Patients on the waiting list for liver transplantation: caregiver burden and stress.

Over the last few decades, informal caregivers of patients with chronic diseases have received more attention, and there is a growing volume of studies demonstrating high rates of burden, stress, and mental disorders in this group of individuals. The objective of this study was to evaluate the burden, stress, and psychosocial characteristics of informal caregivers of liver transplantation candidates. Participants were assessed by individual evaluations with the following instruments: a semistructured interview, the Caregiver Burden Scale, the Inventário de Sintomas de Stress para Adultos de Lipp, and the Beck Depression Inventory. The Mann-Whitney test was used for statistical analysis with a significance level of 0.05. The characteristics of the study group (n = 61) were similar to those of groups in other studies with respect to gender (82% were women), kinship (64% were spouses), and age (the mean age was 47.6 years). The main stressors identified by the participants were as follows: doubts about ways to react in a crisis or in emergency situations (42.6%), mood swings of the patient (29.5%), and care involving food and medications (27.9%). Approximately 25% of the caregivers reported that they felt unprepared to adequately perform their roles. Data analysis indicated a greater burden overall on caregivers when the patient's Model for End-Stage Liver Disease score was greater than or equal to 15 points (P = 0.041). Furthermore, caregivers of patients with alcoholic liver disease showed higher depression (P = 0.034) and overall burden scores (P = 0.031) versus caregivers of patients with liver disease due to other etiologies. In conclusion, the participants showed significantly high levels of burden, stress, and depression. Support measures and caregiver preparation should be implemented by health care providers.

Pseudo-aneurisma de artéria hepática comum direita em mulher jovem com Lupus Eritematoso Sistêmico / Pseudoaneurysm of the right common hepatic artery in a young woman with SystemicLupus Erythematosus

Aneurismas de artéria hepática comum são lesões vasculares raras e representam a segunda incidência deaneurismas de artérias viscerais. As principais etiologias são: aterosclerose (32%) e trauma (22%). Outrascausas menos comuns são vasculites, procedimentos diagnósticos e terapêuticos percutâneos e complicação anastomótica de transplante de fígado. O diagnóstico de aneurisma intra-hepático é difícil antes de suaruptura, o qual está associado a uma mortalidade superior a 20% dos casos. Este artigo relata a história de uma paciente do sexo feminino, de 26 anos, portadora de Lupus Eritematoso Sistêmico (LES) que apresentavahá 2 meses dor tipo cólica na parte superior do abdome com irradiação para dorso. O diagnóstico de pseudo-aneurisma de artéria hepática comum foi feito após investigação da dor abdominal com métodos de imagem.Para aneurisma intra-hepático, o tratamento de escolha é a embolização, e este procedimento tem aumentado a sobrevida desses pacientes. Em alguns casos de aneurismas proximais, torna-se necessária a ressecção do fígado ou mesmo de transplante hepático.

Hepatic artery aneurysms are rare vascular lesions and represent a second incidence of aneurysms ofvisceral arteries. The main etiologies are atherosclerosis (32%) and trauma (22%). Other less common causesinclude vasculitis, diagnostic procedures, percutaneous therapies and as an anastomotic complication ofliver transplantation. Diagnosis of an intra-hepatic aneurysm before its rupture is difficult; ruptures areassociated to mortality in more that 20% of the cases. This work reports the case of a 26-year-old femalepatient with systemic lupus erythematosus who presented with a colic-type pain in the upper abdomen withirradiation to the back for two months. The diagnosis of hepatic artery pseudoaneurysm was made after animaging investigation of the abdominal pain. The first-line treatment for intra-hepatic aneurysms is embolization,which improves the patients’ survival rate. In some cases of proximal aneurysms, resection of the liver oreven liver transplantation is required.