3 y6d ff2 fs1 fc0 sc0 ls1 ws3">não <span class="blank _a"> </span>consiga, <span class="blank _8"> </span>gera <span class="blank _a"> </span>dentro <span class="blank _a"> </span>do <span class="blank _a"> </span>apêndice <span class="blank _a"> </span>um <span class="blank _a"> </span>au-</div><div class="t m0 x2 h3 y6e ff2 fs1 fc0 sc0 ls1 ws3">mento <span class="blank _0"> </span>da <span class="blank _0"> </span>pressão <span class="blank _9"> </span>intraluminal, <span class="blank _0"> </span>não <span class="blank _b"> </span>deixa <span class="blank _9"> </span>mais <span class="blank _0"> </span>o </div><div class="t m0 x2 h3 y6f ff2 fs1 fc0 sc0 ls1 ws3">fluxo <span class="blank _5"> </span>de <span class="blank _9"> </span>muco <span class="blank _9"> </span>ir <span class="blank _9"> </span>para <span class="blank _9"> </span>o <span class="blank _9"> </span>ceco <span class="blank _9"> </span>e <span class="blank _9"> </span>as <span class="blank _9"> </span>bactérias <span class="blank _9"> </span>que </div><div class="t m0 x2 h3 y70 ff2 fs1 fc0 sc0 ls1 ws3">habitam <span class="blank _3"> </span>o <span class="blank _3"> </span>apêndice <span class="blank _3"> </span>se <span class="blank _3"> </span>multiplicam <span class="blank _3"> </span>e <span class="blank _3"> </span>transfor<span class="blank _2"> </span>-</div><div class="t m0 x2 h3 y71 ff2 fs1 fc0 sc0 ls1 ws3">mam <span class="blank _b"> </span>o <span class="blank _b"> </span>muco <span class="blank _b"> </span>em <span class="blank _b"> </span>pus. <span class="blank _b"> </span>Essas <span class="blank _b"> </span>bactérias <span class="blank _b"> </span>sequenci-</div><div class="t m0 x2 h3 y72 ff2 fs1 fc0 sc0 ls1 ws3">almente <span class="blank _8"> </span>invadem <span class="blank _8"> </span>as <span class="blank _8"> </span>paredes <span class="blank _8"> </span>do <span class="blank _8"> </span>apêndice, <span class="blank _8"> </span>até </div><div class="t m0 x2 h3 y73 ff2 fs1 fc0 sc0 ls1 ws3">que o processo inflamatório atinge a serosa. </div><div class="t m0 x2 h3 y74 ff2 fs1 fc0 sc0 ls6 ws3">Então <span class="blank _8"> </span>na <span class="blank _8"> </span><span class="ls1">primeira <span class="blank _8"> </span>fase <span class="blank _8"> </span>da <span class="blank _8"> </span>apendicite <span class="blank _8"> </span>aguda, <span class="blank _8"> </span>a </span></div><div class="t m0 x2 h3 y75 ff2 fs1 fc0 sc0 ls1 ws3">dor <span class="blank _7"> </span>é <span class="blank"> </span>intensa, <span class="blank _a"> </span>mal <span class="blank"> </span>localizada, <span class="blank _a"> </span>que <span class="blank"> </span>perdura <span class="blank _a"> </span>por </div><div class="t m0 x2 h3 y76 ff2 fs1 fc0 sc0 ls1 ws3">6-12h, <span class="blank _5"> </span>característica <span class="blank _5"> </span>de <span class="blank _9"> </span>dor <span class="blank _5"> </span>visceral, <span class="blank _5"> </span>periumbilical </div><div class="t m0 x2 h3 y77 ff2 fs1 fc0 sc0 ls1 ws3">e simula uma cólica, é a <span class="blank _2"> </span>fase em que o apêndice </div><div class="t m0 x2 h3 y78 ff2 fs1 fc0 sc0 ls1 ws3">está <span class="blank _5"> </span>contraindo <span class="blank _5"> </span>para <span class="blank _9"> </span>tentar <span class="blank _5"> </span>devolver <span class="blank _9"> </span>ao <span class="blank _5"> </span>ceco <span class="blank _9"> </span>os </div><div class="t m0 x2 h3 y79 ff2 fs1 fc0 sc0 ls1 ws3">fecalitos. <span class="blank _a"> </span>Os <span class="blank"> </span>fecalitos <span class="blank _a"> </span>que <span class="blank"> </span>não <span class="blank _a"> </span>conseguiram <span class="blank _a"> </span>ser </div><div class="t m0 x2 h3 y7a ff2 fs1 fc0 sc0 ls1 ws3">devolvidos <span class="blank _c"> </span>determinam <span class="blank _c"> </span>um <span class="blank _c"> </span>processo <span class="blank _c"> </span>obstrutivo </div><div class="t m0 x2 h3 y7b ff2 fs1 fc0 sc0 ls1 ws3">no <span class="blank _b"> </span>apêndice <span class="blank _0"> </span>e <span class="blank _b"> </span>faz <span class="blank _b"> </span>com <span class="blank _0"> </span>que <span class="blank _b"> </span>o <span class="blank _b"> </span>processo <span class="blank _0"> </span>de <span class="blank _b"> </span>nor<span class="blank _2"> </span>-</div><div class="t m0 x2 h3 y7c ff2 fs1 fc0 sc0 ls1 ws3">mória <span class="blank _b"> </span>se <span class="blank _b"> </span>transforme <span class="blank _b"> </span>em <span class="blank _b"> </span>disória**. <span class="blank _b"> </span>Nesse <span class="blank _b"> </span>momen-</div><div class="t m0 x2 h3 y7d ff2 fs1 fc0 sc0 ls1 ws3">to, <span class="blank _9"> </span>a <span class="blank _0"> </span>dor <span class="blank _9"> </span>que <span class="blank _0"> </span>era <span class="blank _0"> </span>visceral <span class="blank _9"> </span>se <span class="blank _0"> </span>localiza <span class="blank _9"> </span>passando <span class="blank _0"> </span>a </div><div class="t m0 x2 h3 y7e ff2 fs1 fc0 sc0 ls1 ws3">ser <span class="blank _9"> </span>dor <span class="blank _0"> </span>parietal <span class="blank _0"> </span>no <span class="blank _0"> </span>momento <span class="blank _0"> </span>em <span class="blank _0"> </span>que <span class="blank _9"> </span>o <span class="blank _0"> </span>processo </div><div class="t m0 x2 h3 y7f ff2 fs1 fc0 sc0 ls1 ws3">inflamatório <span class="blank"> </span>chega <span class="blank"> </span>na <span class="blank"> </span>parede <span class="blank"> </span>do <span class="blank _7"> </span>apêndice, <span class="blank"> </span>a </div><div class="t m0 x2 h3 y80 ff2 fs1 fc0 sc0 ls1 ws3">dor <span class="blank _5"> </span>se <span class="blank _9"> </span>tor<span class="blank _2"> </span>na <span class="blank _9"> </span>somática <span class="blank _9"> </span>e <span class="blank _9"> </span>se <span class="blank _9"> </span>tor<span class="blank _2"> </span>na <span class="blank _9"> </span>um <span class="blank _9"> </span>ponto <span class="blank _5"> </span>dolo-</div><div class="t m0 x2 h3 y81 ff2 fs1 fc0 sc0 ls1 ws3">roso, produzindo uma peritonite circunscrita. Além </div><div class="t m0 x2 h3 y82 ff2 fs1 fc0 sc0 ls1 ws3">disso, <span class="blank _b"> </span>se <span class="blank _b"> </span>associa <span class="blank _8"> </span>os <span class="blank _b"> </span>sinais <span class="blank _b"> </span>comemorativos <span class="blank _8"> </span>de <span class="blank _b"> </span>um </div><div class="t m0 x2 h3 y83 ff2 fs1 fc0 sc0 ls1 ws3">abdome agudo cirúrgico. </div><div class="t m0 x2 h3 y84 ff2 fs1 fc0 sc0 ls1 ws3">** <span class="blank _2"> </span>O <span class="blank _2"> </span>processo <span class="blank _5"> </span>de <span class="blank _2"> </span>nor<span class="blank _2"> </span>mória <span class="blank _5"> </span>é <span class="blank _2"> </span>o <span class="blank _2"> </span>fato <span class="blank _5"> </span>do <span class="blank _2"> </span>organismo </div><div class="t m0 x2 h3 y85 ff2 fs1 fc0 sc0 ls1 ws3">produzir 12 litros de <span class="blank _2"> </span>líquido e ter <span class="blank _2"> </span>a capacidade de </div><div class="t m0 x2 h3 y86 ff2 fs1 fc0 sc0 ls1 ws3">absorver <span class="blank _b"> </span>completamente <span class="blank _b"> </span>e <span class="blank _b"> </span>só <span class="blank _b"> </span>eliminar <span class="blank _b"> </span>de <span class="blank _b"> </span>200 <span class="blank _b"> </span>a </div><div class="t m0 x2 h3 y87 ff2 fs1 fc0 sc0 ls1 ws3">300 <span class="blank _2"> </span>ml <span class="blank _2"> </span>de <span class="blank _2"> </span>água nas <span class="blank _2"> </span>fezes. <span class="blank _2"> </span>No <span class="blank _2"> </span>processo <span class="blank _2"> </span>de <span class="blank _2"> </span>disória, </div><div class="t m0 x2 h3 y88 ff2 fs1 fc0 sc0 ls1 ws3">como <span class="blank _0"> </span>acontece <span class="blank _0"> </span>numa <span class="blank _0"> </span>enterocolite <span class="blank _0"> </span>ou <span class="blank _b"> </span>na <span class="blank _9"> </span>apen-</div><div class="t m0 x2 h3 y89 ff2 fs1 fc0 sc0 ls1 ws3">dicite, <span class="blank"> </span>a <span class="blank _3"> </span>lesão <span class="blank _3"> </span>que <span class="blank"> </span>ocorreu <span class="blank _3"> </span>na <span class="blank"> </span>microvilosidade </div><div class="t m0 x2 h3 y8a ff2 fs1 fc0 sc0 ls1 ws3">intestinal <span class="blank _5"> </span>faz <span class="blank _9"> </span>com <span class="blank _5"> </span>que <span class="blank _9"> </span>o <span class="blank _5"> </span>epitéli<span class="blank _2"> </span>o <span class="blank _5"> </span>perca <span class="blank _5"> </span>a <span class="blank _9"> </span>capaci-</div><div class="t m0 x2 h3 y8b ff2 fs1 fc0 sc0 ls1 ws3">dade <span class="blank _0"> </span>de <span class="blank _b"> </span>absorção <span class="blank _0"> </span>dos <span class="blank _b"> </span>12 <span class="blank _0"> </span>litros <span