| Journal: | Revista da Associacao Medica Brasileira |
| Database: | PERIÓDICA |
| System number: | 000308191 |
| ISSN: | 0104-4230 |
| Authors: | Parreira, Jose Gustavo Rego, Ronaldo Elias Carnut Campos, Tercio de Moreno, Cristina Hachul Pacheco-Junior, Adhemar Monteiro Rasslan, Samir |
| Year: | 2004 |
| Season: | Oct-Dic |
| Volumen: | 50 |
| Number: | 4 |
| Pages: | 391-395 |
| Country: | Brasil |
| Language: | Portugués |
| Document type: | Artículo |
| Approach: | Caso clínico, analítico |
| English abstract | BACKGROUND: To assess the role of alkaline phosphatase (AP), gamil-glutamyltransferase (gammaGT) and abdominal ultrasound (US) as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis. METHODS: Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 + 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC) or pre-operative endoscopic retrograde cholangiography (ERCP), which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients sustaining or not such alteration in cholangiography. Student t, Fisher and chi square tests were used for statistical analysis, considering p<0.05 as significant. Positive (PPV) and negative predictor values (NPV) were calculated for each variable. RESULTS: Upon admission, 15 (37%) patients sustained biliary tract dilatation and 5 (12%) choledocholithiasis at the US. Forty eight hours before the operation, 34 (85%) patients had altered levels of gGT and 16 (40%) of AP. Pre-operative US showed biliary tract dilatation in nine patients and choledocholithiasis in three. ERCP was performed in 15 (37%) cases. Higher PPV (55%) was attributed to pre-operative US, which had also a NPV of 96%. CONCLUSION: The best predictor of choledocholithiasis in patients sustaining mild acute pancreatitis was the biliary tract dilatation in pre-operative US |
| Portuguese abstract | OBJETIVO: Avaliar o papel da fosfatase alcalina (FA), gama glutamiltransferase (gamaGT) e ultra-sonografia (US) como fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar (PAB). MÉTODOS: Os dados foram coletados prospectivamente durante um período de 31 meses. Quarenta doentes foram incluídos, sendo 30 mulheres, com média etária de 49 + 16 anos. Foram registrados os dados de todos os doentes com pancreatite aguda biliar. Aqueles doentes ictéricos e com a forma grave da doença foram excluídos. As dosagens de FA e GGT, assim como a US, eram realizadas na admissão e 48 horas antes da cirurgia. Todos os pacientes foram submetidos à colangiografia intra-operatória (CIO) ou à colangiografia retrógrada endoscópica (CPRE) pré-operatória, que era definida baseada na probabilidade de coledocolitíase. Com o intuito de identificar os indicadores de coledocolitíase, as variáveis foram comparadas entre os pacientes com ou sem coledocolitíase. Os testes t de Student, Qui-quadrado e Fisher foram empregados para a análise estatística, considerando-se p<0,05 como significativo. Os valores preditivos positivo (VPP) e negativo (VPN) foram calculados para cada variável. RESULTADOS: Na US realizada à admissão, 15 doentes (37%) apresentavam dilatação de vias biliares e cinco (12%), coledocolitíase. Nos exames realizados 48 horas antes da colecistectomia, 34 doentes (85%) apresentavam valores elevados de gamaGT e 16 (40%) tinham FA acima do normal. Na segunda USG, nove doentes persistiam com dilatação das vias biliares e em três |
| Disciplines: | Medicina |
| Keyword: | Diagnóstico, Gastroenterología, Pancreatitis aguda, Coledocolitiasis, Colangiografía |
| Keyword: | Medicine, Diagnosis, Gastroenterology, Acute pancreatitis, Choledocholithiasis, Cholangiography |
| Full text: | Texto completo (Ver HTML) |
