{"id":32837,"date":"2025-01-06T14:14:13","date_gmt":"2025-01-06T17:14:13","guid":{"rendered":"https:\/\/www.grupomedcof.com.br\/blog\/?p=32837"},"modified":"2025-01-06T14:14:14","modified_gmt":"2025-01-06T17:14:14","slug":"sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva","status":"publish","type":"post","link":"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/","title":{"rendered":"S\u00edndrome hepatopulmonar: como manejar um paciente com hemorragia digestiva"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_74 counter-hierarchy ez-toc-counter ez-toc-transparent ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Sum\u00e1rio<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Hemorragia_Digestiva_Alta_Varicosa\" >Hemorragia Digestiva Alta Varicosa<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Epidemiologia\" >Epidemiologia\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Manejo_Inicial\" >Manejo Inicial<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Tratamento_de_Casos_Refratarios\" >Tratamento de Casos Refrat\u00e1rios<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Profilaxia\" >Profilaxia<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/#Seja_um_MedCoffer\" >Seja um MedCoffer<\/a><\/li><\/ul><\/nav><\/div>\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-1024x576.jpg\" alt=\"\" class=\"wp-image-32838\" srcset=\"https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-1024x576.jpg 1024w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-300x169.jpg 300w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-768x432.jpg 768w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-1536x864.jpg 1536w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-2048x1152.jpg 2048w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-747x420.jpg 747w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-150x84.jpg 150w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-696x392.jpg 696w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-1068x601.jpg 1068w, https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-1920x1080.jpg 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p>Durante a resid\u00eancia em gastroenterologia e cirurgia, por exemplo, um dos temas cr\u00edticos que podemos encontrar \u00e9 o manejo de condi\u00e7\u00f5es complexas como a <strong>hemorragia digestiva alta<\/strong> <strong>varicosa<\/strong> (HDA) e a <strong>s\u00edndrome hepatopulmonar.<\/strong> Por isso, o Grupo MedCof destacou pontos essenciais que futuros residentes devem conhecer para lidar com essas condi\u00e7\u00f5es de forma eficaz.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-hemorragia-digestiva-alta-varicosa\"><span class=\"ez-toc-section\" id=\"Hemorragia_Digestiva_Alta_Varicosa\"><\/span><strong>Hemorragia Digestiva Alta Varicosa<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>A HDA varicosa \u00e9 uma complica\u00e7\u00e3o grave da hipertens\u00e3o portal, frequentemente vista em pacientes com cirrose hep\u00e1tica. O reconhecimento precoce e o manejo adequado s\u00e3o cruciais para reduzir a mortalidade e melhorar os resultados cl\u00ednicos.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-epidemiologia\"><span class=\"ez-toc-section\" id=\"Epidemiologia\"><\/span><strong>Epidemiologia<\/strong>\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Varizes Esof\u00e1gicas e G\u00e1stricas: As varizes esof\u00e1gicas s\u00e3o mais comuns que as g\u00e1stricas, representando menos de 10 a 15% dos casos de varizes g\u00e1stricas isoladas. A mortalidade dessa condi\u00e7\u00e3o pode variar entre 15% a 25% em seis semanas, com uma taxa de recorr\u00eancia de 60% a 70% em 1 a 2 anos sem profilaxia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-manejo-inicial\"><span class=\"ez-toc-section\" id=\"Manejo_Inicial\"><\/span><strong>Manejo Inicial<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>O primeiro passo \u00e9 a estabiliza\u00e7\u00e3o cl\u00ednica, com prote\u00e7\u00e3o das vias a\u00e9reas e expans\u00e3o vol\u00eamica com cristaloides s\u00e3o fundamentais. Um fato importante a ser pontuado \u00e9 que a hemotransfus\u00e3o \u00e9 indicada se a hemoglobina estiver abaixo de 7 g\/dL.