class="blank _0"> </span>e <span class="blank _b"> </span>além <span class="blank _0"> </span>disso <span class="blank _b"> </span>co-</div><div class="t m0 x2 h3 y8c ff2 fs1 fc0 sc0 ls1 ws3">mece <span class="blank"> </span>a <span class="blank _3"> </span>secretar <span class="blank"> </span>líquido, <span class="blank _3"> </span>causando <span class="blank"> </span>muita <span class="blank _3"> </span>diar-</div><div class="t m0 x2 h3 y8d ff2 fs1 fc0 sc0 ls1 ws3">reia. <span class="blank _b"> </span>Na <span class="blank _b"> </span>apendicite, <span class="blank _b"> </span>o <span class="blank _8"> </span>apêndice <span class="blank _b"> </span>perde <span class="blank _b"> </span>a <span class="blank _b"> </span>capa-</div><div class="t m0 x2 h3 y8e ff2 fs1 fc0 sc0 ls1 ws3">cidade <span class="blank _8"> </span>de <span class="blank _a"> </span>absorver <span class="blank _8"> </span>líquido <span class="blank _8"> </span>pela <span class="blank _a"> </span>perda <span class="blank _8"> </span>da <span class="blank _8"> </span>inte-</div><div class="t m0 x2 h3 y8f ff2 fs1 fc0 sc0 ls1 ws3">gridade <span class="blank _0"> </span>mucosa, <span class="blank _b"> </span>produz <span class="blank _0"> </span>mais <span class="blank _b"> </span>muco, <span class="blank _0"> </span>mais <span class="blank _b"> </span>secre-</div><div class="t m0 x2 h3 y90 ff2 fs1 fc0 sc0 ls1 ws3">ção, <span class="blank _0"> </span>os <span class="blank _0"> </span>espasmos <span class="blank _0"> </span>aumentam <span class="blank _0"> </span>a <span class="blank _0"> </span>pressão, <span class="blank _0"> </span>as <span class="blank _0"> </span>bac-</div><div class="t m0 x2 h3 y91 ff2 fs1 fc0 sc0 ls1 ws3">térias <span class="blank _9"> </span>se <span class="blank _9"> </span>multiplicam <span class="blank _0"> </span>e <span class="blank _9"> </span>o <span class="blank _0"> </span>que <span class="blank _9"> </span>estava <span class="blank _0"> </span>dentro <span class="blank _9"> </span>inva-</div><div class="t m0 x2 h3 y92 ff2 fs1 fc0 sc0 ls6 ws3">de a parede. <span class="ls1"> </span></div><div class="t m0 x8 h3 y62 ff2 fs1 fc0 sc0 ls1 ws3"><span class="fc3 sc0"> </span></div><div class="t m0 x8 h3 y93 ff2 fs1 fc0 sc0 ls1 ws3">Obstrução <span class="blank _9"> </span>em <span class="blank _9"> </span>alça <span class="blank _9"> </span>fechada, <span class="blank _9"> </span>multiplicação <span class="blank _9"> </span>bac-</div><div class="t m0 x8 h3 y94 ff2 fs1 fc0 sc0 ls1 ws3">teriana <span class="blank _0"> </span>e <span class="blank _b"> </span>disória <span class="blank _b"> </span>são <span class="blank _0"> </span>causados <span class="blank _b"> </span>por <span class="blank _0"> </span>uma <span class="blank _b"> </span>série <span class="blank _0"> </span>de </div><div class="t m0 x8 h3 y95 ff2 fs1 fc0 sc0 ls1 ws3">eventos. <span class="blank _e"> </span>Primeiro <span class="blank _e"> </span>ocorre <span class="blank _e"> </span>distensão <span class="blank _e"> </span>intraluminal, </div><div class="t m0 x8 h3 y96 ff2 fs1 fc0 sc0 ls1 ws3">invasão <span class="blank _9"> </span>da <span class="blank _9"> </span>bactéria <span class="blank _0"> </span>na <span class="blank _9"> </span>parede <span class="blank _0"> </span>e <span class="blank _9"> </span>o <span class="blank _0"> </span>aumento <span class="blank _9"> </span>de </div><div class="t m0 x8 h3 y97 ff2 fs1 fc0 sc0 ls7 ws3">pressão <span class="blank _d"> </span>intraluminal <span class="blank _d"> </span>compromete <span class="blank _f"> </span>sequencial<span class="ls1">-</span></div><div class="t m0 x8 h3 y98 ff2 fs1 fc0 sc0 ls1 ws3">mente <span class="blank _3"> </span>o <span class="blank _c"> </span>retorno <span class="blank _3"> </span>venoso. <span class="blank _c"> </span>Se <span class="blank _3"> </span>ocorrer <span class="blank _3"> </span>obstrução </div><div class="t m0 x8 h3 y99 ff2 fs1 fc0 sc0 ls1 ws3">arterial, <span class="blank _2"> </span>evolui <span class="blank _2"> </span>para <span class="blank _2"> </span>necrose, <span class="blank _5"> </span>que <span class="blank _2"> </span>evolui <span class="blank _2"> </span>para <span class="blank _2"> </span>per<span class="blank _5"> </span>-</div><div class="t m0 x8 h3 y9a ff2 fs1 fc0 sc0 ls1 ws3">furação. <span class="blank _b"> </span>Na <span class="blank _0"> </span>maioria <span class="blank _b"> </span>das <span class="blank _b"> </span>vezes <span class="blank _b"> </span>produz <span class="blank _0"> </span>uma <span class="blank _b"> </span>peri-</div><div class="t m0 x8 h3 y9b ff2 fs1 fc0 sc0 ls1 ws3">tonite <span class="blank _9"> </span>aguda <span class="blank _9"> </span>circunscrita. <span class="blank _9"> </span>A <span class="blank _0"> </span>partir <span class="blank _9"> </span>da <span class="blank _9"> </span>per<span class="blank _5"> </span>furação </div><div class="t m0 x8 h3 y9c ff2 fs1 fc0 sc0 ls1 ws3">há <span class="blank _9"> </span>dois <span class="blank _0"> </span>caminhos: <span class="blank _9"> </span>bloqueio <span class="blank _0"> </span>pelo <span class="blank _9"> </span>omento <span class="blank _0"> </span>(perito-</div><div class="t m0 x8 h3 y9d ff2 fs1 fc0 sc0 ls1 ws3">nite <span class="blank _9"> </span>localizada <span class="blank _9"> </span>\u2013 <span class="blank _9"> </span>Blumberg <span class="blank _9"> </span>positivo <span class="blank _9"> </span>e <span class="blank _0"> </span>sinais <span class="blank _9"> </span>de <span class="blank _9"> </span>irri-</div><div class="t m0 x8 h3 y6a ff2 fs1 fc0 sc0 ls1 ws3">tação <span class="blank _0"> </span>peritoneal <span class="blank _b"> </span>no <span class="blank _0"> </span>QID) <span class="blank _b"> </span>ou <span class="blank _0"> </span>per<span class="blank _2"> </span>furação <span class="blank _b"> </span>em <span class="blank _0"> </span>ca-</div><div class="t m0 x8 h3 y6b ff2 fs1 fc0 sc0 ls1 ws3">vidade <span class="blank _b"> </span>livre <span class="blank _b"> </span>(fezes <span class="blank _b"> </span>dentro <span class="blank _8"> </span>da <span class="blank _b"> </span>cavidade <span class="blank _b"> </span>abdomi-</div><div class="t m0 x8 h3 y6c ff2 fs1 fc0 sc0 ls1 ws3">nal <span class="blank"> </span><span class="ff5">\u2192</span> <span class="blank _a"> </span>peritonite <span class="blank"> </span>difusa <span class="blank _a"> </span><span class="ff5">\u2192</span> <span class="blank"> </span>distensão <span class="blank _a"> </span>abdominal, </div><div class="t m0 x8 h3 y6d ff2 fs1 fc0 sc0 ls1 ws3">dor <span class="blank _b"> </span>abdominal <span class="blank _0"> </span>difusa <span class="blank _b"> </span>e <span class="blank _0"> </span>sinais <span class="blank _b"> </span>de <span class="blank _0"> </span>i<span class="blank _2"> </span>rritação <span class="blank _0"> </span>perito-</div><div class="t m0 x8 h3 y6e ff2 fs1 fc0 sc0 ls4 ws3">neal nos quatro quadrantes). <span class="ls1"> </span></div><div class="t m0 xe h4 y9e ff3 fs2 fc0 sc0 ls2 ws0">CLÍNICA<span class="fs1 ls1 ws3"> <span class="ff2"> </span></span></div><div class="t m0 x8 h5 y9f ff3 fs1 fc0 sc0 ls6 ws3">Primeira fase:<span class="ff2 ls1"> Dor <span class="blank _2"> </span>visceral, obstrução <span class="blank _2"> </span>e contração </span></div><div class="t m0 x8 h3 ya0 ff2 fs1 fc0 sc0 ls1 ws3">\u2013 <span class="blank _a"> </span>epigástrica, <span class="blank _7"> </span>periumbilical, <span class="blank _a"> </span>difusa, <span class="blank"> </span>não <span class="blank _a"> </span>localiza-</div><div class="t m0 x8 h3 ya1 ff2 fs1 fc0 sc0 ls1 ws3">da, <span class="blank _9"> </span>intensa, <span class="blank _0"> </span>perdura <span class="blank _0"> </span>6 <span class="blank _0"> </span>- <span class="blank _0"> </span>12h. <span class="blank _0"> </span>Corresponde <span class="blank _0"> </span>a <span class="blank _0"> </span>fase </div><div class="t m0 x8 h3 ya2 ff2 fs1 fc0 sc0 ls1 ws3">de espasmo do apêndice. </div><div class="t m0 x8 h5 ya3 ff3 fs1 fc0 sc0 ls1 ws3">Segunda <span class="blank _9"> </span>fase:<span class="ff2"> <span class="blank _0"> </span>Dor <span class="blank _0"> </span>parietal <span class="blank _0"> </span>adquire <span class="blank _9"> </span>sinal <span class="blank _0"> </span>migrató-</span></div><div class="t m0 x8 h3 ya4 ff2 fs1 fc0 sc0 ls1 ws3">rio <span class="blank _b"> </span>e <span class="blank _0"> </span>se <span class="blank _b"> </span>localizou <span class="blank _b"> </span>\u2013 <span class="blank _b"> </span>dor <span class="blank _b"> </span>somática <span class="blank _0"> </span>carreada <span class="blank _b"> </span>pelos </div><div class="t m0 x8 h3 ya5 ff2 fs1 fc0 sc0 ls1 ws3">últimos <span class="blank _a"> </span>nervos <span class="blank _a"> </span>intercostais, <span class="blank _a"> </span>localizada, <span class="blank _a"> </span>menos <span class="blank _a"> </span>in-</div><div class="t m0 x8 h3 ya6 ff2 fs1 fc0 sc0 ls1 ws3">tensa, <span class="blank _8"> </span>piora <span class="blank _a"> </span>com <span class="blank _a"> </span>movimentação <span class="blank _a"> </span>\u201csinal <span class="blank _8"> </span>do <span class="blank _a"> </span>que-</div><div class="t m0 x8 h3 ya7 ff2 fs1 fc0 sc0 ls1 ws3">bra-molas\u201d. <span class="blank _9"> </span>Fase <span class="blank _9"> </span>em <span class="blank _0"> </span>que <span class="blank _9"> </span>o <span class="blank _9"> </span>processo <span class="blank _0"> </span>inflamatório </div><div class="t m0 x8 h3 ya8 ff2 fs1 fc0 sc0 ls6 ws3">atingiu o peritôneo. <span class="ls1"> </span></div><div class="t m0 x8 h3 ya9 ff2 fs1 fc0 sc0 ls1 ws3">Em <span class="blank _0"> </span>60-70% <span class="blank _b"> </span>dos <span class="blank _0"> </span>casos, <span class="blank _b"> </span>a <span class="blank _0"> </span>clínica <span class="blank _b"> </span>é <span class="blank _0"> </span>típica, <span class="blank _b"> </span><span class="ls6">dor <span class="blank _0"> </span>que </span></div><div class="t m0 x8 h3 yaa ff2 fs1 fc0 sc0 ls1 ws3">começa <span class="blank _b"> </span>na <span class="blank _b"> </span>região <span class="blank _0"> </span>periumbilical <span class="blank _b"> </span>e <span class="blank _b"> </span>assume <span class="blank _b"> </span>cará-</div><div class="t m0 x8 h3 yab ff2 fs1 fc0 sc0 ls1 ws3">ter migratório <span class="blank _2"> </span>para <span class="blank _2"> </span>FID. Hipersensibilidade, <span class="blank _2"> </span>contra-</div><div class="t m0 x8 h3 yac ff2 fs1 fc0 sc0 ls1 ws3">tura <span class="blank _b"> </span>e <span class="blank _b"> </span>defesa <span class="blank _b"> </span>na <span class="blank _b"> </span>FID<span class="ls4">, <span class="blank _0"> </span>o <span class="blank _b"> </span>restante <span class="blank _b"> </span>dos <span class="blank _b"> </span>quadrantes </span></div><div class="t m0 x8 h3 yad ff2 fs1 fc0 sc0 ls1 ws3">estão livres. Sinais de reação peritoneal: <span class="blank _2"> </span>Blumberg </div><div class="t m0 x8 h3 yae ff2 fs1 fc0 sc0 ls1 ws3">e <span class="blank _9"> </span>Dunphy <span class="blank _0"> </span>(colocar <span class="blank _9"> </span>o <span class="blank _0"> </span>paciente <span class="blank _9"> </span>em <span class="blank _0"> </span>decúbito <span class="blank _0"> </span>dor-</div><div class="t m0 x8 h3 yaf ff2 fs1 fc0 sc0 ls1 ws3">sal <span class="blank _5"> </span>e <span class="blank _9"> </span>pedir <span class="blank _5"> </span>para <span class="blank _9"> </span>ele <span class="blank _9"> </span>tossir <span class="blank _5"> </span>forte, <span class="blank _9"> </span>quando <span class="blank _5"> </span>ele <span class="blank _9"> </span>tosse, </div><div class="t m0 x8 h3 yb0 ff2 fs1 fc0 sc0 ls1 ws3">ele <span class="blank _8"> </span>aponta <span class="blank _8"> </span>o <span class="blank _8"> </span>local <span class="blank _a"> </span>da <span class="blank _8"> </span>dor <span class="blank _8"> </span>no <span class="blank _8"> </span>ponto <span class="blank _8"> </span>de <span class="blank _a"> </span>McBur-</div><div class="t m0 x8 h3 yb1 ff2 fs1 fc0 sc0 ls1 ws3">ney), <span class="blank _b"> </span>tumor <span class="blank _b"> </span>inflamatório <span class="blank _b"> </span>na <span class="blank _b"> </span>FID. <span class="blank _b"> </span>O <span class="blank _b"> </span>diagnóstico <span class="blank _b"> </span>é </div><div class="t m0 x8 h3 yb2 ff2 fs1 fc0 sc0 ls1 ws3">mais <span class="blank _2"> </span>simples <span class="blank _2"> </span>em <span class="blank _2"> </span>homens, <span class="blank _2"> </span>porque <span class="blank _2"> </span>na <span class="blank _2"> </span>mulher <span class="blank _5"> </span>pode </div><div class="t m0 x8 h3 yb3 ff2 fs1 fc0 sc0 ls1 ws3">ter <span class="blank _b"> </span>doenças <span class="blank _0"> </span>nos <span class="blank _b"> </span>órgãos <span class="blank _b"> </span>ginecológicos <span class="blank _0"> </span>que <span class="blank _b"> </span>simu-</div><div class="t m0 x8 h3 yb4 ff2 fs1 fc0 sc0 ls1 ws3">lam abdome agudo. </div><div class="t m0 x8 h3 yb5 ff2 fs1 fc0 sc0 ls1 ws3">Além disso, <span class="blank _2"> </span>outra <span class="blank _2"> </span>clínica <span class="blank _2"> </span>possível <span class="blank _2"> </span>é o <span class="blank _2"> </span>aparecimen-</div><div class="t m0 x8 h3 yb6 ff2 fs1 fc0 sc0 ls1 ws3">to <span class="blank _0"> </span>de <span class="blank _b"> </span>sinais <span class="blank _9"> </span>de <span class="blank _b"> </span>peritonite <span class="blank _9"> </span>difusa, <span class="blank _b"> </span>per<span class="blank _2"> </span>furou <span class="blank _0"> </span>a <span class="blank _b"> </span>cavi-</div><div class="t m0 x8 h3 yb7 ff2 fs1 fc0 sc0 ls1 ws3">dade <span class="blank"> </span>abdominal <span class="blank _a"> </span>e <span class="blank"> </span>gerou <span class="blank _a"> </span>uma <span class="blank"> </span>peritonite <span class="blank _7"> </span>fecal. </div><div class="t m0 x8 h3 yb8 ff2 fs1 fc0 sc0 ls1 ws3">T<span class="blank _1"></span>ambém <span class="blank _9"> </span>pode <span class="blank _9"> </span>ocorrer <span class="blank _5"> </span>sinais <span class="blank _9"> </span>de <span class="blank _5"> </span>obstrução <span class="blank _9"> </span>intesti-</div><div class="t m0 x8 h3 yb9 ff2 fs1 fc0 sc0 ls1 ws3">nal <span class="blank _8"> </span>quando <span class="blank _b"> </span>o <span class="blank _8"> </span>apêndice <span class="blank _8"> </span>estrangula <span class="blank _8"> </span>o <span class="blank _8"> </span>íleo <span class="blank _8"> </span>ter<span class="blank _2"> </span>mi-</div><div class="t m0 x8 h3 yba ff2 fs1 fc0 sc0 ls1 ws3">nal, mas isso é raro. </div><div class="t m0 x8 h5 ybb ff3 fs1 fc0 sc0 ls6 ws3">Pode <span class="blank"> </span>faltar: <span class="blank"> </span><span class="ff2 ls8">sinal <span class="blank"> </span>do <span class="blank _3"> </span>psoas, <span class="blank"> </span>sinal <span class="blank"> </span>do <span class="blank"> </span>obiturador<span class="blank _4"></span>, </span></div><div class="t m0 x8 h3 ybc ff2 fs1 fc0 sc0 ls1 ws3">Rovsing, <span class="blank _8"> </span>vômitos, <span class="blank _a"> </span>febre, <span class="blank _a"> </span>leucocitose, <span class="blank _8"> </span>bastonedo-</div><div class="t m0 x8 h5 ybd ff2 fs1 fc0 sc0 ls1 ws3">se. Pode <span class="blank _2"> </span>faltar <span class="blank _2"> </span>tudo, só <span class="blank _2"> </span>não <span class="blank _2"> </span>pode <span class="blank _2"> </span>faltar <span class="ff3 ls8">dor, <span class="blank _2"> </span>defe<span class="ls1">-</span></span></div><div class="t m0 x8 h5 ybe ff3 fs1 fc0 sc0 ls4 ws3">sa, contratura e DBD +. <span class="ff2 ls1"> </span></div></div><div class="c x1 y59 w2 h7"><div class="t m0 xb h8 y5a ff6 fs0 fc1 sc0 ls1 ws3">Amanda Viol</div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf3" class="pf w0 h0" data-page-no="3"><div class="pc pc3 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w0 h0" alt="" src="https://files.passeidireto.com/2e5848d1-314e-4838-84e2-598f98ea6d0b/bg3.png"><div class="c x1 y1 w6 hd"><div class="t m0 x2 h3 y27 ff2 fs1 fc0 sc0 ls1 ws3">Obs: <span class="blank"> </span>atualmente, <span class="blank _7"> </span>nem <span class="blank"> </span>todos <span class="blank"> </span>as <span class="blank _a"> </span>apendicites <span class="blank"> </span>di-</div><div class="t m0 x2 h3 y28 ff2 fs1 fc0 sc0 ls1 ws3">agnosticadas são operadas, depende do grau. </div><div class="t m0 x2 h5 y29 ff3 fs1 fc0 sc0 ls1 ws3"> </div><div class="t m0 xf h4 ybf ff3 fs2 fc0 sc0 ls1 ws3">DIAGNÓSTICO </div><div class="t m0 x2 h5 yc0 ff3 fs1 fc0 sc0 ls4 ws4">Laboratório:<span class="ff2 ls1 ws3"> <span class="blank _b"> </span>PCR <span class="blank _0"> </span>(significa <span class="blank _b"> </span>aumento <span class="blank _b"> </span>do <span class="blank _0"> </span>processo </span></div><div class="t m0 x2 h3 yc1 ff2 fs1 fc0 sc0 ls1 ws3">inflamatório), <span class="blank _5"> </span>leucograma, <span class="blank _5"> </span>ß-hcg <span class="blank _5"> </span>quantitativo <span class="blank _5"> </span>em </div><div class="t m0 x2 h3 yc2 ff2 fs1 fc0 sc0 ls1 ws3">mulheres, <span class="blank _d"> </span>piócitos <span class="blank _d"> </span>(20)**, <span class="blank _d"> </span>amilase, <span class="blank _d"> </span>bilirrubina <span class="blank _d"> </span>e </div><div class="t m0 x2 h3 yc3 ff2 fs1 fc0 sc0 ls1 ws3">procalcitonina <span class="blank _b"> </span>(essas <span class="blank _b"> </span>duas <span class="blank _8"> </span>últimas <span class="blank _b"> </span>são <span class="blank _b"> </span>importan-</div><div class="t m0 x2 h3 yc4 ff2 fs1 fc0 sc0 ls1 ws3">tes para prognóstico). </div><div class="t m0 x2 h3 yc5 ff2 fs1 fc0 sc0 ls1 ws3">** Apendicite Aguda <span class="blank _2"> </span>dá piúria, mas <span class="blank _2"> </span>existe um limi-</div><div class="t m0 x2 h3 yc6 ff2 fs1 fc0 sc0 ls1 ws3">te <span