Hepatita viral acut tip A forma colestatic la o pacient vrstnic

Autorii: Piiga Eleonora Liza, Nan Delia, Poptelecan Patricia, Trinc Bogdan, Paliu Mirela,
Trnea Livius, Marincu Iosif.
Departamentul de Boli Infecioase, Pneumologie i Parazitologie, Universitatea de Medicin i
Farmacie Victor Babe, Timioara.
Obiective: Prezentarea unui caz clinic de hepatit viral acut A, form colestatic, la o pacient
vrstnic, fr alte comorbiditi.
Pacienti si metode: Autorii prezint cazul unei paciente de 69 de ani, care a fost internat n
Clinica de Boli Infecioase. La internare pacienta acuza de 5 zile astenie marcat, inapeten ,
hepatalgii, urini hipercrome, scaune acolice, prurit tegumentar la nivelul regiunii toracale
anterioare. Examenul obiectiv decela: stare general influenat, afebril, normoponderal, cu
icter sclero-tegumenar, limb sabural , pliu cutanat persistent, buze uscate, echilibrat din punct
de vedere cardio-pulmonar; abdomen meteorizat, sensibil la palparea profund n hipocondrul
drept, tranzit intestinal prezent cu scaune acolice; ficat palpabil la circa 4 cm sub rebordul costal
drept, consisten de organ, splina nepalpabil, urini hipercrome.
Rezultate: Leucocite: 5690/L (N:66,9%; Ly:20,2%; Mo:12,7%); Proteina C Reactiv:
8,82mg/L; TGP:2011 U/L; TGO: 1740 U/L; Bilirubin totala:13,3mg/dL; Bilirubin direct:
11,7mg/dL; Amilazemie=15,5U/L; Creatinin=0,25mg/dL; Ac.IgM HAV: pozitiv; Ag.HBS:
negativ; Ac.HCV: negativ. S-a instituit tratament complex cu Arginin-Sorbitol (500 ml/zi),
Aspatofort (2x1 f/zi), enzime digestive, protector gastric i regim alimentar hepatoprotector.
Evoluia clinic i biologic a fost lent, datorit formei colestatice a hepatitei asociat cu terenul
individual particular la o pacienta vrstnic. Menionm c pacienta nu a prezentat alte
comorbiditi.
Concluzii: Pacienii vrstnici pot dezvolta forme clinice colestatice ale hepatitei acute A cu
evoluie lent, asociat cu terenul individual corespunztor vrstei.

Acute viral hepatitis A, a cholestatic form in an elderly patient

Authors: Piiga Eleonora Liza, Nan Delia, Poptelecan Patricia, Trinc Bogdan, Paliu Mirela,
Trnea Livius, Marincu Iosif.
Department of Infectious Diseases, Pneumology and Parasitology, University of Medicine and
Pharmacy Victor Babe, Timioara.
Objectives: The presentation of a clinical case of an acute viral hepatitis A, a cholestatic form,
found in an elderly patient without any other comorbidities.
Patients and methods: The authors present the case of a 69-year-old woman, admitted in the
Infectious Diseases Hospital. During the admission, the pacient has accused significant fatigue 5
days prior to that day, loss of appetite, pain in the liver area, hyperchromic urine, acholic stools
and skin pruritus on the anterior thorax. The physical examination detected: severe general
condition, normal weight, skin pruritus, dehydrated tongue, persistent skin fold, dry lips,
sensitive abdomen at palpation in the right upper quadrant, regular acholic bowels; palpable liver
at about 4 cm below the costal margin presenting regular organ consistency and an unpalpable
spleen.
Results: WBC: 5690/mcl (N: 66.9%; Ly: 20.2%; Mo: 12.7%); C-Reactive Protein: 8,82mg/L;
TGP: 2011 U/L; TGO: 1740 U/L; Total bilirubin: 13,3mg/dL; Direct bilirubin: 11,7mg/dL;
Amylasemia = 15,5U/L; Creatinine = 0.25 mg/dL; IgM HAV Ab: positive; HBS Ab: negative;
HCV Ab: negative. The treatment consisted in Arginine-Sorbitol (500 ml/day), Aspatofort
(2x10ml/day), digestive enzymes, gastric protectors and hepatoprotective diet.
The clinical and biological evolution has been slow, due to the cholestatic nature of the hepatitis,
associated with the age related diseases of the pacient. The authors highlight that the patient did
not present other comorbidities.
Conclusions: Elderly patients may develop cholestatic forms of acute viral hepatitis Awith a
slow evolution, that can be associated with age related diseases.