Covid-19 and Its Gastrointestinal Implications

Introduction: Since the 2019 Coronavirus Disease (COVID-19) outbreak in December 2019, several digestive symptoms have been frequently reported in patients infected with the virus. In this study, we aimed to report the case of a patient with COVID-19 with digestive symptoms. Methods: The information was obtained through a review of the medical records, interview with the patient, photographic record of the diagnostic methods; laboratory tests; Computed tomography of the chest, including RT-PCR for the diagnosis of COVID-19, in addition

especially in elderly patients. Unusual radiographic findings were observed for computered tomography in hospital admission [6].
There is a literature consensus [7], explains that the most part of symptomatic individuals shows fever with the complication presence, like cough and dyspnea. Until the moment, we have few studies that describe extrapulmonary systems. However, with the advance cases, become possible and necessary that symptomatic approaches can be studied and described to the community, as Pan studies et al., (2020) that describes the most usual digestive symptom with COVID-19 individuals and [8] that checks diarrhea presence, anorexia and vomit, as initial symptoms infection. Before the exposed, this study aims investigate reports and the patients results with COVID-19 with digestive symptoms.

Methods
This study is a report case from a COVID-19 patient and gastrointestinal predominantly symptoms. The data were obtained through anamnesis collection contained in the medical report in addition to laboratory tests. Computed tomography of the chest, including RT-PCR to the diagnosis COVID-19.

Case Report
Patient, F.A.B.M., female, 59 years old, white, married, nurse, born in Rio de Janeiro, sought care due to the complaint of fever and diarrhea. Reports that she started abruptly with fever (38,0°C), chills and diarrhea of foul-smelling, explosive and with softened consistency. She reports that she used antipyretic during the febrile period and that it lasted for a maximum period of 24 hours after its appearance. It also states that in her work environment there were four cases of positive COVID-19. She denies previous comorbidities, mainly digestive diseases and regular use of medications.
On physical examination, vital signs (SPO2: 99%, RR: 17 breaths/ min HR: 88 bpm and blood pressure: 122x80 mmHg), regular heart rhythm in 2 times with normal heart sounds without murmur, universally audible vesicular murmur without adventitious noises,   show gastrointestinal symptoms, as diarrhea, nauseous and vomit the mainlines. It is important to note, that in critically ill patients, appear many dysfunction organs [11].
It was possible to observe in this study that gastrointestinal symptoms as diarrhea in the beginning was considered unusual in COVID-19, but there is an emerging evidence that is more usual we could think [12].

There aren't specifically studies about SARS-COV-2 has
gastrointestinal symptoms, it is important to remember this virus is similar SARS-COV, so it's possible to enter in human body through angiotensin converting enzyme (ACE-2) which allows the liver tissue lesion through positive regulation expression by ECA-2 in the hepatic organ imported by proliferation hepatocytes originated by cells from biliary duct [8].
Another fact that contributes to this guide, is the inflammatory response caused by SARS-COV can damage the digestive system.
Research's [14,15] shows nucleic viral acid presence in stool sample in 53,4% infected patients. According to observe the intestinal mucous membrane, is virus liable and can bring gastrointestinal symptoms, however, new studies can improve the scientific debate.
Furthermore, we know that intestinal flora is produced by the intestine in a surprising way and different while has been the most important ever. Combined to human body performance, contributing to the nutritional positively metabolism, to develop the maturity of the immunological system and antibacterial effects [16].
There are reports [2,17]  In [18] there are variations in hepatic function with COVID-19 patients. According to researchers found gastrointestinal symptoms cause more probability to show hepatic changed tests as AST and ALT when compared to gastric symptom patients. the results obtained with the report case, found here [19]. They also report that, symptomatic digestive delayed more than being submitted to exams or tests, extended coagulation and hepatic enzyme. This late is also checking in admission clinical and all these elements [20], difficulty new studies. Therefore, is necessary to analyze the prevalence, evidence, predictors and gastrointestinal symptoms results [21,22].

Conclusions
The case reported and publications selected bring to light the discussion of the digestive symptoms of COVID-19. The results of the report suggest that physicians should keep in mind that digestive symptoms, such as diarrhea mainly, may be one of the presentation resources of COVID-19; in some cases, they may arise before respiratory symptoms and on rare occasions, it is the only symptom of COVID-19. Physicians should increase their index of suspicion of patients who have digestive symptoms, even in the absence of respiratory symptoms. This knowledge can help with identification of COVID-19, shorter treatment time, earlier quarantine and less exposure to other people.