class="blank _9"> </span>de <span class="blank _9"> </span>20 <span class="blank _9"> </span>piócitos/campo, <span class="blank _5"> </span>s<span class="blank _2"> </span>e <span class="blank _5"> </span>tiver <span class="blank _9"> </span>mais <span class="blank _9"> </span>de <span class="blank _9"> </span>20 <span class="blank _9"> </span>pió-</div><div class="t m0 x2 h3 yc7 ff2 fs1 fc0 sc0 ls1 ws3">citos/campo, <span class="blank _8"> </span>o <span class="blank _8"> </span>médico <span class="blank _8"> </span>está <span class="blank _8"> </span>autorizado <span class="blank _8"> </span>a <span class="blank _8"> </span>tratar </div><div class="t m0 x2 h3 yc8 ff2 fs1 fc0 sc0 ls1 ws3">infecção <span class="blank _d"> </span>urinária. <span class="blank _f"> </span>Nesse <span class="blank _f"> </span>último <span class="blank _f"> </span>caso, <span class="blank _d"> </span>deve-se </div><div class="t m0 x2 h3 yc9 ff2 fs1 fc0 sc0 ls1 ws3">monitorar <span class="blank _0"> </span>o <span class="blank _0"> </span>paciente <span class="blank _b"> </span>e <span class="blank _9"> </span>pedir <span class="blank _0"> </span>que <span class="blank _b"> </span>ele <span class="blank _9"> </span>volte <span class="blank _b"> </span>após </div><div class="t m0 x2 h3 y36 ff2 fs1 fc0 sc0 ls8 ws3">48 <span class="blank _2"> </span>horas <span class="blank _5"> </span>para <span class="blank _2"> </span>ser <span class="blank _2"> </span>reavaliado, <span class="blank _5"> </span>nesse <span class="blank _2"> </span>período <span class="blank _2"> </span>a <span class="blank _5"> </span>dor </div><div class="t m0 x2 h3 y37 ff2 fs1 fc0 sc0 ls1 ws3">tem <span class="blank"> </span>que <span class="blank _a"> </span>acabar <span class="blank"> </span>ou <span class="blank _7"> </span>melhorar <span class="blank"> </span>muito, <span class="blank _a"> </span>se <span class="blank"> </span>persistir </div><div class="t m0 x2 h3 y38 ff2 fs1 fc0 sc0 ls1 ws3">tem que pensar em abdome agudo. </div><div class="t m0 x2 h5 y3a ff3 fs1 fc0 sc0 ls3 ws3">Imagem: <span class="blank _8"> </span><span class="ff2 ls1">Se <span class="blank _a"> </span>o <span class="blank _8"> </span>quadro <span class="blank _8"> </span>é <span class="blank _a"> </span>típico, <span class="blank _8"> </span>não <span class="blank _8"> </span>há <span class="blank _a"> </span>necessi-</span></div><div class="t m0 x2 h3 y3b ff2 fs1 fc0 sc0 ls1 ws3">dade <span class="blank _e"> </span>de <span class="blank _e"> </span>pedir <span class="blank _c"> </span>USG. <span class="blank _e"> </span>O <span class="blank _e"> </span>tratamento <span class="blank _e"> </span>específico </div><div class="t m0 x2 h3 y3c ff2 fs1 fc0 sc0 ls1 ws3">pode <span class="blank _9"> </span>ser <span class="blank _0"> </span>laparoscopia <span class="blank _9"> </span>ou <span class="blank _9"> </span>l<span class="blank _2"> </span>aparotomia <span class="blank _9"> </span>e <span class="blank _9"> </span>a <span class="blank _0"> </span>esco-</div><div class="t m0 x2 h3 y3d ff2 fs1 fc0 sc0 ls1 ws3">lha <span class="blank _0"> </span>desses <span class="blank _0"> </span>métodos <span class="blank _0"> </span>depende <span class="blank _0"> </span>da <span class="blank _b"> </span>experiência <span class="blank _9"> </span>do </div><div class="t m0 x2 h3 y3e ff2 fs1 fc0 sc0 ls1 ws3">cirurgião <span class="blank _5"> </span>e <span class="blank _9"> </span>da <span class="blank _9"> </span>disponibilidade <span class="blank _5"> </span>dos <span class="blank _9"> </span>métodos, <span class="blank _9"> </span>con-</div><div class="t m0 x2 h3 yca ff2 fs1 fc0 sc0 ls1 ws3">tudo, <span class="blank _9"> </span>a <span class="blank _0"> </span>primeira <span class="blank _0"> </span>opção <span class="blank _9"> </span>atualmente <span class="blank _0"> </span>é <span class="blank _0"> </span>laparosco-</div><div class="t m0 x2 h3 y3f ff2 fs1 fc0 sc0 ls1 ws3">pia <span class="blank _5"> </span>nas <span class="blank _9"> </span>duas <span class="blank _9"> </span>for<span class="blank _2"> </span>mas <span class="blank _9"> </span>de <span class="blank _9"> </span>apendicite <span class="blank _9"> </span>aguda <span class="blank _5"> </span>(<span class="blank _2"> </span>com-</div><div class="t m0 x2 h3 y40 ff2 fs1 fc0 sc0 ls1 ws3">plicada e não-complicada). </div><div class="t m0 x2 h3 y41 ff2 fs1 fc0 sc0 ls1 ws3">Se <span class="blank _0"> </span>o <span class="blank _b"> </span>diagnóstico <span class="blank _b"> </span>ger<span class="blank _6"></span>ou <span class="blank _b"> </span>dúvida, <span class="blank _0"> </span>é <span class="blank _b"> </span>indicado <span class="blank _0"> </span>fazer </div><div class="t m0 x2 h3 y42 ff2 fs1 fc0 sc0 ls1 ws3">ecografia <span class="blank _5"> </span>abdominal <span class="blank _9"> </span>ou <span class="blank _9"> </span>USG, <span class="blank _9"> </span>especialmente <span class="blank _9"> </span>em </div><div class="t m0 x2 h5 y43 ff2 fs1 fc0 sc0 ls1 ws3">mulheres. <span class="blank"> </span><span class="ff3">Na <span class="blank _3"> </span>mulher, <span class="blank _3"> </span>o <span class="blank _3"> </span>USG <span class="blank"> </span>é <span class="blank _3"> </span>imperativo <span class="blank _3"> </span>pela </span></div><div class="t m0 x2 h5 y44 ff3 fs1 fc0 sc0 ls6 ws3">complexidade <span class="blank"> </span>da <span class="blank _a"> </span>anatomia <span class="blank"> </span>feminina. <span class="blank _7"> </span><span class="ff2 ls1">Se <span class="blank"> </span>ainda </span></div><div class="t m0 x2 h3 y45 ff2 fs1 fc0 sc0 ls1 ws3">persistir <span class="blank _0"> </span>a <span class="blank _0"> </span>dúvida, <span class="blank _0"> </span>pode <span class="blank _0"> </span>ser <span class="blank _0"> </span>solicitado <span class="blank _b"> </span>uma <span class="blank _9"> </span>tomo-</div><div class="t m0 x2 h3 y46 ff2 fs1 fc0 sc0 ls1 ws3">grafia, <span class="blank _2"> </span>contudo <span class="blank _2"> </span>se <span class="blank _5"> </span>a <span class="blank _2"> </span>mulher <span class="blank _2"> </span>estiver <span class="blank _2"> </span>grávida, <span class="blank _5"> </span>opta-</div><div class="t m0 x2 h3 y47 ff2 fs1 fc0 sc0 ls1 ws3">se <span class="blank _b"> </span>pela <span class="blank _b"> </span>ressonância. <span class="blank _b"> </span>Se <span class="blank _b"> </span>esses <span class="blank _0"> </span>últimos <span class="blank _b"> </span>exames <span class="blank _b"> </span>fo-</div><div class="t m0 x2 h3 y48 ff2 fs1 fc0 sc0 ls1 ws3">rem inconclusivos, faz a laparoscopia. </div><div class="t m0 x2 h3 y4a ff2 fs1 fc0 sc0 ls1 ws3">Se <span class="blank _b"> </span>o <span class="blank _b"> </span>USG, <span class="blank _0"> </span>TC <span class="blank _b"> </span>ou <span class="blank _b"> </span>RNM <span class="blank _b"> </span>forem <span class="blank _0"> </span>nor<span class="blank _2"> </span>mais, <span class="blank _b"> </span>mas <span class="blank _b"> </span>a <span class="blank _b"> </span>dor </div><div class="t m0 x2 h3 y4b ff2 fs1 fc0 sc0 ls1 ws3">persistir <span class="blank _2"> </span>por <span class="blank _2"> </span>mais <span class="blank _2"> </span>de <span class="blank _2"> </span>48 <span class="blank _5"> </span>horas, <span class="blank _2"> </span>também <span class="blank _2"> </span>é <span class="blank _2"> </span>indicado </div><div class="t m0 x2 h3 y4c ff2 fs1 fc0 sc0 ls1 ws3">realizar a laparoscopia. </div><div class="t m0 x2 h5 y4e ff3 fs1 fc0 sc0 ls6 ws3">Ultrassom: <span class="blank _3"> </span><span class="ff2 ls1">Sensibilidade <span class="blank _3"> </span>de <span class="blank _3"> </span>85-90% <span class="blank _3"> </span>e <span class="blank _3"> </span>especifici-</span></div><div class="t m0 x2 h3 y4f ff2 fs1 fc0 sc0 ls1 ws3">dade <span class="blank _0"> </span>de <span class="blank _0"> </span>92-96% <span class="blank _0"> </span>em <span class="blank _b"> </span>centros <span class="blank _9"> </span>de <span class="blank _0"> </span>referência, <span class="blank _b"> </span>esses </div><div class="t m0 x2 h3 y50 ff2 fs1 fc0 sc0 ls1 ws3">valores <span class="blank _9"> </span>não <span class="blank _0"> </span>são <span class="blank _9"> </span>encontrados <span class="blank _0"> </span>em <span class="blank _0"> </span>todos <span class="blank _9"> </span>os <span class="blank _0"> </span>locais. </div><div class="t m0 x2 h3 y51 ff2 fs1 fc0 sc0 ls1 ws3">É <span class="blank _9"> </span>operador-dependente, <span class="blank _0"> </span>não <span class="blank _0"> </span>invasivo, <span class="blank _9"> </span>disponível </div><div class="t m0 x2 h3 y52 ff2 fs1 fc0 sc0 ls1 ws3">em <span class="blank _9"> </span>qualquer <span class="blank _0"> </span>lugar<span class="blank _1"></span>. <span class="blank _0"> </span>É <span class="blank _9"> </span>melhor <span class="blank _0"> </span>para <span class="blank _0"> </span>pacientes <span class="blank _0"> </span>ma-</div><div class="t m0 x2 h3 y53 ff2 fs1 fc0 