Bíblia de Semiologia

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DIGITADA PELO 3º ANO “A” DE MEDICINA /2000 
Universidade Federal de Alagoas 
 
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DIGITADORES: 
 
 
ANADELIA DE FRANÇA 
ARMANDO DE HOLANDA GUERRA JÚNIOR 
ARTHUR DANTAS VIEIRA 
BRENO RÉGIS DINIZ 
CRISTIANE CEDRIM SAMPAIO 
DANIELLA BEZERRA DUARTE 
ERYJANE TENÓRIO 
EVELINE DE AMORIM GAMELEIRA 
FABIANA SOPHIA GONZALEZ DA NÓBREGA 
FERNANDA COELHO PEREIRA DA COSTA 
FERNANDA LIMA CORREIA 
FLÁVIA Mª CERQUEIRA DE MEDEIROS CAVALCANTE 
FLÁVIO ABS DE LIMA 
HÉRIKA DA SILVA TRANGEL 
JAIRO LYRA DE ANDRADE FILHO 
JANDIR NICACIO 
JANICE DE SOUZA GUIMARÃES TAVARES 
KALLIANNA PAULA DUARTE GAMELEIRA 
LILIAN BRITO LIRA MALTA 
SARAH BARBOSA DA SILVA 
VANESSA ALBUQUERQUE 
VALFRIDO LEÃO DE MELO NETO 
 
 
 
 
 
 
 
 
 
 
 
DIGITALIZAÇÃO DAS FIGURAS: 
 
 
FABIANA SOPHIA GONZALEZ DA NÓBREGA 
 
 
 
 
 
 
 
 
CORREÇÕES FINAIS E EDITORAÇÃO: 
 
 
FABIANA SOPHIA GONZALEZ DA NÓBREGA 
 
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Os erros de um cozinheiro se cobrem com salsa; os de 
um arquiteto, com flores; e os de um médico se 
cobrem com terra... 
 
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ÍNDICE: 
 
INTRODUÇÃO À SEMIOLOGIA _______________________________________________________________ 12 
MÉTODO CLÍNICO __________________________________________________________________________________________________________________ 12 
1. INTRODUÇÃO __________________________________________________________________________________________________________________ 12 
2. MÉTODO CLÍNICO ______________________________________________________________________________________________________________ 13 
2.1.SUBDIVISÃO DO MÉTODO CLÍNICO _____________________________________________________________________________________________ 13 
2.1.1. ANAMNESE ______________________________________________________________________________________________________________ 13 
● IDENTIFICAÇÃO _________________________________________________________________________________________________________ 13 
● QUEIXA PRINCIPAL ______________________________________________________________________________________________________ 14 
● HISTÓRIA DA DOENÇA ATUAL (HDA)______________________________________________________________________________________ 14 
● ANTECEDENTES: AF., A.FAM, AS. E A.P.P. __________________________________________________________________________________ 14 
● ANTECEDENTES FAMILIARES _____________________________________________________________________________________________ 15 
2.1.2. EXAME FÍSICO ___________________________________________________________________________________________________________ 15 
● INSPEÇÃO _______________________________________________________________________________________________________________ 15 
● PALPAÇÃO ______________________________________________________________________________________________________________ 16 
● PERCUSSÃO _____________________________________________________________________________________________________________ 16 
● AUSCULTA ______________________________________________________________________________________________________________ 16 
EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 16 
● DIAGNÓSTICO ___________________________________________________________________________________________________________ 17 
● PROGNÓSTICO ___________________________________________________________________________________________________________ 17 
SOMATOSCOPIA____________________________________________________________________________________________________________________ 18 
● REVISÃO SOBRE MÉTODO CLÍNICO ______________________________________________________________________________________________ 18 
● EXAME FÍSICO GERAL/SOMATOSCOPIA __________________________________________________________________________________________ 18 
INTRODUÇÃO ________________________________________________________________________________________________________________ 18 
● ETAPAS DA SOMATOSCOPIA ____________________________________________________________________________________________________ 19 
1. ESTADO GERAL _____________________________________________________________________________________________________________ 19 
2. PESO _______________________________________________________________________________________________________________________ 19 
● VARIAÇÕES DO PESO_____________________________________________________________________________________________________ 20 
3. ALTURA ____________________________________________________________________________________________________________________ 20 
● ALTERAÇÕES NO DESENVOLVIMENTO ESTATURAL ________________________________________________________________________ 20 
4. BIÓTIPO ____________________________________________________________________________________________________________________ 21 
5. MARCHA ___________________________________________________________________________________________________________________ 22 
6. TEMPERATURA CORPORAL __________________________________________________________________________________________________ 23 
● FEBRE ___________________________________________________________________________________________________________________ 24 
7. POSTURA ___________________________________________________________________________________________________________________ 26 
CIRCULAÇÃO COLATERAL VENOSA SUBCUTÂNEA __________________________________________________________________________________ 31 
1. CONCEITO _____________________________________________________________________________________________________________________ 31 
TIPOS DE CIRCULAÇÃO COLATERAL VENOSA SUBCUTÂNEA _______________________________________________________________________ 31 