<\/p>\n\n\n\n<p>&nbsp;Depois disso, partimos para os casos espec\u00edficos, buscando ind\u00edcios de hepatopatia. Se identificada, seguimos com a terapia farmacol\u00f3gica, incluindo o uso de vasoconstrictores espl\u00e2ncnicos (terlipressina ou octreotida) e antibi\u00f3ticos profil\u00e1ticos (ceftriaxona ou norfloxacino) para prevenir peritonite bacteriana espont\u00e2nea (PBE).<\/p>\n\n\n\n<p>&nbsp;A terceira medida que pode ser implementada \u00e9 a Endoscopia Digestiva Alta (EDA): Procedimento essencial para ligadura ou esclerose de varizes esof\u00e1gicas e uso de cianoacrilato para varizes g\u00e1stricas.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/lh7-rt.googleusercontent.com\/docsz\/AD_4nXeKUO80ADsyuxuXhD_HeAG9tWI1tvMvmVHC6-xmBXlNe08hu4bP_xN3jd-xJrv1tSbV8zzjisW-3AtZVIsQRGQsFdWJOVjtp86otBh4aOcwi4_zbANdPX5vFxdVWmPP1oVKsSnILw?key=yG8X-3nV0FJYhKD6SNibnUvh\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/lh7-rt.googleusercontent.com\/docsz\/AD_4nXfAm7-wwtWeP3d4voyMIEbBG6wleSSh8H26KBZKjDOXHP4N51StixCqaqsZn0otY0GNE-8IH3NciCTPix27GZbyOGjFNIPY0kQOCzdCu5B7EP8N_H6-e0reKtDMAPtseOlDtyfw-g?key=yG8X-3nV0FJYhKD6SNibnUvh\" alt=\"\"\/><figcaption class=\"wp-element-caption\">Fonte: Acervo de Aulas do Grupo MedCof<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/lh7-rt.googleusercontent.com\/docsz\/AD_4nXeUBLzba5zJFLEWZUlIzuyXL8tTTQiqkYX6mpYf49iud3Adn7Ok75fmbw18OXVG9OiEZaBGb8OFJzg6hJ8ZrrQ_ee1Ixzohok-I2XqKRZ6ET37DsDF-BJFpSMSpvWVGn6H7xVxAhg?key=yG8X-3nV0FJYhKD6SNibnUvh\" alt=\"\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-tratamento-de-casos-refratarios\"><span class=\"ez-toc-section\" id=\"Tratamento_de_Casos_Refratarios\"><\/span><strong>Tratamento de Casos Refrat\u00e1rios<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>O Bal\u00e3o de Sengstaken-Blakemore pode ser usado como terapia ponte, mas deve ser utilizado por no m\u00e1ximo 24 horas devido ao risco de ulcera\u00e7\u00e3o. J\u00e1 as TIPS (Shunt Portossist\u00eamico Intra-hep\u00e1tico Transjugular) s\u00e3o \u00fateis para reduzir a press\u00e3o portal. A cirurgia de Deriva\u00e7\u00e3o Portossist\u00eamica \u00e9 menos comum e somente \u00e9 considerada em casos refrat\u00e1rios.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-profilaxia\"><span class=\"ez-toc-section\" id=\"Profilaxia\"><\/span><strong>Profilaxia<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>De forma prim\u00e1ria usamos betabloqueadores n\u00e3o seletivos como propranolol e nadolol em pacientes com hipertens\u00e3o portal clinicamente significativa. Ademais, de forma secund\u00e1ria podemos aplicar uma combina\u00e7\u00e3o de betabloqueadores e ligadura el\u00e1stica para pacientes que j\u00e1 tiveram HDA.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"seja-um-medcoffer\"><span class=\"ez-toc-section\" id=\"Seja_um_MedCoffer\"><\/span><strong>Seja um MedCoffer<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Para conquistar a aprova\u00e7\u00e3o nas provas de resid\u00eancia, seja um&nbsp;<strong>MedCoffer<\/strong>! Aqui te ajudaremos na busca da aprova\u00e7\u00e3o com conte\u00fados de qualidade e uma&nbsp;<a href=\"https:\/\/www.grupomedcof.com.br\/blog\/presenca-da-medcof-nas-aprovacoes-em-residencia-medica-no-brasil\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>metodologia que j\u00e1 aprovou mais de 10 mil residentes no pa\u00eds<\/strong><\/a>!