sc0 ls1 ws3">gros <span class="blank _5"> </span>(IMC <span class="blank _9"> </span>menor); <span class="blank _9"> </span>é <span class="blank _9"> </span>positivo <span class="blank _9"> </span>quando <span class="blank _9"> </span>o <span class="blank _9"> </span>apêndice </div><div class="t m0 x2 h3 y54 ff2 fs1 fc0 sc0 ls1 ws3">está acima de 6 mm. </div><div class="t m0 x2 h3 ycb ff2 fs1 fc0 sc0 ls1 ws3">É <span class="blank _9"> </span>dito <span class="blank _9"> </span>que <span class="blank _9"> </span>se <span class="blank _9"> </span>deve <span class="blank _0"> </span>decorrer <span class="blank _9"> </span>12 <span class="blank _9"> </span>a <span class="blank _9"> </span>18 <span class="blank _9"> </span>horas <span class="blank _9"> </span>do <span class="blank _0"> </span>iní-</div><div class="t m0 x2 h3 ycc ff2 fs1 fc0 sc0 ls1 ws3">cio <span class="blank _a"> </span>do <span class="blank _8"> </span>quadro <span class="blank _a"> </span>até <span class="blank _a"> </span>que <span class="blank _a"> </span>se <span class="blank _a"> </span>faça <span class="blank _a"> </span>o <span class="blank _8"> </span>USG, <span class="blank _a"> </span>porque </div><div class="t m0 x2 h3 ycd ff2 fs1 fc0 sc0 ls1 ws3">não <span class="blank _2"> </span>dá <span class="blank _5"> </span>tempo <span class="blank _2"> </span>de <span class="blank _5"> </span>espessar <span class="blank _2"> </span>a <span class="blank _5"> </span>parede <span class="blank _2"> </span>antes <span class="blank _5"> </span>desse </div><div class="t m0 x2 h3 yce ff2 fs1 fc0 sc0 ls1 ws3">tempo. <span class="blank _e"> </span>O <span class="blank _e"> </span>que <span class="blank _e"> </span>vai <span class="blank _e"> </span>nos <span class="blank _e"> </span>dar <span class="blank _e"> </span>o <span class="blank _e"> </span>diagnóstico <span class="blank _e"> </span>de </div><div class="t m0 x2 h3 ycf ff2 fs1 fc0 sc0 ls1 ws3">apendicite <span class="blank _5"> </span>aguda <span class="blank _5"> </span>é <span class="blank _9"> </span>o <span class="blank _5"> </span>espessamento <span class="blank _9"> </span>da <span class="blank _5"> </span>parede. </div><div class="t m0 x8 h3 y27 ff2 fs1 fc0 sc0 ls1 ws3">O <span class="blank _5"> </span>USG <span class="blank _5"> </span>negativo <span class="blank _5"> </span>não <span class="blank _5"> </span>exclui <span class="blank _5"> </span>diagnóstico <span class="blank _5"> </span>de <span class="blank _5"> </span>apen-</div><div class="t m0 x8 h3 y28 ff2 fs1 fc0 sc0 ls1 ws3">dicite. </div><div class="t m0 x8 h5 y2a ff3 fs1 fc0 sc0 ls1 ws3">Tomografia <span class="blank _9"> </span>Computadorizada: <span class="blank _0"> </span><span class="ff2">melhor <span class="blank _9"> </span>para <span class="blank _0"> </span>paci-</span></div><div class="t m0 x8 h3 y2b ff2 fs1 fc0 sc0 ls1 ws3">entes <span class="blank _8"> </span>com <span class="blank _a"> </span>IMC <span class="blank _a"> </span>maior <span class="blank _a"> </span>e <span class="blank _8"> </span>para <span class="blank _a"> </span>os <span class="blank _a"> </span>casos <span class="blank _8"> </span>atípicos, </div><div class="t m0 x8 h3 y2c ff2 fs1 fc0 sc0 ls1 ws3">espe<span class="blank _2"> </span>cial<span class="blank _2"> </span>men<span class="blank _2"> </span>te <span class="blank _f"> </span>qu<span class="blank _2"> </span>and<span class="blank _2"> </span>o <span class="blank _f"> </span>tem <span class="blank _10"> </span>comp<span class="blank _2"> </span>lica<span class="blank _2"> </span>ção <span class="blank _10"> </span>ou </div><div class="t m0 x8 h3 y2d ff2 fs1 fc0 sc0 ls1 ws3">suspeita de <span class="blank _2"> </span>complicação, <span class="blank _2"> </span>como abscessos <span class="blank _2"> </span>e per<span class="blank _5"> </span>-</div><div class="t m0 x8 h3 y2e ff2 fs1 fc0 sc0 ls1 ws3">furação. Quando <span class="blank _2"> </span>tem plastrão <span class="blank _2"> </span>na FID, <span class="blank _2"> </span>é <span class="blank _2"> </span>obrigató-</div><div class="t m0 x8 h3 yd0 ff2 fs1 fc0 sc0 ls1 ws3">rio <span class="blank _2"> </span>fazer <span class="blank _5"> </span>TC <span class="blank _2"> </span>e <span class="blank _5"> </span>nessa <span class="blank _5"> </span>mostrará <span class="blank _2"> </span>a <span class="blank _5"> </span>for<span class="blank _2"> </span>ma <span class="blank _2"> </span>flegmonosa </div><div class="t m0 x8 h3 y2f ff2 fs1 fc0 sc0 ls1 ws3">da <span class="blank _2"> </span>apendicite <span class="blank _5"> </span>aguda <span class="blank _5"> </span>(tumor <span class="blank _2"> </span>inflamatório <span class="blank _5"> </span>na <span class="blank _2"> </span>FID <span class="blank _5"> </span>- </div><div class="t m0 x8 h3 y30 ff2 fs1 fc0 sc0 ls1 ws3">flegmão). <span class="blank"> </span>No <span class="blank _a"> </span>passado, <span class="blank"> </span>todas <span class="blank"> </span>os <span class="blank _a"> </span>pacientes <span class="blank"> </span>que </div><div class="t m0 x8 h3 y31 ff2 fs1 fc0 sc0 ls1 ws3">apresentavam <span class="blank _0"> </span>a <span class="blank _0"> </span>for<span class="blank _2"> </span>ma <span class="blank _0"> </span>flegmonosa <span class="blank _b"> </span>eram <span class="blank _9"> </span>opera-</div><div class="t m0 x8 h3 y32 ff2 fs1 fc0 sc0 ls1 ws3">dos <span class="blank _5"> </span>e <span class="blank _5"> </span>muitas <span class="blank _5"> </span>vezes <span class="blank _5"> </span>era <span class="blank _9"> </span>necessário <span class="blank _5"> </span>fazer <span class="blank _5"> </span>uma <span class="blank _5"> </span>ileo-</div><div class="t m0 x8 h3 y33 ff2 fs1 fc0 sc0 ls1 ws3">colectomia, <span class="blank _b"> </span>tendo <span class="blank _b"> </span>que <span class="blank _0"> </span>retirar <span class="blank _b"> </span>quase <span class="blank _b"> </span>metade <span class="blank _b"> </span>do </div><div class="t m0 x8 h3 yd1 ff2 fs1 fc0 sc0 ls1 ws3">intestino; <span class="blank _9"> </span>hoje <span class="blank _9"> </span>em <span class="blank _0"> </span>dia <span class="blank _9"> </span>sabe-se <span class="blank _0"> </span>que <span class="blank _9"> </span>esse <span class="blank _0"> </span>caso <span class="blank _9"> </span>é <span class="blank _0"> </span>o </div><div class="t m0 x8 h3 yd2 ff2 fs1 fc0 sc0 ls1 ws3">mais <span class="blank _d"> </span>indicado <span class="blank _e"> </span>de <span class="blank _d"> </span>tratamento <span class="blank _e"> </span>não <span class="blank _d"> </span>operatório, </div><div class="t m0 x8 h3 yd3 ff2 fs1 fc0 sc0 ls1 ws3">porque <span class="blank _a"> </span>o <span class="blank _a"> </span>organismo <span class="blank _7"> </span>bloqueou <span class="blank _a"> </span>a <span class="blank _7"> </span>inflamação, <span class="blank _a"> </span>a </div><div class="t m0 x8 h3 yd4 ff2 fs1 fc0 sc0 ls1 ws3">opção <span class="blank _5"> </span>é <span class="blank _5"> </span>antibioticoterapia <span class="blank _5"> </span>e <span class="blank _5"> </span>o <span class="blank _5"> </span>processo <span class="blank _5"> </span>inflama-</div><div class="t m0 x8 h3 yd5 ff2 fs1 fc0 sc0 ls1 ws3">tório <span class="blank _c"> </span>regride <span class="blank _3"> </span>totalmente, <span class="blank _c"> </span>exceto <span class="blank _3"> </span>nos <span class="blank _c"> </span>casos <span class="blank _3"> </span>em </div><div class="t m0 x8 h3 yd6 ff2 fs1 fc0 sc0 ls1 ws3">que <span class="blank"> </span>o <span class="blank"> </span>paciente <span class="blank"> </span>já <span class="blank"> </span>tem <span class="blank"> </span>disfunção <span class="blank _7"> </span>orgânica. <span class="blank"> </span>Se </div><div class="t m0 x8 h3 yd7 ff2 fs1 fc0 sc0 ls1 ws3">tiver <span class="blank _a"> </span>pelo <span class="blank"> </span>menos <span class="blank _a"> </span>uma <span class="blank _7"> </span>disfunção <span class="blank _a"> </span>orgânica, <span class="blank"> </span>já <span class="blank _a"> </span>é </div><div class="t m0 x8 h3 yd8 ff2 fs1 fc0 sc0 ls1 ws3">indicado <span class="blank _c"> </span>cirurgia. <span class="blank _e"> </span>Nos <span class="blank _c"> </span>pacientes <span class="blank _c"> </span>acima <span class="blank _11"> </span>de <span class="blank _c"> </span>40 </div><div class="t m0 x8 h3 yd9 ff2 fs1 fc0 sc0 ls1 ws3">anos, <span class="blank"> </span>é <span class="blank"> </span>indicado <span class="blank _7"> </span>fazer <span class="blank"> </span>uma <span class="blank"> </span>colonoscopia <span class="blank _a"> </span>pela </div><div class="t m0 x8 h3 yda ff2 fs1 fc0 sc0 ls1 ws3">possibilidade <span class="blank"> </span>de <span class="blank _3"> </span>um <span class="blank"> </span>tumor <span class="blank"> </span>de <span class="blank _3"> </span>ceco <span class="blank"> </span>ter <span class="blank"> </span>sido <span class="blank _3"> </span>a </div><div class="t m0 x8 h3 ydb ff2 fs1 fc0 sc0 ls1 ws3">causa da apendicite. </div><div