A) CAVA SUPERIOR ___________________________________________________________________________________________________________ 31 
● ETIOLOGIA ______________________________________________________________________________________________________________ 32 
● DADOS CLÍNICOS ________________________________________________________________________________________________________ 32 
B) BRAQUIOCEFÁLICA ________________________________________________________________________________________________________ 32 
À ESQUERDA ______________________________________________________________________________________________________________ 32 
● ETIOLOGIA ___________________________________________________________________________________________________________ 32 
● DADOS CLÍNICOS _____________________________________________________________________________________________________ 32 
À DIREITA ____________________________________________________________________________________________________________________ 33 
● ETIOLOGIAS _____________________________________________________________________________________________________________ 33 
● DADOS CLÍNICOS ________________________________________________________________________________________________________ 33 
C) PORTA _____________________________________________________________________________________________________________________ 33 
● ETIOLOGIAS _____________________________________________________________________________________________________________ 33 
● DADOS CLÍNICOS ________________________________________________________________________________________________________ 33 
● SENTIDO DO SANGUE ____________________________________________________________________________________________________ 33 
D) CAVA INFERIOR ____________________________________________________________________________________________________________ 33 
● ETIOLOGIA ______________________________________________________________________________________________________________33 
● DADOS CLÍNICOS ________________________________________________________________________________________________________ 34 
● SENTIDO DO FLUXO ______________________________________________________________________________________________________ 34 
E) CIRCULAÇÃO PORTO-CAVA INFERIOR _______________________________________________________________________________________ 34 
● ETIOLOGIA ______________________________________________________________________________________________________________ 34 
EDEMA SUBCUTÂNEO ______________________________________________________________________________________________________________ 35 
1. INTRODUÇÃO __________________________________________________________________________________________________________________ 35 
2. CARACTERÍSTICAS PROPEDÊUTICAS DO EDEMA _________________________________________________________________________________ 35 
3. FENÔMENOS CLÍNICOS ASSOCIADOS ____________________________________________________________________________________________ 36 
4. FISIOPATOLOGIA DO EDEMA ___________________________________________________________________________________________________ 36 
5. ENFISEMA SUBCUTÂNEO _______________________________________________________________________________________________________ 38 
6. MIXEDEMA ____________________________________________________________________________________________________________________ 38 
SEMIOLOGIA DO APARELHO RESPIRATÓRIO ________________________________________________ 39 
1. REVISÃO ANATÔMICA _________________________________________________________________________________________________________ 39 
1.1. VIAS AÉREAS SUPERIORES _________________________________________________________________________________________________ 39 
1.2. VIAS AÉREAS INFERIORES _________________________________________________________________________________________________ 39 
1.3. PLEURAS _________________________________________________________________________________________________________________ 39 
1.4. CIRCULAÇÃO PULMONAR _________________________________________________________________________________________________ 39 
2. REVISÃO FISIOLÓGICA _________________________________________________________________________________________________________ 39 
3. ANATOMIA CLINICA ___________________________________________________________________________________________________________ 40 
3.1. PONTOS DE REFERÊNCIA ANATÔMICA ______________________________________________________________________________________ 40 
3.2. LINHAS TORÁCICAS _______________________________________________________________________________________________________ 41 
● LINHAS VERTICAIS ______________________________________________________________________________________________________ 42 
● LINHAS HORIZONTAIS ___________________________________________________________________________________________________ 42 
3.3. REGIÕES TORÁCICAS ______________________________________________________________________________________________________ 43 
4. EXAME CLÍNICO _______________________________________________________________________________________________________________ 43 
4.1. ANAMNESE _______________________________________________________________________________________________________________ 43 
4.2. HDA ______________________________________________________________________________________________________________________ 44 
4.3. HISTÓRIA FAMILIAR _______________________________________________________________________________________________________ 45 
4.4. ANTECEDENTES PESSOAIS _________________________________________________________________________________________________ 45 
4.5. HÁBITOS DE VIDA _________________________________________________________________________________________________________ 45 
 
