MEDICINA INTERNA DE LA HEPATITIS CRÓNICA EN CANINOS
Fecha
2009-03-13
Autores
Loría Cervantes, César Ándres
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad Nacional, Costa Rica
Resumen
La presente práctica dirigida se realizó en las instalaciones del Hospital de Especies
Menores y Silvestres de la Escuela de Medicina Veterinaria de la Universidad Nacional
(HEMS) ubicado en Lagunilla de Heredia, Costa Rica, durante un periodo de 25 semanas entre
el 14 de mayo al 31 de octubre del año 2007 y consistió en la evaluación de todos los pacientes
ingresados con sintomatología de enfermedad hepática. En total se atendió 36 pacientes con
anormalidades hepáticas.
Las enfermedades hepáticas son comunes en caninos, sin embargo, este órgano posee
una mucha capacidad de regeneración y una gran reserva estructural y funcional. La enfermedad
crónica hepática está caracterizada por una destrucción gradual del tejido hepático conforme
avanza el tiempo, muchos pacientes no muestran signos clínicos hasta que la disfunción es
moderada o severa. A esto se le suma sintomatologías inespecíficas como lo son anorexia,
depresión, vomito, diarrea, pérdida de peso, poliuria, etc.
Las pruebas de laboratorio no permiten conocer en su totalidad el estado funcional del
hígado y la falta de especificidad de muchos exámenes hacen difícil su interpretación. Es así
como los diagnósticos de alteraciones hepatobiliares realmente representan un verdadero reto.
Por ejemplo, el tipo específico de hepatitis crónica solo puede ser determinado mediante la
realización de una biopsia hepática. Los análisis de laboratorio proveerán evidencia de daño
persistente y disfunción, identificando entonces la necesidad de realizar una biopsia hepática.
Dicha biopsia se requiere para llegar a un diagnóstico definitivo de hepatitis crónica, y así
caracterizar la fibrosis, determinar si hay progresión a cirrosis (la cirrosis por definición es
irreversible y posee un mal pronóstico) y cuantificar los niveles de cobre en el hígado.
De los 36 casos de pacientes con anormalidades hepáticas analizados en este trabajo,
aunque la mayoría de los exámenes de laboratorio (química sanguínea, urianálisis, etc.) y de
exámenes de imagen (ultrasonido y rayos x) indicaban la necesidad de realizar biopsia hepática
a estos pacientes, solamente a 3 de ellos se les realizó dicha biopsia. Otros 3 diagnósticos se
realizaron post-mortem (necropsia). Esto se debe principalmente a razones económicas y a la
negativa de los propietarios de los pacientes a realizar este examen histopatológico, por lo tanto,
solamente se reportan 6 diagnósticos definitivos; de los cuales 3 casos presentaron enfermedad
hepática crónica. Debido a esto, se le dio mucha relevancia al resto de exámenes colaterales y no
tanto a los resultados histopatológicos.
The following supervised practice was conducted at the facilities of the Hospital of Minor Species of the National University Veterinary Medicine School located at Lagunilla of Heredia, Costa Rica for a period of 25 weeks between May 14th and October 31st of 2007, which consisted in an evaluation of all the patients that were admitted showing symptoms of liver disease. As a total, 36 patients were checked showing hepatic abnormalities. Liver diseases are common in canines; however, this organ has not only a great capacity for regeneration but also a tremendous structural and functional reserve. Chronic liver disease is marked by the gradual destruction of liver tissue over time, which means that many patients show no clinical signs until such dysfunction is in its intermediate or final stages. Additionally, some symptomatic conditions—such as anorexia, depression, vomiting, diarrhea, weight loss, polyuria, and so on—contribute to this scenario. Laboratory tests do not fully disclose the functional status of the liver and the lack of specificity in other tests makes it difficult to interpret them. Thus, diagnosing liver abnormalities actually represent a real challenge. For instance, the specific type of chronic hepatitis can only be determined by a liver biopsy. Laboratory tests will provide evidence of persistent damage and dysfunction, identifying then the need for a liver biopsy. Such a biopsy is required to reach a conclusive diagnosis of chronic hepatitis, characterize the extent of fibrosis and determine if there is progression to cirrhosis (by definition, it is an irreversible illness having a poor long-term prognosis), and quantify hepatic copper levels. Of the 36 cases of patients with liver abnormalities analyzed in this research—despite that the majority of the laboratory tests (blood chemistry, urianalysis, etc.) and image examinations (ultrasound and x-rays) indicated the need for a liver biopsy in all of those patients—only in three of them a biopsy was carried out. Another 3 diagnoses were done post- mortem (autopsy). This was mainly due to economic reasons and the refusal of the patients’ owners to authorize the performance of this histopathological review. As a result, only six reported diagnoses were finalized, of which 3 cases showed chronic liver disease. Consequently, great importance was given to the rest of the collateral reviews and not so much to the histopathological results.
The following supervised practice was conducted at the facilities of the Hospital of Minor Species of the National University Veterinary Medicine School located at Lagunilla of Heredia, Costa Rica for a period of 25 weeks between May 14th and October 31st of 2007, which consisted in an evaluation of all the patients that were admitted showing symptoms of liver disease. As a total, 36 patients were checked showing hepatic abnormalities. Liver diseases are common in canines; however, this organ has not only a great capacity for regeneration but also a tremendous structural and functional reserve. Chronic liver disease is marked by the gradual destruction of liver tissue over time, which means that many patients show no clinical signs until such dysfunction is in its intermediate or final stages. Additionally, some symptomatic conditions—such as anorexia, depression, vomiting, diarrhea, weight loss, polyuria, and so on—contribute to this scenario. Laboratory tests do not fully disclose the functional status of the liver and the lack of specificity in other tests makes it difficult to interpret them. Thus, diagnosing liver abnormalities actually represent a real challenge. For instance, the specific type of chronic hepatitis can only be determined by a liver biopsy. Laboratory tests will provide evidence of persistent damage and dysfunction, identifying then the need for a liver biopsy. Such a biopsy is required to reach a conclusive diagnosis of chronic hepatitis, characterize the extent of fibrosis and determine if there is progression to cirrhosis (by definition, it is an irreversible illness having a poor long-term prognosis), and quantify hepatic copper levels. Of the 36 cases of patients with liver abnormalities analyzed in this research—despite that the majority of the laboratory tests (blood chemistry, urianalysis, etc.) and image examinations (ultrasound and x-rays) indicated the need for a liver biopsy in all of those patients—only in three of them a biopsy was carried out. Another 3 diagnoses were done post- mortem (autopsy). This was mainly due to economic reasons and the refusal of the patients’ owners to authorize the performance of this histopathological review. As a result, only six reported diagnoses were finalized, of which 3 cases showed chronic liver disease. Consequently, great importance was given to the rest of the collateral reviews and not so much to the histopathological results.
Descripción
Modalidad: Práctica dirigida
Palabras clave
HOSPITAL VETERINARIO DE LA UNIVERSIDAD NACIONAL (COSTA RICA), PERRO, MEDICINA INTERNA (VETERINARIA), HIGADO