class="t m0 x8 h3 ydc ff2 fs1 fc0 sc0 ls1 ws3">A <span class="blank _5"> </span>TC <span class="blank _5"> </span>tem <span class="blank _9"> </span>o <span class="blank _5"> </span>risco <span class="blank _9"> </span>do <span class="blank _5"> </span>contraste, <span class="blank _5"> </span>possui <span class="blank _9"> </span>alta <span class="blank _5"> </span>sensibi-</div><div class="t m0 x8 h3 ydd ff2 fs1 fc0 sc0 ls1 ws3">lidade <span class="blank _9"> </span>e <span class="blank _9"> </span>especifidade. <span class="blank _0"> </span>Raramente <span class="blank _9"> </span>a <span class="blank _9"> </span>TC <span class="blank _0"> </span>gera <span class="blank _9"> </span>dú-</div><div class="t m0 x8 h3 yde ff2 fs1 fc0 sc0 ls1 ws3">vida na apendicite aguda. </div><div class="t m0 x10 h4 ydf ff3 fs2 fc0 sc0 ls1 ws3">TRATAMENTO <span class="ff2"> </span></div><div class="t m0 x8 h5 y43 ff2 fs1 fc0 sc0 ls1 ws3">\u2022 <span class="blank _b"> </span><span class="ff3 ls4">Tratamento <span class="blank _0"> </span>não-operatório:</span> <span class="blank _b"> </span>ideal <span class="blank _0"> </span>para <span class="blank _b"> </span>fase <span class="blank _b"> </span>de </div><div class="t m0 x8 h3 y44 ff2 fs1 fc0 sc0 ls1 ws3">flegmão ou <span class="blank _2"> </span>plastrão, em que <span class="blank _2"> </span>o apêndice <span class="blank _2"> </span>é classi-</div><div class="t m0 x8 h3 y45 ff2 fs1 fc0 sc0 ls1 ws3">ficado <span class="blank _e"> </span>como <span class="blank _11"> </span>tumor <span class="blank _e"> </span>inflamatório. <span class="blank _e"> </span>Nesses <span class="blank _e"> </span>casos </div><div class="t m0 x8 h3 y46 ff2 fs1 fc0 sc0 ls1 ws3">pode-se ser feito uso de antibióticos.<span class="ff5 ws5">""</span></div><div class="t m0 x8 h5 y48 ff2 fs1 fc0 sc0 ls1 ws3">\u2022 <span class="ff3 ls4">Tratamento operatório:</span> </div><div class="t m0 x8 h5 y49 ff2 fs1 fc0 sc0 ls4 ws3"> <span class="ff3">- Laparotomia<span class="ls1"> </span></span></div><div class="t m0 x8 h3 ycc ff2 fs1 fc0 sc0 ls1 ws3">Incisões <span class="blank _9"> </span>mais <span class="blank _9"> </span>utilizadas: <span class="blank _9"> </span>incisão <span class="blank _0"> </span>de <span class="blank _9"> </span>McCarthur <span class="blank _9"> </span>(3), </div><div class="t m0 x8 h3 ycd ff2 fs1 fc0 sc0 ls1 ws3">incisão <span class="blank _5"> </span>de <span class="blank _9"> </span>Davis <span class="blank _9"> </span>(10) <span class="blank _9"> </span>e <span class="blank _5"> </span>laparotomia <span class="blank _9"> </span>mediada <span class="blank _9"> </span>(2), </div><div class="t m0 x8 h3 yce ff2 fs1 fc0 sc0 ls1 ws3">essa <span class="blank _5"> </span>última <span class="blank _9"> </span>utilizada <span class="blank _9"> </span>para <span class="blank _5"> </span>peritonite <span class="blank _9"> </span>difusa. <span class="blank _9"> </span>Às <span class="blank _9"> </span>ve-</div><div class="t m0 x8 h3 ycf ff2 fs1 fc0 sc0 ls1 ws3">zes, <span class="blank _9"> </span>alguns <span class="blank _9"> </span>cirurgiões <span class="blank _9"> </span>fazem <span class="blank _9"> </span>a <span class="blank _9"> </span>incisão <span class="blank _9"> </span>9 <span class="blank _0"> </span>para <span class="blank _9"> </span>não </div></div><div class="c x1 y59 w2 h7"><div class="t m0 xb h8 y5a ff6 fs0 fc1 sc0 ls1 ws3">Amanda Viol</div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf4" class="pf w0 h0" data-page-no="4"><div class="pc pc4 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w0 h0" alt="" src="https://files.passeidireto.com/2e5848d1-314e-4838-84e2-598f98ea6d0b/bg4.png"><div class="c x1 y1 w5 hd"><div class="t m0 x2 h3 y27 ff2 fs1 fc0 sc0 ls1 ws3">deixar <span class="blank _b"> </span>muita <span class="blank _0"> </span>cicatriz, <span class="blank _b"> </span>mas <span class="blank _0"> </span>não <span class="blank _b"> </span>é <span class="blank _b"> </span>muito <span class="blank _0"> </span>indicado, </div><div class="t m0 x2 h3 y28 ff2 fs1 fc0 sc0 ls1 ws3">porque <span class="blank _5"> </span>se <span class="blank _5"> </span>for <span class="blank _5"> </span>um <span class="blank _9"> </span>apêndice <span class="blank _5"> </span>retrocecal <span class="blank _5"> </span>no <span class="blank _9"> </span>QSD, <span class="blank _5"> </span>o </div><div class="t m0 x2 h3 y29 ff2 fs1 fc0 sc0 ls1 ws3">cirurgião não alcançará o apêndice. </div><div class="t m0 x2 h5 y2b ff2 fs1 fc0 sc0 ls9 ws3"> <span class="blank _1"></span><span class="ff3 ls4">- <span class="blank _5"> </span>Laparoscopia: <span class="blank _9"> </span><span class="ff2 ls1">é <span class="blank _5"> </span>o <span class="blank _9"> </span>tto <span class="blank _9"> </span>de <span class="blank _5"> </span>primeira <span class="blank _9"> </span>escolha, </span></span></div><div class="t m0 x2 h3 y2c ff2 fs1 fc0 sc0 ls6 ws3">apesar de ainda não ser o padrão ouro.<span class="ls1"> </span></div><div class="t m0 x2 h3 y2e ff2 fs1 fc0 sc0 ls1 ws3">Nota: se <span class="blank _2"> </span>paciente <span class="blank _2"> </span>com dor <span class="blank _2"> </span>e realiza <span class="blank _2"> </span>laparoscopia </div><div class="t m0 x2 h3 yd0 ff2 fs1 fc0 sc0 ls1 ws3">exploratória <span class="blank _5"> </span><span class="ff5">\u2192</span> <span class="blank _2"> </span>a) <span class="blank _5"> </span>se <span class="blank _5"> </span>apêndice <span class="blank _5"> </span>nor<span class="blank _2"> </span>mal <span class="blank _5"> </span>e <span class="blank _5"> </span>presente </div><div class="t m0 x2 h3 y2f ff2 fs1 fc0 sc0 ls1 ws3">alguma <span class="blank"> </span>causa <span class="blank"> </span>visível <span class="blank"> </span>(ex: <span class="blank"> </span>cisto <span class="blank"> </span>de <span class="blank"> </span>ovário <span class="blank"> </span>roto): </div><div class="t m0 x2 h3 y30 ff2 fs1 fc0 sc0 ls1 ws3">deixar <span class="blank _9"> </span>o <span class="blank _0"> </span>apêndice <span class="blank _0"> </span>(pois <span class="blank _9"> </span>ele <span class="blank _0"> </span>é <span class="blank _0"> </span>importante <span class="blank _0"> </span>para <span class="blank _9"> </span>a </div><div class="t m0 x2 h3 y31 ff2 fs1 fc0 sc0 lsa ws3">recolonização <span class="blank _f"> </span>da <span class="blank _f"> </span>microbiota <span class="blank _f"> </span>intestinal) <span class="blank _f"> </span>b) <span class="blank _f"> </span>se </div><div class="t m0 x2 h3 y32 ff2 fs1 fc0 sc0 ls1 ws3">apêndice <span class="blank _11"> </span>normal <span class="blank _11"> </span>e <span class="blank _11"> </span>ausência <span class="blank _11"> </span>de <span class="blank _11"> </span>causa <span class="blank _11"> </span>visível </div><div class="t m0 x2 h3 y33 ff2 fs1 fc0 sc0 ls1 ws3">para dor: retirar o apêndice </div><div class="t m0 x11 h4 ye0 ff3 fs2 fc0 sc0 ls1 ws6">PROGNÓSTICO<span class="fs1 ws3"> </span></div><div class="t m0 x2 h3 yc1 ff2 fs1 fc0 sc0 ls1 ws3">Grau <span class="blank _10"> </span>0 <span class="blank _f"> </span>(NÃO <span class="blank _10"> </span>COMPLIC<span class="blank _2"> </span>ADA): <span class="blank _10"> </span>apêndi<span class="blank _2"> </span>ce <span class="blank _f"> </span>co<span class="blank _2"> </span>m </div><div class="t m0 x2 h3 yc2 ff2 fs1 fc0 sc0 ls1 ws3">aparência nor<span class="blank _2"> </span>mal </div><div class="t m0 x2 h3 yc3 ff2 fs1 fc0 sc0 ls1 ws3">Grau <span class="blank _8"> </span>1 <span class="blank _8"> </span>(NÃO <span class="blank _8"> </span>COMPLICADA): <span class="blank _b"> </span>apêndice <span class="blank _8"> </span>inflama-</div><div class="t m0 x2 h3 yc4 ff2 fs1 fc0 sc0 ls6 ws7">do<span class="ls1 ws3"> </span></div><div class="t m0 x2 h3 ye1 ff2 fs1 fc0 sc0 ls1 ws3">Grau 2: Necrose, mas ainda não tem pus </div><div class="t m0 x12 h3 yc5 ff2 fs1 fc0 sc0 ls6 ws8">a.<span class="blank"> </span><span class="ls1 ws3">Não atinge a base (fácil de tratar<span class="blank _4"></span>, só colo-</span></div><div class="t m0 x13 h3 yc6 ff2 fs1 fc0 sc0 ls1 ws3">car um clipe) </div><div class="t m0 x12 h3 yc7 ff2 fs1 fc0 sc0 ls6 ws9">b.<span class="blank"> </span><span class="lsb ws3">At<span class="blank _6"></span>in<span class="blank _6"></span>ge<span class="blank _6"></span> a<span class="blank _6"></span> b<span class="blank _6"></span>as<span class="blank _6"></span>e <span class="blank _6"></span>(e<span class="blank _6"></span>n<span class="blank _6"></span><span class="ls1">-</span></span></div><div class="t m0 x13 h3 yc8 ff2 fs1 fc0 sc0 ls1 ws3">dogrampeador ou sutura laparoscópica) </div><div class="t m0 x2 h3 yc9 ff2 fs1 fc0 sc0 ls1 ws3">Grau 3: T<span class="blank _6"></span>umor Inflamatório </div><div class="t m0 x12 h3 y36 ff2 fs1 fc0 sc0 ls6 ws8">a.<span class="blank"> </span><span class="lsc ws3">Flegmão <span class="blank _f"> </span>(tratamento <span class="blank _f"> </span>de <span class="blank _f"> </span>eleição <span class="blank _f"> </span>é <span class="blank _10"> </span>não </span></div><div class="t m0 x13 h3 y37 ff2 fs1 fc0 sc0 ls3 wsa">operatório)<span class="ls1 ws3"> </span></div><div class="t m0 x12 h3 y38 ff2 fs1 fc0 sc0 ls6 ws9">b.