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5. SINAIS E SINTOMAS ____________________________________________________________________________________________________________ 45 
5.1. DOR TORÁCICA ___________________________________________________________________________________________________________ 46 
5.1.1. DOR PLEURÍTICA _____________________________________________________________________________________________________ 46 
5.1.2. DOR DIAFRAGMÁTICA ________________________________________________________________________________________________ 47 
5.2. TOSSE ____________________________________________________________________________________________________________________ 47 
5.3. EXPECTORAÇÃO __________________________________________________________________________________________________________ 48 
5.4. HEMOPTISE _______________________________________________________________________________________________________________ 48 
5.5. VÔMICA __________________________________________________________________________________________________________________ 49 
5.6. DISPNÉIA _________________________________________________________________________________________________________________ 49 
5.7. ROUQUIDÃO ______________________________________________________________________________________________________________ 50 
6. EXAME FÍSICO DO TÓRAX ______________________________________________________________________________________________________ 50 
6.1. INSPEÇÃO DO APARELHO RESPIRATÓRIO ___________________________________________________________________________________ 50 
● FREQÜÊNCIA RESPIRATÓRIA _____________________________________________________________________________________________ 51 
● TIPO RESPIRATÓRIO _____________________________________________________________________________________________________ 51 
● RITMOS RESPIRATÓRIOS _________________________________________________________________________________________________ 51 
٭ CHEYNE-STOKES _____________________________________________________________________________________________________ 52 
٭ BIOT _________________________________________________________________________________________________________________ 52 
٭ KUSSMAULL __________________________________________________________________________________________________________ 52 
٭ RESPIRAÇÃO SUSPIROSA ______________________________________________________________________________________________ 53 
6.2. PALPAÇÃO DO APARELHO RESPIRATÓRIO __________________________________________________________________________________ 53 
● DAS BASES ______________________________________________________________________________________________________________ 53 
● DOS ÁPICES (MANOBRA DE RUAULT) _____________________________________________________________________________________ 53 
● FACE ANTERIOR DO TÓRAX ______________________________________________________________________________________________ 54 
● EXAME DA ELASTICIDADE _______________________________________________________________________________________________ 54 
● VIBRAÇÕES _____________________________________________________________________________________________________________ 54 
٭ FRÊMITO TÓRACO-VOCAL _____________________________________________________________________________________________ 54 
٭ TORACOMETRIA ______________________________________________________________________________________________________ 55 
٭ FRÊMITO BRÔNQUICO _________________________________________________________________________________________________ 55 
٭ FRÊMITO PLEURAL ___________________________________________________________________________________________________ 55 
6.3. PERCUSSÃO DO APARELHO RESPIRATÓRIO _________________________________________________________________________________ 55 
● TÉCNICA ________________________________________________________________________________________________________________ 56 
6.4. AUSCULTA DO APARELHO RESPIRATÓRIO __________________________________________________________________________________ 56 
● ALTERAÇÕES DO MV _____________________________________________________________________________________________________57 
● TEMPO RESPIRATÓRIO ___________________________________________________________________________________________________ 57 
● RUÍDOS ADVENTÍCIOS ___________________________________________________________________________________________________ 57 
● ESTERTORES SECOS ______________________________________________________________________________________________________ 57 
● ESTERTORES BOLHOSOS _________________________________________________________________________________________________ 58 
● ATRITO PLEURAL ________________________________________________________________________________________________________ 58 
● SOPROS _________________________________________________________________________________________________________________ 58 
7. EXAMES COMPLEMENTARES ___________________________________________________________________________________________________ 59 
7.1. EXAME DE ESCARRO ______________________________________________________________________________________________________ 59 
7.2. RADIOGRAFIA ____________________________________________________________________________________________________________ 59 
7.3. TOMOGRAFIA COMPUTADORIZADA ________________________________________________________________________________________ 60 
7.4. ANGIOGRAFIA ____________________________________________________________________________________________________________ 60 
7.5. CINTILOGRAFIA PULMONAR _______________________________________________________________________________________________ 60 
7.6. ULTRA-SONOGRAFIA ______________________________________________________________________________________________________ 60 
7.8. BRONCOSCOPIA ___________________________________________________________________________________________________________ 61 
7.9. PROVAS DE FUNÇÕES DO APARELHO RESPIRATÓRIO ________________________________________________________________________ 61 
7.10. BRONCOESPIROMETRIA __________________________________________________________________________________________________ 61 
7.11. EXAME DE SECREÇÕES BRÔNQUICAS _____________________________________________________________________________________ 61 
7.12. EXAME DO LÍQUIDO PLEURAL ____________________________________________________________________________________________ 61 
7.13. BIÓPSIA PULMONAR ______________________________________________________________________________________________________ 61 
7.14. TORACOTOMIA EXPLORADORA ___________________________________________________________________________________________ 61 
8. SÍNDROMES CLÍNICAS__________________________________________________________________________________________________________ 61 
8.1 DERRAME PLEURAL _______________________________________________________________________________________________________ 61 
● SINAIS __________________________________________________________________________________________________________________ 61 
● ETIOLOGIA ______________________________________________________________________________________________________________ 62 
● SINTOMAS _______________________________________________________________________________________________________________ 62 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 62 
● COMPLICAÇÕES _________________________________________________________________________________________________________ 62 
● TIPOS DE DERRAMES _____________________________________________________________________________________________________ 62 
8.2- PNEUMOTÓRAX ___________________________________________________________________________________________________________ 63 
● ETIOLOGIA ______________________________________________________________________________________________________________ 63 
● TIPOS DE PNEUMOTÓRAX ________________________________________________________________________________________________ 63 
● SINTOMAS _______________________________________________________________________________________________________________ 63 
● SINAIS __________________________________________________________________________________________________________________ 63 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 64 
● COMPLICAÇÕES _________________________________________________________________________________________________________ 64 
8.3 SÍNDROMES PNEUMÔNICAS ________________________________________________________________________________________________ 64 
● TIPOS ___________________________________________________________________________________________________________________ 64 
● ETIOLOGIA ______________________________________________________________________________________________________________ 64 
● SINTOMAS _______________________________________________________________________________________________________________ 64 
● SINAIS __________________________________________________________________________________________________________________ 64 
● EXAMES LABORATORIAIS ________________________________________________________________________________________________ 65 
● COMPLICAÇÕES DA PNEUMONIA _________________________________________________________________________________________ 65 
8.4 ATELECTASIAS ____________________________________________________________________________________________________________ 65 
● ETIOLOGIA ______________________________________________________________________________________________________________ 65 
● TIPOS DE ATELECTASIAS ____________________________________________________________________________________________________ 65 
● SINTOMAS _______________________________________________________________________________________________________________ 65 
● SINAIS DA ATELECTASIA _________________________________________________________________________________________________ 65 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 66 
● COMPLICAÇÕES _________________________________________________________________________________________________________ 66 
8.5 ENFISEMA PULMONAR _____________________________________________________________________________________________________ 66 
● ETIOLOGIA ______________________________________________________________________________________________________________ 66 
● SINTOMAS DO ENFISEMA PULMONAR _____________________________________________________________________________________ 66 
● SINAIS DO ENFISEMA ____________________________________________________________________________________________________ 66 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 66 
● COMPLICAÇÕES _________________________________________________________________________________________________________ 67 
8.6. ABSCESSO PULMONAR ____________________________________________________________________________________________________ 67 
● ETIOLOGIA ______________________________________________________________________________________________________________ 67 
● CONDIÇÕES PARA O DESENVOLVIMENTO DO ABSCESSO ___________________________________________________________________ 67 
 
