RESUMO
The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease.
Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade Mórbida/complicações , Adulto , Alanina Transaminase/sangue , Glicemia/metabolismo , Feminino , Fibrose/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Obesidade Mórbida/epidemiologia , Triglicerídeos/sangueRESUMO
Os autores apresentam uma revisão de 3102 colecistectomias realizadas no período de maio de 1993 à janeiro de 1996 no Serviço de Cirurgia Geral do Complexo Hospitalar da Santa Casa de Porto Alegre, onde encontraram 37 casos (0,012 porcento) de carcinoma de vesícula biliar, sendo que o achado ocasional desta patologia foi de 40,5 porcento neste grupo de pacientes. Concluem reafirmando a dificuldade diagnóstica do carcinoma de vesícula biliar no pré-operatório e alertaram para que seja feito um exame minucioso no transoperatório com a confirmação do diagnóstico firmado pelo laudo anatomopatológico.