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<div class=\"youtube-embed\" data-video_id=\"yvNHyyQMmOw\"><iframe loading=\"lazy\" title=\"Urg\u00eancias Endosc\u00f3picas: Como Lidar com Hemorragia Digestiva Alta Varicosa. Com Dr. Paulo Mega\" width=\"696\" height=\"392\" src=\"https:\/\/www.youtube.com\/embed\/yvNHyyQMmOw?feature=oembed&#038;enablejsapi=1\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\n<\/div><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Um dos temas cr\u00edticos que encontramos na resid\u00eancia \u00e9 o manejo de condi\u00e7\u00f5es como a hemorragia digestiva alta varicosa e a s\u00edndrome hepatopulmonar. <\/p>\n","protected":false},"author":21,"featured_media":32838,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[115],"tags":[2431,2432],"ppma_author":[3617],"class_list":{"0":"post-32837","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-clinica-medica","8":"tag-hemorragia-digestiva-alta-varicosa","9":"tag-sindrome-hepatopulmonar"},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>S\u00edndrome hepatopulmonar: como manejar um paciente com hemorragia digestiva - Blog de Medcof: conte\u00fados, editais, revalida e mais!<\/title>\n<meta name=\"description\" content=\"Um dos temas cr\u00edticos que encontramos na resid\u00eancia \u00e9 o manejo de condi\u00e7\u00f5es como a hemorragia digestiva alta varicosa e a s\u00edndrome hepatopulmonar.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"S\u00edndrome hepatopulmonar: como manejar um paciente com hemorragia digestiva\" \/>\n<meta property=\"og:description\" content=\"Um dos temas cr\u00edticos que encontramos na resid\u00eancia \u00e9 o manejo de condi\u00e7\u00f5es como a hemorragia digestiva alta varicosa e a s\u00edndrome hepatopulmonar.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.grupomedcof.com.br\/blog\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\/\" \/>\n<meta property=\"og:site_name\" content=\"Blog de Medcof: conte\u00fados, editais, revalida e mais!\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/MedCofQbank\/\" \/>\n<meta property=\"article:published_time\" content=\"2025-01-06T17:14:13+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-01-06T17:14:14+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.grupomedcof.com.br\/blog\/wp-content\/uploads\/2025\/01\/Blog-MedCof-47-scaled.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1440\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Kiara Adelino\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Kiara Adelino\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/\"},\"author\":{\"name\":\"Kiara Adelino\",\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/#\\\/schema\\\/person\\\/db19a651f86c5fc202d6eee744fd3292\"},\"headline\":\"S\u00edndrome hepatopulmonar: como manejar um paciente com hemorragia digestiva\",\"datePublished\":\"2025-01-06T17:14:13+00:00\",\"dateModified\":\"2025-01-06T17:14:14+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/\"},\"wordCount\":457,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/wp-content\\\/uploads\\\/2025\\\/01\\\/Blog-MedCof-47-scaled.jpg\",\"keywords\":[\"Hemorragia Digestiva Alta Varicosa\",\"S\u00edndrome Hepatopulmonar\"],\"articleSection\":[\"Cl\u00ednica M\u00e9dica\"],\"inLanguage\":\"pt-BR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/\",\"url\":\"https:\\\/\\\/www.grupomedcof.com.br\\\/blog\\\/sindrome-hepatopulmonar-como-manejar-um-paciente-com-hemorragia-digestiva\\\/\",\"name\":\"S\u00edndrome hepatopulmonar: como manejar um paciente com hemorragia digestiva - 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