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● EXAMES LABORATORIAIS ________________________________________________________________________________________________ 67 
● COMPLICAÇÕES DO ABSCESSO ___________________________________________________________________________________________ 67 
8.7.HIPERTENSÃO PULMONAR _________________________________________________________________________________________________ 68 
● ETIOLOGIA ______________________________________________________________________________________________________________ 68 
● TIPOS DE HIPERTENSÃO PULMONAR ______________________________________________________________________________________68 
● SINTOMAS E SINAIS ______________________________________________________________________________________________________ 68 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 68 
8.8. INSUFICIÊNCIA RESPIRATÓRIA _____________________________________________________________________________________________ 68 
● TIPOS DE INSUFICIÊNCIA RESPIRATÓRIA __________________________________________________________________________________ 68 
● ETIOLOGIA ______________________________________________________________________________________________________________ 68 
● SINTOMAS _______________________________________________________________________________________________________________ 69 
● SINAIS __________________________________________________________________________________________________________________ 69 
● EXAMES COMPLEMENTARES _____________________________________________________________________________________________ 69 
SEMIOLOGIA DO SISTEMA CARDIOVASCULAR _______________________________________________ 70 
SINAIS E SINTOMAS ________________________________________________________________________________________________________________ 70 
1. INTRODUÇÃO __________________________________________________________________________________________________________________ 70 
2. SINAIS E SINTOMAS ____________________________________________________________________________________________________________ 70 
2.1. DISPNÉIA _________________________________________________________________________________________________________________ 70 
2.1.1. CAUSAS FISIOPATOLÓGICAS __________________________________________________________________________________________ 71 
2.2. DOR TORÁCICA ___________________________________________________________________________________________________________ 71 
2.2.1. ANGINA ______________________________________________________________________________________________________________ 72 
2.2.2. INFARTO DO MIOCÁRDIO _____________________________________________________________________________________________ 72 
2.3. PALPITAÇÃO ______________________________________________________________________________________________________________ 73 
2.4. SÍNCOPE __________________________________________________________________________________________________________________ 73 
2.5. EDEMA ___________________________________________________________________________________________________________________ 73 
2.6. CIANOSE__________________________________________________________________________________________________________________ 73 
2.7. HEMOPTISE _______________________________________________________________________________________________________________ 74 
EXAME FÍSICO DA REGIÃO PRECORDIAL ___________________________________________________________________________________________ 75 
1. LIMITES DA REGIÃO ___________________________________________________________________________________________________________ 75 
2. INSPEÇÃO _____________________________________________________________________________________________________________________ 75 
2.1. ABAULAMENTOS __________________________________________________________________________________________________________ 75 
2.2. RETRAÇÕES_______________________________________________________________________________________________________________ 76 
2.3. PULSAÇÕES VISÍVEIS ______________________________________________________________________________________________________ 76 
3. PALPAÇÃO ____________________________________________________________________________________________________________________ 77 
3.1. FRÊMITO _________________________________________________________________________________________________________________ 77 
3.2. ATRITO PERICÁRDICO _____________________________________________________________________________________________________ 77 
3.3. CHOQUE VALVAR _________________________________________________________________________________________________________ 77 
3.4. ICTUS CORDIS _____________________________________________________________________________________________________________ 77 
3.4.1. LOCALIZAÇÃO _______________________________________________________________________________________________________ 78 
3.4.2. EXTENSÃO ___________________________________________________________________________________________________________ 78 
3.4.3. MOTILIDADE _________________________________________________________________________________________________________ 78 
4. AUSCULTA ____________________________________________________________________________________________________________________ 79 
4.1. RITMO ____________________________________________________________________________________________________________________ 79 
4.2. FREQÜÊNCIA CARDÍACA __________________________________________________________________________________________________ 79 
4.3. BULHAS CARDÍACAS ______________________________________________________________________________________________________ 80 
4.3.1. PRIMEIRA BULHA (B1) ________________________________________________________________________________________________ 80 
● MECANISMO DE FECHAMENTO DAS VALVAS MITRAL E TRICÚSPIDE _____________________________________________________ 80 
4.3.2. SEGUNDA BULHA (B2) ________________________________________________________________________________________________ 81 
4.3.3. FONESES _____________________________________________________________________________________________________________ 82 
● HIPERFONESE DA 1º BULHA ___________________________________________________________________________________________ 82 
● HIPOFONESE DA 1º BULHA ____________________________________________________________________________________________ 82 
● HIPERFONESE DA 2ª BULHA ___________________________________________________________________________________________ 82 
● HIPOFONESE DA 2ª BULHA_____________________________________________________________________________________________ 83 
4.4. DESDOBRAMENTO ________________________________________________________________________________________________________ 83 
4.5. 4a BULHA _________________________________________________________________________________________________________________ 84 
● CAUSAS _________________________________________________________________________________________________________________ 84 
4.5. 3a BULHA _________________________________________________________________________________________________________________ 84 
4.6. ESTALIDOS _______________________________________________________________________________________________________________ 85 
● ESTALIDOS SISTÓLICOS DE EJEÇÃO _______________________________________________________________________________________ 85 
● ESTALIDOS DIASTÓLICOS ________________________________________________________________________________________________ 85 
4.7. SOPROS ___________________________________________________________________________________________________________________ 85 
4.7.1. CLASSIFICAÇÃO ______________________________________________________________________________________________________ 86 
● SOPROS SISTÓLICOS __________________________________________________________________________________________________ 86 
● SOPROS DIASTÓLICOS ________________________________________________________________________________________________ 86 
● SOPROS SITODIASTÓLICOS OU CONTÍNUOS ____________________________________________________________________________ 87 
● SOPROS INOCENTES __________________________________________________________________________________________________ 87 
● VENOUS HUM (RUMOR VENOSO) ______________________________________________________________________________________ 88 
4.8. CARACTERÍSTICAS DE AUSCULTA DAS PRINCIPAISLESÕES OROVALVARES __________________________________________________ 88 
● ESTENOSE MITRAL _______________________________________________________________________________________________________ 88 
● ESTENOSE TRICÚSPIDE ___________________________________________________________________________________________________ 89 
● INSUFICIÊNCIA MITRAL __________________________________________________________________________________________________ 89 
● INSUFICIÊNCIA TRICÚSPIDE ______________________________________________________________________________________________ 90 
● ESTENOSE AÓRTICA _____________________________________________________________________________________________________ 90 
● ESTENOSE PULMONAR ___________________________________________________________________________________________________ 90 
● INSUFICIÊNCIA AÓRTICA _________________________________________________________________________________________________ 91 
● INSUFICIÊNCIA PULMONAR ______________________________________________________________________________________________ 91 
LESÕES OROVALVULARES ADQUIRIDAS ____________________________________________________________________________________________ 92 
1. GENERALIDADES ______________________________________________________________________________________________________________ 92 
2. ESTENOSE AÓRTICA ___________________________________________________________________________________________________________ 92 
2.1. MANIFESTAÇÕES CLÍNICAS ________________________________________________________________________________________________ 92 
2.2. EXAME FÍSICO ____________________________________________________________________________________________________________ 92 
2.3 EXAMES COMPLEMENTARES _______________________________________________________________________________________________ 92 
3. INSUFICIÊNCIA AÓRTICA _______________________________________________________________________________________________________ 93 
3.1. MANIFESTAÇÕES CLÍNICAS ________________________________________________________________________________________________ 93 
3.2. EXAME FÍSICO ____________________________________________________________________________________________________________ 93 
● NO CORAÇÃO ____________________________________________________________________________________________________________ 93 
● SINAIS PERIFÉRICOS _____________________________________________________________________________________________________ 93 
3.3. EXAMES COMPLEMENTARES ______________________________________________________________________________________________ 94 
4. ESTENOSE MITRAL _____________________________________________________________________________________________________________ 94 
 