<span class="blank"> </span><span class="ls1 ws3">Flegmão <span class="blank _5"> </span>com <span class="blank _5"> </span>abscesso <span class="blank _9"> </span>< <span class="blank _5"> </span>4 <span class="blank _5"> </span>cm <span class="blank _9"> </span>(tratamento </span></div><div class="t m0 x13 h3 y39 ff2 fs1 fc0 sc0 ls1 ws3">não-operatório <span class="blank"> </span>desde <span class="blank _3"> </span>que <span class="blank _3"> </span>não <span class="blank _3"> </span>tenha <span class="blank"> </span>di<span class="blank _2"> </span>s-</div><div class="t m0 x13 h3 y3a ff2 fs1 fc0 sc0 ls1 ws3">função orgânica) </div><div class="t m0 x12 h3 y3b ff2 fs1 fc0 sc0 ls1 ws3">c.<span class="blank _12"> </span>Abscesso <span class="blank _8"> </span>> <span class="blank _a"> </span>4 <span class="blank _a"> </span>cm <span class="blank _a"> </span>(faz <span class="blank _8"> </span>punção <span class="blank _a"> </span>percutânea </div><div class="t m0 x13 h3 y3c ff2 fs1 fc0 sc0 ls1 ws3">para <span class="blank _9"> </span>drenar <span class="blank _9"> </span>o <span class="blank _9"> </span>abscesso <span class="blank _9"> </span>e <span class="blank _9"> </span>depois <span class="blank _0"> </span>trata <span class="blank _9"> </span>clini-</div><div class="t m0 x13 h3 y3d ff2 fs1 fc0 sc0 ls1 ws3">camente. <span class="blank _5"> </span>Se <span class="blank _5"> </span>dentro <span class="blank _5"> </span>de <span class="blank _5"> </span>48 <span class="blank _5"> </span>horas <span class="blank _5"> </span>o <span class="blank _5"> </span>paciente </div><div class="t m0 x13 h3 y3e ff2 fs1 fc0 sc0 ls1 ws3">não <span class="blank _b"> </span>melhorar <span class="blank _0"> </span>ou <span class="blank _b"> </span>se <span class="blank _0"> </span>advir <span class="blank _b"> </span>disfunção <span class="blank _0"> </span>orgâni-</div><div class="t m0 x13 h3 yca ff2 fs1 fc0 sc0 ls1 ws3">ca, esse paciente deve ser operado). </div><div class="t m0 x2 h3 y3f ff2 fs1 fc0 sc0 ls1 ws3">Grau <span class="blank _5"> </span>4: <span class="blank _5"> </span>Peritonite <span class="blank _5"> </span>Difusa <span class="blank _5"> </span>\u2013 <span class="blank _5"> </span>responsável <span class="blank _5"> </span>pela <span class="blank _5"> </span>maior </div><div class="t m0 x2 h3 y40 ff2 fs1 fc0 sc0 ls1 ws3">morbimortalidade da apendicite aguda. </div><div class="t m0 x14 h4 ye2 ff3 fs2 fc0 sc0 ls1 ws3">COMPLICAÇÕES </div><div class="t m0 x2 h5 ye3 ff3 fs1 fc0 sc0 ls4 ws3">- <span class="blank _b"> </span>Laparotomia: <span class="blank"> </span> <span class="blank _b"> </span><span class="ff2 ls1">complicação <span class="blank _0"> </span>mais <span class="blank _b"> </span>comum <span class="blank _b"> </span>é <span class="blank _0"> </span><span class="ls8 wsb">in</span>-</span></div><div class="t m0 x2 h3 ye4 ff2 fs1 fc0 sc0 ls1 ws3">fecção <span class="blank"> </span>sitio <span class="blank"> </span>cirúrgico <span class="blank"> </span>superficial. <span class="blank"> </span>Outras <span class="blank"> </span>compli-</div><div class="t m0 x2 h3 ye5 ff2 fs1 fc0 sc0 ls1 ws3">cações <span class="blank _3"> </span>que <span class="blank _3"> </span>podem <span class="blank"> </span>ocorrer: <span class="blank _3"> </span>abscesso <span class="blank _3"> </span>residual, </div><div class="t m0 x2 h3 ye6 ff2 fs1 fc0 sc0 ls1 ws3">deiscência <span class="blank _a"> </span>de <span class="blank _a"> </span>aponeurose, <span class="blank _a"> </span>sangramento, <span class="blank _a"> </span>fístula </div><div class="t m0 x2 h3 ye7 ff2 fs1 fc0 sc0 ls1 ws3">estercoral <span class="blank"> </span>(coto <span class="blank _3"> </span>apendicular), <span class="blank"> </span>obstrução <span class="blank _3"> </span>intesti-</div><div class="t m0 x2 h3 ye8 ff2 fs1 fc0 sc0 ls1 ws3">nal, sepse (abscesso hepático - pileflebite). </div><div class="t m0 x2 h5 ye9 ff3 fs1 fc0 sc0 ls4 ws3">- <span class="blank _a"> </span>Laparoscopia: <span class="blank _7"> </span><span class="ff2 ls1">a <span class="blank _a"> </span>complicação <span class="blank _a"> </span>mais <span class="blank"> </span>comum <span class="blank _8"> </span>é<span class="ff3"> </span></span></div><div class="t m0 x2 h3 yea ff2 fs1 fc0 sc0 ls1 ws3">infecção sitio cirúrgico intra-abdominal<span class="ls4">. </span> </div><div class="t m0 x2 h3 yeb ff2 fs1 fc0 sc0 ls1 ws3">Não <span class="blank _b"> </span>usa <span class="blank _0"> </span>antibiótico, <span class="blank _b"> </span>nem <span class="blank _b"> </span>antiinflamatório <span class="blank _0"> </span>na <span class="blank _b"> </span>pri-</div><div class="t m0 x2 h3 yec ff2 fs1 fc0 sc0 ls1 ws3">meira <span class="blank _a"> </span>fase <span class="blank _a"> </span>da <span class="blank _a"> </span>apendicite <span class="blank _a"> </span>aguda, <span class="blank _a"> </span>deve-se <span class="blank _a"> </span>ape-</div><div class="t m0 x2 h3 yed ff2 fs1 fc0 sc0 ls1 ws3">nas <span class="blank _8"> </span>acompanhar <span class="blank _a"> </span>o <span class="blank _8"> </span>paciente <span class="blank _a"> </span>e <span class="blank _8"> </span>tirar <span class="blank _a"> </span>a <span class="blank _8"> </span>dor <span class="blank _8"> </span>dele. </div><div class="t m0 x2 h3 yee ff2 fs1 fc0 sc0 ls1 ws3">Reexamina <span class="blank _c"> </span>o <span class="blank _11"> </span>paciente <span class="blank _11"> </span>no <span class="blank _11"> </span>outro <span class="blank _c"> </span>dia, <span class="blank _11"> </span>3 <span class="blank _11"> </span>coisas </div><div class="t m0 x2 h3 yef ff2 fs1 fc0 sc0 ls1 ws3">pode acontecer: 1) <span class="blank _2"> </span>abortar o processo inflamató-</div><div class="t m0 x2 h3 yf0 ff2 fs1 fc0 sc0 ls1 ws3">rio; <span class="blank _0"> </span>2) <span class="blank _0"> </span>diarreia <span class="blank _b"> </span>a <span class="blank _9"> </span>noite <span class="blank _b"> </span>toda <span class="blank _9"> </span>\u2013 <span class="blank _b"> </span>tem <span class="blank _9"> </span>que <span class="blank _b"> </span>operar; <span class="blank _9"> </span>3) </div><div class="t m0 x2 h3 yf1 ff2 fs1 fc0 sc0 ls1 ws3">dor <span class="blank"> </span>melhor<span class="blank _6"></span>ou, <span class="blank"> </span>mas <span class="blank _a"> </span>quando <span class="blank"> </span>tinha <span class="blank _7"> </span>alguma <span class="blank"> </span>trepi-</div><div class="t m0 x2 h3 yf2 ff2 fs1 fc0 sc0 ls1 ws3">dação, <span class="blank _2"> </span>por <span class="blank _2"> </span>exemplo, <span class="blank _2"> </span>passava <span class="blank _5"> </span>num <span class="blank _2"> </span>buraco, <span class="blank _2"> </span>a <span class="blank _2"> </span>dor </div><div class="t m0 x2 h3 yf3 ff2 fs1 fc0 sc0 ls1 ws3">piorava \u2013 opera também. </div><div class="t m0 x2 h3 y56 ff2 fs1 fc0 sc0 ls1 ws3">O <span class="blank _9"> </span>adiamento <span class="blank _9"> </span>cirúrgico <span class="blank _9"> </span>da <span class="blank _9"> </span>apendicite <span class="blank _9"> </span>aguda <span class="blank _0"> </span>em </div><div class="t m0 x2 h3 y57 ff2 fs1 fc0 sc0 ls1 ws3">24 <span class="blank _b"> </span>horas <span class="blank _b"> </span>não <span class="blank _b"> </span>altera <span class="blank _b"> </span>o <span class="blank _b"> </span>resultado, <span class="blank _b"> </span>exceto <span class="blank _b"> </span>quando </div><div class="t m0 x2 h3 y58 ff2 fs1 fc0 sc0 ls1 ws3">tem peritonite difusa. </div><div class="t m0 x8 h5 y28 ff3 fs1 fc0 sc0 ls1 ws3">LEMBRAR: </div><div class="t m0 x8 h5 y2b ff3 fs1 fc0 sc0 lsd ws3"><span class="fc3 sc0"> </span><span class="ls3"><span class="fc3 sc0"> </span><span class="ff2 ls1"><span class="fc3 sc0"> </span></span></span></div><div class="t m0 x8 h3 yd1 ff2 fs1 fc0 sc0 ls1 ws3">A <span class="blank _2"> </span>melhor <span class="blank _2"> </span>for<span class="blank _2"> </span>ma <span class="blank _2"> </span>de <span class="blank _5"> </span>não <span class="blank _2"> </span>se <span class="blank _2"> </span>perder <span class="blank _2"> </span>um <span class="blank _5"> </span>diagnóstico </div><div class="t m0 x8 h3 yd2 ff2 fs1 fc0 sc0 ls1 ws3">de <span class="blank _5"> </span>apendicite <span class="blank _9"> </span>aguda <span class="blank _5"> </span>naquela <span class="blank _9"> </span>fase <span class="blank _5"> </span>de <span class="blank _9"> </span>migração </div><div class="t m0 x8 h3 yd3 ff2 fs1 fc0 sc0 ls1 ws3">de <span class="blank _b"> </span>dor <span class="blank _b"> </span>visceral <span class="blank _b"> </span>para <span class="blank _b"> </span>dor <span class="blank _0"> </span>somática <span class="blank _b"> </span>em <span class="blank _b"> </span>que <span class="blank _b"> </span>o <span