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Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

Open Journal of Gastroenterology 2021年第6期11卷 81-88页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho esteban fortuny pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil Industrial University of Santander (UIS) Bucaramanga Colombia University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Uniredentor University Rio de Janeiro Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC) S&#227o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Rigshospital Copenhagen East K&#248benhavn Denmark Centro Universitário do Rio Grande do Norte Natal Brazil

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

关键词： Ascites Hypernatremia Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy

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Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report

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Advances in Lung Cancer 2021年第3期10卷 40-47页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Célia Regina Martins Korzenieski Julia Braga da Silveira Carolina Boeira Soares Carina Marangoni Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho esteban fortuny pacheco Felice Picariello Joice Nedel Ott Isabel Cristina Reinheimer Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Danielle de Mello Florentino Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&#227 o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Federal University of Ceará (UFC) Fortaleza Brazil Uniredentor University Rio de Janeiro Brazil Centro Universitário do Rio Grande do Norte Natal RN Brazil

Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.

关键词： Acute Kidney Injury Febrile Neutropenia Sepsis Chemotherapy

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Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

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Open Journal of Gastroenterology（肠胃病学期刊） 2021年第6期

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