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4.1. MANIFESTAÇÕES CLÍNICAS ________________________________________________________________________________________________ 94 
4.2. EXAME FÍSICO ____________________________________________________________________________________________________________ 95 
4.3. EXAMES COMPLEMENTARES ______________________________________________________________________________________________ 95 
5. INSUFICIÊNCIA MITRAL ________________________________________________________________________________________________________ 95 
5.1. MANIFESTAÇÕES CLÍNICAS ________________________________________________________________________________________________ 96 
5.2. EXAME FÍSICO ____________________________________________________________________________________________________________ 96 
5.3. EXAMES COMPLEMENTARES ______________________________________________________________________________________________ 96 
6. ESTENOSE TRICÚSPIDE _________________________________________________________________________________________________________ 96 
6.1. EXAME FÍSICO E MANIFESTAÇÕES CLÍNICAS________________________________________________________________________________ 96 
7. INSUFICIÊNCIA TRICÚSPIDE ____________________________________________________________________________________________________ 97 
7.1. EXAME FÍSICO E MANIFESTAÇÕES CLÍNICAS________________________________________________________________________________ 97 
EXAMES COMPLEMENTARES _______________________________________________________________________________________________________ 98 
1. INTRODUÇÃO __________________________________________________________________________________________________________________ 98 
2. ELETROCARDIOGRAMA ________________________________________________________________________________________________________ 98 
2.1. ELETROCARDIÓGRAFO ____________________________________________________________________________________________________ 98 
2.2. O ECG NORMAL ___________________________________________________________________________________________________________ 98 
● DESPOLARIZAÇÃO ATRIAL _______________________________________________________________________________________________ 98 
● DESPOLARIZAÇÃO VENTRICULAR ________________________________________________________________________________________ 99 
● REPOLARIZAÇÃO VENTRICULAR _________________________________________________________________________________________ 99 
2.3. IMPORTÂNCIA DO ECG ____________________________________________________________________________________________________ 99 
3. EXAME RADIOLÓGICO ________________________________________________________________________________________________________ 101 
3.1. INTERPRETAÇÃO DE UMA RADIOGRAFIA __________________________________________________________________________________ 101 
3.2. CONFIGURAÇÃO OU SILHUETA CARDÍACA ________________________________________________________________________________ 101 
3.3. CIRCULAÇÃO PULMONAR ________________________________________________________________________________________________ 102 
4. ECOCARDIOGRAMA ___________________________________________________________________________________________________________ 102 
5. TESTE ERGOMÉTRICO _________________________________________________________________________________________________________ 103 
6. CINTILOGRAFIA DE PERFUSÃO ________________________________________________________________________________________________ 103 
7. HOLTER ______________________________________________________________________________________________________________________ 103 
8. CATETERISMO CARDÍACO _____________________________________________________________________________________________________ 103 
SÍNDROMES _______________________________________________________________________________________________________________________ 105 
1. INTRODUÇÃO _________________________________________________________________________________________________________________ 105 
2. INSUFICIÊNCIA CARDÍACA ____________________________________________________________________________________________________ 105 
2.2. INSUFICIÊNCIA CARDÍACA CONGESTIVA (ICC) _____________________________________________________________________________ 105 
● SINAIS E SINTOMAS DECORRENTES DA DIMINUIÇÃO DO DÉBITO CARDÍACO _______________________________________________ 106 
● MANIFESTAÇÕES CLÍNICAS _____________________________________________________________________________________________ 106 
● EXAMES COMPLEMENTARES ____________________________________________________________________________________________ 107 
3. HIPERTENSÃO ARTERIAL SISTÊMICA ___________________________________________________________________________________________ 107 
3.1. ÓRGÃOS ALVO ACOMETIDOS PELA HIPERTENSÃO _________________________________________________________________________ 108 
3.2. EXAME FÍSICO ___________________________________________________________________________________________________________ 108 
3.3. MANIFESTAÇÕES CLÍNICAS _______________________________________________________________________________________________ 108 
3.4. EXAMES COMPLEMENTARES_____________________________________________________________________________________________ 109 
4. DOENÇAS ISQUÊMICAS ________________________________________________________________________________________________________ 109 
4.1. ANGINA DO PEITO ________________________________________________________________________________________________________ 109 
4.2. INFARTO_________________________________________________________________________________________________________________ 109 
● CARACTERÍSTICAS ______________________________________________________________________________________________________ 109 
● EXAMES COMPLEMENTARES ____________________________________________________________________________________________ 110 
● MANIFESTAÇÕES CLÍNICAS _____________________________________________________________________________________________ 110 
● PROGNÓSTICO DO INFARTO _____________________________________________________________________________________________ 110 
SEMIOLOGIA DO SISTEMA NERVOSO _______________________________________________________ 112 
1. INTRODUÇÃO _________________________________________________________________________________________________________________ 112 
1.1. NEURÔNIO _______________________________________________________________________________________________________________ 112 
1.2. NEURÓGLIA______________________________________________________________________________________________________________ 112 
1.3. MICRÓGLIA ______________________________________________________________________________________________________________ 112 
VIAS DAS MOTRICIDADES E DAS SENSIBILIDADES _________________________________________________________________________________ 113 
2. VIAS MOTORAS _______________________________________________________________________________________________________________ 113 
2.1. VIA PIRAMIDAL __________________________________________________________________________________________________________ 113 
2.2. VIA EXTRAPIRAMIDAL ___________________________________________________________________________________________________ 114 
3. SENSIBILIDADE _______________________________________________________________________________________________________________ 114 
3.1. SENSIBILIDADE ELEMENTAR _____________________________________________________________________________________________ 114 
3.1.1. SENSIBILIDADE SUPERFICIAL OU CUTÂNEA ___________________________________________________________________________ 114 
3.1.2. SENSIBILIDADE PROFUNDA __________________________________________________________________________________________ 114 
3.2. SENSIBILIDADE COMPLEXA _______________________________________________________________________________________________ 115 
3.3. VIAS DA SENSIBILIDADE __________________________________________________________________________________________________ 115 
3.3.1. NEURÔNIO I OU PRIMEIRA ORDEM (SENSITIVO PERIFÉRICO) ___________________________________________________________ 115 
3.3.2. NEURÔNIO II OU SEGUNDA ORDEM ___________________________________________________________________________________ 115 
3.3.3. NEURÔNIO III OU DE TERCEIRA ORDEM _______________________________________________________________________________ 115 
4. VIAS _________________________________________________________________________________________________________________________ 116 
4.1. FEIXES GRACIAIS E CUNEATUS OU CUNEIFORME __________________________________________________________________________ 116 
4.2. FEIXES ESPINO-TALÂMICOS ______________________________________________________________________________________________ 116 
4.2.1. FEIXE ESPINO-TALÂMICO LATERAL __________________________________________________________________________________ 116 
4.2.2. FEIXE ESPINO-TALÂMICO VENTRAL OU ANTERIOR ____________________________________________________________________ 116 
4.2.3. FEIXES ESPINO-CEREBELARES ___________________________________________________________________________________________ 117 
5. LESÕES MOTORAS E SENSITIVAS ______________________________________________________________________________________________ 117 
5.1. LESÕES MOTORAS________________________________________________________________________________________________________ 117 
● LESÕES PIRAMIDAIS E EXTRAPIRAMIDAIS ___________________________________________________________________________________ 118 
A) SÍNDROME DO NEURÔNIO MOTOR SUPERIOR OU CENTRAL _______________________________________________________________ 118 
B) SÍNDROME DO NEURÔNIO MOTOR INFERIOR OU PERIFÉRICO _____________________________________________________________ 118 
5.2. LESÕES SENSITIVAS ______________________________________________________________________________________________________ 119 
5.2.1. NERVOS PERIFÉRICOS E RAÍZES POSTERIORES ________________________________________________________________________ 119 
5.2.2. MEDULA ____________________________________________________________________________________________________________ 120 
5.2.3. LESÕES DO FEIXE ESPINO-TALÂMICO LATERAL _______________________________________________________________________ 120 
5.2.4. CEREBRAIS _________________________________________________________________________________________________________ 120 
6. EXAME DOS MOVIMENTOS VOLUNTÁRIOS _____________________________________________________________________________________ 120 
● FORÇA MUSCULAR _________________________________________________________________________________________________________ 121 
7. EXAME DO TÔNUS MUSCULAR ________________________________________________________________________________________________ 121 
7.1. HIPERTONIA _____________________________________________________________________________________________________________ 121 
● HIPERTONIA PIRAMIDAL (EPASTICIDADE) ________________________________________________________________________________ 121 
● HIPERTONIA OU RIGIDEZ EXTRAPIRAMIDAL _____________________________________________________________________________ 122 
7.2. HIPOTONIA ______________________________________________________________________________________________________________ 122 
8. REAÇÕES MUSCULARES PATOLÓGICAS ________________________________________________________________________________________ 123 
 