class="blank _b"> </span>di-</div><div class="t m0 x8 h3 yd4 ff2 fs1 fc0 sc0 ls1 ws3">agnóstico <span class="blank _b"> </span>é <span class="blank _8"> </span>muito <span class="blank _b"> </span>fácil <span class="blank _8"> </span>é <span class="blank _8"> </span>ter <span class="blank _b"> </span>o <span class="blank _8"> </span>paciente <span class="blank _b"> </span>na <span class="blank _8"> </span>sua </div><div class="t m0 x8 h3 yd5 ff2 fs1 fc0 sc0 ls1 ws3">mão <span class="blank _5"> </span>e <span class="blank _9"> </span>explicar <span class="blank _9"> </span>para <span class="blank _9"> </span>ele <span class="blank _9"> </span>e <span class="blank _9"> </span>para <span class="blank _5"> </span>os <span class="blank _9"> </span>familiares <span class="blank _9"> </span>que </div><div class="t m0 x8 h3 yd6 ff2 fs1 fc0 sc0 ls1 ws3">quer examiná-lo a cada 8 horas. </div><div class="t m0 x8 h3 yd7 ff2 fs1 fc0 sc0 ls1 ws3"> A maneira <span class="blank _2"> </span>de se <span class="blank _2"> </span>reduzir a chance <span class="blank _2"> </span>de per<span class="blank _5"> </span>furação </div><div class="t m0 x8 h3 yd8 ff2 fs1 fc0 sc0 ls1 ws3">do <span class="blank _b"> </span>apêndice <span class="blank _0"> </span>é <span class="blank _b"> </span>não <span class="blank _b"> </span>restringir <span class="blank _0"> </span>o <span class="blank _b"> </span>diagnóstico <span class="blank _b"> </span>ape-</div><div class="t m0 x8 h3 yd9 ff2 fs1 fc0 sc0 ls1 ws3">nas <span class="blank _9"> </span>pela <span class="blank _9"> </span>localização <span class="blank _9"> </span>d<span class="blank _2"> </span>a <span class="blank _9"> </span>dor<span class="blank _4"></span>, <span class="blank _9"> </span>porque <span class="blank _9"> </span>o <span class="blank _9"> </span>apêndice </div><div class="t m0 x8 h3 yda ff2 fs1 fc0 sc0 ls1 ws3">pode <span class="blank _2"> </span>se <span class="blank _2"> </span>localizar <span class="blank _2"> </span>em <span class="blank _2"> </span>qualquer lugar <span class="blank _2"> </span>na <span class="blank _2"> </span>cavidade </div><div class="t m0 x8 h3 ydb ff2 fs1 fc0 sc0 ls1 ws3">abdominal. <span class="blank _2"> </span>A <span class="blank _2"> </span>presença <span class="blank _5"> </span>de <span class="blank _2"> </span>febre <span class="blank _2"> </span>não <span class="blank _2"> </span>define <span class="blank _5"> </span>uma </div><div class="t m0 x8 h3 yf4 ff2 fs1 fc0 sc0 ls1 ws3">doença <span class="blank"> </span>cirúrgica. <span class="blank"> </span>A <span class="blank"> </span>leucocitose <span class="blank"> </span>existe <span class="blank _3"> </span>em <span class="blank"> </span>11% </div><div class="t m0 x8 h3 ydc ff2 fs1 fc0 sc0 ls1 ws3">dos <span class="blank _3"> </span>pacientes <span class="blank _c"> </span>normais <span class="blank _c"> </span>e <span class="blank _3"> </span>o <span class="blank _c"> </span>desvio <span class="blank _3"> </span>à <span class="blank _c"> </span>esquerda </div><div class="t m0 x8 h3 ydd ff2 fs1 fc0 sc0 ls1 ws3">está <span class="blank _8"> </span>presente <span class="blank _8"> </span>em <span class="blank _8"> </span>13% <span class="blank _8"> </span>dos <span class="blank _8"> </span>pacientes <span class="blank _8"> </span>nor<span class="blank _2"> </span>mais, <span class="blank _8"> </span>o </div><div class="t m0 x8 h3 yde ff2 fs1 fc0 sc0 ls1 ws3">EAS <span class="blank _b"> </span>falso <span class="blank _b"> </span>positivo <span class="blank _b"> </span>está <span class="blank _b"> </span>presente <span class="blank _b"> </span>em <span class="blank _b"> </span>30% <span class="blank _8"> </span>dos <span class="blank _b"> </span>ca-</div><div class="t m0 x8 h3 yf5 ff2 fs1 fc0 sc0 ls8 wsb">sos.<span class="ls1 ws3"> </span></div><div class="t m0 x8 h3 yf6 ff2 fs1 fc0 sc0 ls1 ws3">E <span class="blank _b"> </span>para <span class="blank _0"> </span>finalizar<span class="blank _4"></span>, <span class="blank _b"> </span>o <span class="blank _0"> </span>quadro <span class="blank _b"> </span>clássico <span class="blank _b"> </span>da <span class="blank _0"> </span>apendicite </div><div class="t m0 x8 h3 yf7 ff2 fs1 fc0 sc0 ls1 ws3">aguda <span class="blank _8"> </span>pode <span class="blank _8"> </span>ser <span class="blank _8"> </span>ilustrado <span class="blank _8"> </span>por <span class="blank _8"> </span>uma <span class="blank _a"> </span>moça <span class="blank _8"> </span>de <span class="blank _8"> </span>18 </div><div class="t m0 x8 h3 yf8 ff2 fs1 fc0 sc0 ls1 ws3">anos, <span class="blank _c"> </span>estudante, <span class="blank _3"> </span>que <span class="blank _c"> </span>começou <span class="blank _c"> </span>com <span class="blank _3"> </span>uma <span class="blank _c"> </span>dor </div><div class="t m0 x8 h3 yf9 ff2 fs1 fc0 sc0 ls1 ws3">periumbilical, <span class="blank _9"> </span>menstruação <span class="blank _0"> </span>nor<span class="blank _2"> </span>mal, <span class="blank _0"> </span>sem <span class="blank _0"> </span>fluxo <span class="blank _0"> </span>va-</div><div class="t m0 x8 h3 yfa ff2 fs1 fc0 sc0 ls1 ws3">ginal, <span class="blank _9"> </span>não <span class="blank _0"> </span>está <span class="blank _9"> </span>grávida <span class="blank _0"> </span>Beta <span class="blank _9"> </span>HCG <span class="blank _0"> </span>negativo <span class="blank _9"> </span>e <span class="blank _0"> </span>diz </div><div class="t m0 x8 h3 yfb ff2 fs1 fc0 sc0 ls1 ws3">que <span class="blank _a"> </span>a <span class="blank _a"> </span>dor <span class="blank"> </span>migr<span class="blank _6"></span>ou <span class="blank _a"> </span>para <span class="blank _a"> </span>fossa <span class="blank"> </span>ilíaca <span class="blank _8"> </span>direita <span class="blank _7"> </span>e <span class="blank _a"> </span>ali </div><div class="t m0 x8 h3 yfc ff2 fs1 fc0 sc0 ls1 ws3">per<span class="blank _2"> </span>manece <span class="blank _a"> </span>com <span class="blank _a"> </span>dor<span class="blank _4"></span>, <span class="blank _a"> </span>defesa, <span class="blank _a"> </span>contratura <span class="blank _8"> </span>e <span class="blank _a"> </span>des-</div><div class="t m0 x8 h3 yfd ff2 fs1 fc0 sc0 ls1 ws3">compressão brusca e dolorosa positiva.<span class="ff5 ws5">"</span> </div><div class="t m0 x8 h3 yfe ff2 fs1 fc0 sc0 ls1 ws3">Nota: <span class="blank _5"> </span>Paciente <span class="blank _5"> </span>chegou <span class="blank _5"> </span>com <span class="blank _5"> </span>dor <span class="blank _9"> </span>atípica: <span class="blank _5"> </span>analge-</div><div class="t m0 x8 h3 yff ff2 fs1 fc0 sc0 ls1 ws3">sia <span class="blank _8"> </span>o <span class="blank _8"> </span>paciente <span class="blank _a"> </span>e <span class="blank _8"> </span>manda <span class="blank _8"> </span>para <span class="blank _a"> </span>casa <span class="blank _8"> </span>(nunca <span class="blank _8"> </span>dar </div><div class="t m0 x8 h3 y100 ff2 fs1 fc0 sc0 ls1 ws3">antibiótico <span class="blank _b"> </span>e <span class="blank _b"> </span>anti-infamatório <span class="blank _8"> </span>em <span class="blank _b"> </span>dor <span class="blank _b"> </span>abdominal </div><div class="t m0 x8 h3 y101 ff2 fs1 fc0 sc0 ls1 ws3">desconhecida). <span class="blank _c"> </span>No <span class="blank _3"> </span>dia <span class="blank _c"> </span>seguinte <span class="blank _3"> </span>pode-se <span class="blank _c"> </span>ter <span class="blank _3"> </span>3 </div><div class="t m0 x8 h3 y102 ff2 fs1 fc0 sc0 ls1 ws3">desfechos: </div><div class="t m0 x8 h3 y103 ff2 fs1 fc0 sc0 ls1 ws3">1. <span class="blank _5"> </span>Paciente <span class="blank _2"> </span>melhorou <span class="blank _5"> </span>a <span class="blank _5"> </span>dor: <span class="blank _5"> </span>fecalito <span class="blank _5"> </span>pode <span class="blank _2"> </span>ter <span class="blank _5"> </span>de-</div><div class="t m0 x8 h3 y104 ff2 fs1 fc0 sc0 ls1 ws3">sobstruído <span class="blank _2"> </span>o <span class="blank _5"> </span>apendice, <span class="blank _5"> </span>ou <span class="blank _5"> </span>seja, <span class="blank _2"> </span>a <span class="blank _5"> </span>apendicite <span class="blank _5"> </span>não </div><div class="t m0 x8 h3 y105 ff2 fs1 fc0 sc0 ls1 ws3">evoluiu pois teve melhora espontanea; </div><div class="t m0 x8 h3 y106 ff2 fs1 fc0 sc0 ls1 ws3">2. <span class="blank _b"> </span>Paciente <span class="blank _b"> </span>começou <span class="blank _b"> </span>com <span class="blank _8"> </span>diarréia: <span class="blank _b"> </span>fala <span class="blank _b"> </span>a <span class="blank _b"> </span>favor </div><div class="t m0 x8 h3 y107 ff2 fs1 fc0 sc0 ls1 ws3">de gastroenterocolite; </div><div class="t m0 x8 h3 y108 ff2 fs1 fc0 sc0 ls1 ws3">3. Dor localizou em FID: apendicite. </div></div><div class="c x1 y59 w2 h7"><div class="t m0 xb h8 y5a ff6 fs0 fc1 sc0 ls1 ws3">Amanda Viol</div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div>
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