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9. CONTRAÇÕES E MOVIMENTOS INVOLUNTÁRIOS ________________________________________________________________________________ 124 
● MOVIMENTOS CORÉICOS ___________________________________________________________________________________________________ 124 
● TIQUES ____________________________________________________________________________________________________________________ 124 
● MOVIMENTOS ATETÓTICOS ________________________________________________________________________________________________ 124 
● MIOCLONIAS ______________________________________________________________________________________________________________ 124 
● CÃIBRAS __________________________________________________________________________________________________________________ 124 
● CONVULSÕES ______________________________________________________________________________________________________________ 124 
● EXAME DO TROFISMO MUSCULAR E DA MARCHA ____________________________________________________________________________ 125 
● DIFERENÇA DOS SINAIS PRESENTES NAS SÍNDROMES PIRAMIDAL E EXTRAPIRAMIDAL ________________________________________ 125 
– SÍNDROME PIRAMIDAL __________________________________________________________________________________________________ 125 
– SÍNDROMES EXTRAPIRAMIDAIS _________________________________________________________________________________________ 125 
10. COORDENAÇÃO MOTORA E EQUILÍBRIO _______________________________________________________________________________________ 126 
10.1. ATAXIA ESTÁTICA ______________________________________________________________________________________________________126 
● ALTERAÇÕES NA COORDENAÇÃO _______________________________________________________________________________________ 127 
10.2. ATAXIA CINÉTICA _______________________________________________________________________________________________________ 127 
10.3. ATAXIA LOCOMOTORA __________________________________________________________________________________________________ 128 
11. EXAME DA SENSIBILIDADE ___________________________________________________________________________________________________ 129 
11.1. SENSIBILIDADE ELEMENTAR ____________________________________________________________________________________________ 129 
11.1.1. SENSIBILIDADE DOLOROSA _________________________________________________________________________________________ 129 
11.1.2. SENSIBILIDADE À PRESSÃO (BARESTÉSICA) __________________________________________________________________________ 129 
11.2.SENSIBILIDADE COMPLEXA ______________________________________________________________________________________________ 129 
11.2.1. ESTATESIA _________________________________________________________________________________________________________ 129 
11.2.2. CINESTESIA ________________________________________________________________________________________________________ 130 
11.2.3. ESTEREOGNÓSIA ___________________________________________________________________________________________________ 130 
12. REFLEXOS ___________________________________________________________________________________________________________________ 130 
12.1. REFLEXOS SUPERFICIAIS (CUTÂNEO – MUCOSOS) _________________________________________________________________________ 130 
● REFLEXO CUTÂNEO-PLANTAR ___________________________________________________________________________________________ 130 
● REFLEXOS ABDOMINAIS ________________________________________________________________________________________________ 131 
● REFLEXO CREMASTÉRICO _______________________________________________________________________________________________ 131 
● REFLEXO CÍNIO-ESPINHAL ______________________________________________________________________________________________ 131 
● REFLEXO CORNEAL _____________________________________________________________________________________________________ 131 
● REFLEXO PALATINO ____________________________________________________________________________________________________ 131 
● REFLEXO FARÍNGEO ____________________________________________________________________________________________________ 131 
12.2. REFLEXOS PROFUNDOS OU OSTEOTENDINOSOS ___________________________________________________________________________ 131 
● REFLEXO PATELAR _____________________________________________________________________________________________________ 132 
● REFLEXO BICIPITAL _____________________________________________________________________________________________________ 132 
● REFLEXO TRICIPITAL ___________________________________________________________________________________________________ 133 
● REFLEXO AQUILEU _____________________________________________________________________________________________________ 133 
● REFLEXO ESTILO RADICAL (OU BRAQUIORADIAL) ________________________________________________________________________ 133 
● REFLEXO CUBITAL (OU DOS PRONADORES) ______________________________________________________________________________ 134 
● REFLEXO MANDIBULAR (OU MASSETÉRICO) _____________________________________________________________________________ 134 
12.3. REFLEXOS DE DEFESA ___________________________________________________________________________________________________ 134 
12.4. REFLEXOS POSTURAIS ___________________________________________________________________________________________________ 134 
12.5. REFLEXO DA PREENSÃO _________________________________________________________________________________________________ 134 
12.6. REFLEXO PILOMOTOR ___________________________________________________________________________________________________ 134 
12.7. REFLEXOS VAGAIS ______________________________________________________________________________________________________ 134 
ESTUDO DOS PARES CRANIANOS – PRINCIPAIS ALTERAÇÕES ______________________________________________________________________ 136 
1º PAR: NERVO OLFATÓRIO ______________________________________________________________________________________________________ 136 
2º PAR: NERVO ÓPTICO __________________________________________________________________________________________________________ 136 
3º PAR: NERVO OCULOMOTOR, 4º PAR: NERVO TROCLEAR, 6º PAR: NERVO ABDUCENTE _____________________________________________ 136 
5º PAR: NERVO TRIGÊMIO ________________________________________________________________________________________________________ 136 
6º PAR: NERVO ABDUCENTE _____________________________________________________________________________________________________ 136 
7º PAR: NERVO FACIAL __________________________________________________________________________________________________________ 137 
8º PAR: NERVO AUDITIVO ________________________________________________________________________________________________________ 137 
9º PAR: NERVO GLOSSOFARÍNGEO _______________________________________________________________________________________________ 137 
10º PAR: NERVO VAGO ___________________________________________________________________________________________________________ 137 
11º PAR: NERVO ESPINHAL _______________________________________________________________________________________________________ 137 
12º PAR: NERVO HIPOGLOSSO ____________________________________________________________________________________________________ 138 
ROTEIRO DA AULA PRÁTICA ______________________________________________________________________________________________________ 138 
1. FORÇA MOTORA ______________________________________________________________________________________________________________ 138 
2. SENSIBILIDADE _______________________________________________________________________________________________________________ 138 
A) ELEMENTAR ______________________________________________________________________________________________________________ 138 
B) COMPLEXA _______________________________________________________________________________________________________________ 138 
C) SENSIBILIDADE PALESTÉSICA E BARESTÉSICA ______________________________________________________________________________ 138 
3. COORDENAÇÃO MOTORA E EQUILÍBRIO (ATAXIA) ______________________________________________________________________________ 138 
4. REFLEXOS ____________________________________________________________________________________________________________________ 138 
A) SUPERFICIAIS _____________________________________________________________________________________________________________ 138 
B) PROFUNDOS ______________________________________________________________________________________________________________ 138 
5. EXAME DOS PARES CRANIANOS _______________________________________________________________________________________________ 139 
6. EXAME DO PACIENTE COMATOSO _____________________________________________________________________________________________ 139 
SEMIOLOGIA DO APARELHO DIGESTIVO ___________________________________________________ 140 
SINAIS E SINTOMAS DO APARELHO DIGESTIVO ____________________________________________________________________________________ 140 
1- INTRODUÇÃO ________________________________________________________________________________________________________________ 140 
2- DOR ABDOMINAL _____________________________________________________________________________________________________________ 140 
● ORIGEM INTRA-ABDOMINAL ___________________________________________________________________________________________________ 140 
a) DOR PROTOPÁTICA________________________________________________________________________________________________________ 140 
b) DOR EPICRÍTICA ___________________________________________________________________________________________________________ 140 
c) DOR DEVIDA AO REFLEXO PERITÔNIO-CUTÂNEO DE MORLEY ________________________________________________________________ 140 
● ORIGEM EXTRA-ABDOMINAL __________________________________________________________________________________________________ 141 
a) PARIETAL _________________________________________________________________________________________________________________ 141 
b) CENTRAL _________________________________________________________________________________________________________________ 141 
c) METABÓLICA______________________________________________________________________________________________________________ 141 
d) DOR REFERIDA ____________________________________________________________________________________________________________ 141 
● CARACTERÍSTICAS DA DOR ABDOMINAL _______________________________________________________________________________________ 141 
– LOCALIZAÇÃO DA DOR ANATOMICAMENTE ____________________________________________________________________________________ 142 
1- ABDOME ANTERIOR __________________________________________________________________________________________________________ 142 
A- LIMITES _____________________________________________________________________________________________________________________ 142 
B- DIVISÃO _____________________________________________________________________________________________________________________ 142 
● QUADRANTES: _____________________________________________________________________________________________________________ 143 
 
8 
● ANDARES __________________________________________________________________________________________________________________ 143 
● REGIÕES ___________________________________________________________________________________________________________________ 143 
C- PROTEÇÃO NA PAREDE DOS ÓRGÃOS ABDOMINAIS ____________________________________________________________________________ 144 
2- ABDOME POSTERIOR __________________________________________________________________________________________________________ 144 
3- DISFAGIA ____________________________________________________________________________________________________________________ 145 
4-ODINOFAGIA: DISFAGIA DOLOROSA ____________________________________________________________________________________________ 145 
5-DISTÚRBIOS DO APETITE ______________________________________________________________________________________________________ 145 
6- AGEUSIA OU HIPOGEUSIA: ____________________________________________________________________________________________________ 146 
7- HALITOSE ____________________________________________________________________________________________________________________ 146 
8- PIROSE _______________________________________________________________________________________________________________________ 147 
9- NÁUSEAS E VÔMITOS _________________________________________________________________________________________________________ 147 
● CAUSAS ___________________________________________________________________________________________________________________ 147 
10- REGURGITAÇÃO _____________________________________________________________________________________________________________ 148 
● CAUSAS ___________________________________________________________________________________________________________________ 148 
11- CONSTIPAÇÃO _______________________________________________________________________________________________________________ 148 
● CAUSAS ___________________________________________________________________________________________________________________ 148 
12- DIARRÉIA E DISENTERIA _____________________________________________________________________________________________________ 148 
13- HEMATÊMESE, MELENA, ENTERORRAGIA, SANGUE OCULTO ___________________________________________________________________ 148 
14- ICTERÍCIA ___________________________________________________________________________________________________________________ 149 
EXAME FÍSICO DO ABDOME _______________________________________________________________________________________________________ 150 
1- ESTABELECER OS LIMITES DO ABDOME ________________________________________________________________________________________ 150 
2- DIVISÃO DO ABDOME EM QUADRANTES E EM REGIÕES _________________________________________________________________________ 150 
A) INSPEÇÃO ___________________________________________________________________________________________________________________ 150 
A) FORMA E VOLUME DO ABDOME____________________________________________________________________________________________ 150 
B) CARACTERÍSTICAS DA PELE _______________________________________________________________________________________________ 152 
C) ALTERAÇÕES DA CICATRIZ UMBILICAL ____________________________________________________________________________________ 152 
D) CIRCULAÇÃO VENOSA SUBCUTÂNEA ______________________________________________________________________________________ 152 
E) MOVIMENTOS PERISTÁLTICOS _____________________________________________________________________________________________ 152 
F) PULSAÇÕES _______________________________________________________________________________________________________________ 152 
G) MOVIMENTOS RESPIRATÓRIOS ____________________________________________________________________________________________ 152 
H) ABAULAMENTOS LOCALIZADOS ___________________________________________________________________________________________ 153 
B) PALPAÇÃO DO ABDOME ______________________________________________________________________________________________________ 153 
٭ PALPAÇÃO SUPERFICIAL ______________________________________________________________________________________________________ 153 
1- ESPESSURA DA PAREDE ____________________________________________________________________________________________________ 153 
2- SENSIBILIDADE ___________________________________________________________________________________________________________ 153 
3- TEMPERATURA ____________________________________________________________________________________________________________ 153 
4- TENSÃO DA PAREDE _______________________________________________________________________________________________________ 153 
5- SOLUÇÕES DE CONTINUIDADE DA PAREDE _________________________________________________________________________________ 154 
6- ABAULAMENTO DA PAREDE _______________________________________________________________________________________________ 154 
7- REFLEXOS CUTÂNEOS ABDOMINAIS ________________________________________________________________________________________ 154 
٭ PALPAÇÃO PROFUNDA ________________________________________________________________________________________________________ 154 
1- SENSIBILIDADE ___________________________________________________________________________________________________________ 154 
2- MASSA ____________________________________________________________________________________________________________________ 154 
3- TUMORAÇÃO ______________________________________________________________________________________________________________ 155 
4- FRÊMITOS _________________________________________________________________________________________________________________ 155 
5- SINAIS DE IRRITAÇÃO PERITONIAL _________________________________________________________________________________________ 155 
6- EXAME DOS ÓRGÃOS ______________________________________________________________________________________________________ 156 
● FÍGADO ___________________________________________________________________________________________________________________156 
● VESÍCULA E VIAS BILIARES _________________________________________________________________________________________________ 157 
● BAÇO _____________________________________________________________________________________________________________________ 158 
● CÓLON E APÊNDICE ________________________________________________________________________________________________________ 158 
C) PERCUSSÃO DO ABDOME _____________________________________________________________________________________________________ 159 
● MACICEZ MÓVEL DE DECÚBITO ____________________________________________________________________________________________ 160 
● PALPAÇÃO/PERCUSSÃO: SINAL DE PIPAROTE ________________________________________________________________________________ 161 
D) AUSCULTA DO ABDOME ______________________________________________________________________________________________________ 161 
1- RUÍDOS HIDROAÉREOS ____________________________________________________________________________________________________ 161 
2- SOPROS ___________________________________________________________________________________________________________________ 161 
3- ATRITO PERITONIAL _______________________________________________________________________________________________________ 161 
4- BATIMENTOS CARDIO-FETAIS ______________________________________________________________________________________________ 161 
HIPERTENSÃO PORTAL ____________________________________________________________________________________________________________ 162 
1) CONCEITO ____________________________________________________________________________________________________________________ 162 
2) CLASSIFICAÇÃO DA HIPERTENSÃO PORTAL ____________________________________________________________________________________ 162 
A) SUPRA HEPÁTICA ____________________________________________________________________________________________________________ 162 
● ETIOLOGIAS _______________________________________________________________________________________________________________ 162 
– CARACTERÍSTICAS DA H.P. SUPRA-HEPÁTICA ________________________________________________________________________________ 162 
B) INTRA-HEPÁTICA _____________________________________________________________________________________________________________ 163 
● ETIOLOGIAS _______________________________________________________________________________________________________________ 163 
C) SUB-HEPÁTICAS ______________________________________________________________________________________________________________ 163 
● ETIOLOGIAS _______________________________________________________________________________________________________________ 163 
3) SINAIS E SINTOMAS DA HIPERTENSÃO PORTAL _________________________________________________________________________________ 164 
A) HEMATÊMESE, MELENA E ENTERORRAGIA _________________________________________________________________________________ 164 
B) ASCITE ___________________________________________________________________________________________________________________ 164 
C) CIRCULAÇÃO COLATERAL COM OU SEM CAPUT MEDUSAE ___________________________________________________________________ 164 
D) HEPATOMEGALIA _________________________________________________________________________________________________________ 164 
E) ESPLENOMEGALIA CONGESTIVA ___________________________________________________________________________________________ 164 
F) HIPERESPLENISMO ________________________________________________________________________________________________________ 164 
G) EDEMA ___________________________________________________________________________________________________________________ 165 
H) HEMORRÓIDEA ___________________________________________________________________________________________________________ 165 
4) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 165 
ASCITE ____________________________________________________________________________________________________________________________ 166 
1) CONCEITO ____________________________________________________________________________________________________________________ 166 
2) FATORES FISIOPATOLÓGICOS _________________________________________________________________________________________________ 166 
3) ETIOPATOGENIA ______________________________________________________________________________________________________________ 166 
4)EXAME FÍSICO DO PACIENTE ___________________________________________________________________________________________________ 166 
A) INSPEÇÃO ________________________________________________________________________________________________________________ 166 
B) PALPAÇÃO ________________________________________________________________________________________________________________ 167 
C) PERCUSSÃO _______________________________________________________________________________________________________________ 167 
D) AUSCULTA _______________________________________________________________________________________________________________ 167 
5) NATUREZA DO LÍQUIDO ASCÍTICO _____________________________________________________________________________________________ 167 
6- EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 167 
INSUFICIÊNCIA HEPÁTICA ________________________________________________________________________________________________________ 169 
 
9 
1) CONCEITO ____________________________________________________________________________________________________________________ 169 
2) ETIOLOGIA: __________________________________________________________________________________________________________________ 169 
3) SINAIS E SINTOMAS ___________________________________________________________________________________________________________ 169 
4) PROGNÓSTICO ________________________________________________________________________________________________________________ 170 
5) COMPLICAÇÕES ______________________________________________________________________________________________________________ 171 
– ENCEFALOPATIA PORTO-SISTÊMICA ________________________________________________________________________________________ 171 
6) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 172 
ICTERÍCIA ________________________________________________________________________________________________________________________ 173 
1) CONCEITO ____________________________________________________________________________________________________________________ 173 
2) TIPOS DE BILIRRUBINA________________________________________________________________________________________________________ 173 
3) GRUPO DAS ICTERÍCIAS _______________________________________________________________________________________________________ 173 
4) CARACTERÍSTICAS PROPEDÊUTICAS ___________________________________________________________________________________________ 173 
A) INÍCIO ____________________________________________________________________________________________________________________ 173 
B) COR DA URINA ____________________________________________________________________________________________________________ 173 
C) COR DAS FEZES ___________________________________________________________________________________________________________ 174 
D) INTENSIDADE DE COLORAÇÃO_____________________________________________________________________________________________ 174 
E) DISPEPSIA BILIAR (PRECEDE A CÓLICA HEPÁTICA) __________________________________________________________________________ 174 
F) PRURIDO __________________________________________________________________________________________________________________174 
G) VÍRUS ____________________________________________________________________________________________________________________ 174 
H) PERDA DE PESO ___________________________________________________________________________________________________________ 174 
I) REGRA DE COURVOISIER-TERRIER __________________________________________________________________________________________ 174 
5) CLASSIFICAÇÃO ______________________________________________________________________________________________________________ 175 
I) HIPERBILIRRUBINEMIA NÃO CONJUGADA: IC. HEMOLÍTICA __________________________________________________________________ 175 
II) HIPERBILIRRUBINEMIA CONJUGADA (IC. COLESTÁTICA) ____________________________________________________________________ 175 
6) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 175 
DIARRÉIAS ________________________________________________________________________________________________________________________ 176 
1) CONCEITO ____________________________________________________________________________________________________________________ 176 
2) MECANISMOS FISIOPATOLÓGICOS _____________________________________________________________________________________________ 176 
3) CARACTERÍSTICAS DA DIARRÉIA ______________________________________________________________________________________________ 177 
A) QUANTO À LOCALIZAÇÃO DA DOR _________________________________________________________________________________________ 177 
B) QUANTO AO NÚMERO DE EVACUAÇÕES ____________________________________________________________________________________ 177 
C) QUANTO À CONSISTÊNCIA _________________________________________________________________________________________________ 177 
D) QUANTO AOS COMPONENTES ______________________________________________________________________________________________ 177 
E) QUANTO AO VOLUME _____________________________________________________________________________________________________ 177 
F) QUANTO À URGÊNCIA _____________________________________________________________________________________________________ 177 
4) PRINCIPAIS CAUSAS DE DIARRÉIA _____________________________________________________________________________________________ 178 
5) CLÍNICA ______________________________________________________________________________________________________________________ 178 
6) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 178 
SÍNDROME DE MÁ ABSORÇÃO _____________________________________________________________________________________________________ 180 
1) CONCEITO ____________________________________________________________________________________________________________________ 180 
2) ETIOPATOGENIA ______________________________________________________________________________________________________________ 180 
A) PRÉ-ENTÉRICA OU EXTRA-INTESTINAL _____________________________________________________________________________________ 180 
B) ENTÉRICAS _______________________________________________________________________________________________________________ 180 
C) PÓS-ENTÉRICA ____________________________________________________________________________________________________________ 181 
3) CLINICA ______________________________________________________________________________________________________________________ 181 
4) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 181 
HEMORRAGIA DIGESTIVA _________________________________________________________________________________________________________ 182 
1) CONCEITO ____________________________________________________________________________________________________________________ 182 
2) CLASSIFICAÇÃO DAS H.P. _____________________________________________________________________________________________________ 182 
– CONSIDERAÇÕES PARA AS PERDAS SANGÜÍNEAS MÍNIMAS ___________________________________________________________________ 182 
3) VOLUME DE SANGUE PERDIDO E MANIFESTAÇÕES CLÍNICAS ___________________________________________________________________ 183 
4) CLASSIFICAÇÃO EM GRAUS ___________________________________________________________________________________________________ 183 
5) ETIOPATOGENIA ______________________________________________________________________________________________________________ 183 
– HEMORRAGIA DIGESTIVA ALTA_____________________________________________________________________________________________ 183 
– HEMORRAGIA DIGESTIVA BAIXA____________________________________________________________________________________________ 184 
6) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 185 
ABDOME AGUDO __________________________________________________________________________________________________________________ 186 
1) CONCEITO ____________________________________________________________________________________________________________________ 186 
2) CLÍNICA (SINAIS E SINTOMAS) _________________________________________________________________________________________________ 186 
A) DOR ______________________________________________________________________________________________________________________ 186 
B) DEFESA ABDOMINAL ______________________________________________________________________________________________________ 186 
C) DISTENSÃO ABDOMINAL __________________________________________________________________________________________________ 186 
D) SINAL DE BLUMBERG _____________________________________________________________________________________________________ 186 
E) SINAL DE JOBERT _________________________________________________________________________________________________________ 187 
F) HIPERESTESIA CUTÂNEA. __________________________________________________________________________________________________ 187 
G) PARADA DO TRÂNSITO INTESTINAL ________________________________________________________________________________________ 187 
H) PARADA DOS RUÍDOS HIDROAÉREOS _______________________________________________________________________________________ 187 
I)SINAIS GERAIS _____________________________________________________________________________________________________________ 187 
3) ETIOPATOGENIA ______________________________________________________________________________________________________________ 187 
4) EXAMES COMPLEMENTARES __________________________________________________________________________________________________ 187 
SEMIOLOGIA DO SISTEMA URINÁRIO ______________________________________________________ 188 
1. INTRODUÇÃO _________________________________________________________________________________________________________________ 188 
2. SINAIS E SINTOMAS ___________________________________________________________________________________________________________ 188 
A) DOR ______________________________________________________________________________________________________________________ 188 
B) EDEMA ___________________________________________________________________________________________________________________ 189 
C) AUMENTO DA TEMPERATURA � FEBRE ____________________________________________________________________________________ 189 
D) ALTERAÇÕES DA URINA ___________________________________________________________________________________________________ 189 
● ALTERAÇÕES DO VOLUME ______________________________________________________________________________________________ 189 
● ALTERAÇÕES DA COR ___________________________________________________________________________________________________ 190 
● DISTÚRBIOS DA MICÇÃO ________________________________________________________________________________________________