Colangitis esclerosante primaria y enfermedad de Crohn / Primary sclerosing cholangitis associate whith Crohn disease

La colangitis esclerosante primaria es una enfermedad crónica del hígado de etiología desconocida caracterizada por inflamación y fibrosis del árbol biliar. Provoca una cirrosis biliar e incrementa el riesgo de colangiocarcinoma. Afecta más a hombres en la cuarta década de vida. Debuta con escasos síntomas ó con un cuadro sintomático florido. La forma primaria se asocia a enfermedades inflamatorias intestinales, en el 90 por ciento a la colitis ulcerosa y rara vez a enfermedad de Crohn. Se presenta paciente femenina de 53 años, raza negra y antecedente de salud, que comenzó con coloración amarilla-verdosa de piel y mucosas, orinas oscuras, prurito intenso y cambios del hábito intestinal. Al examinarla se constató íctero y hepatomegalia. Se realizó diagnóstico enzimático, imagenológico, endoscópico e histopatológico de una colangitis esclerosante primaria asociada a una enfermedad de Crohn. El tratamiento medicamentoso con ácido ursodexicólico reportó beneficios, sin embargo, la paciente muere por complicaciones antes del trasplante hepático

Primary sclerosing cholangitis is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The disease progresses to cirrhosis and liver failure and cholangiocarcinoma develops in many of patients. The mean age at diagnosis is around 40 years and men are affected more often. The disease started is usually insidious and many patients are asymptomatic at diagnosis or have many symptoms. It is often associated with inflammatory bowel disease, especially ulcerative colitis. A case of black female 53 years old patient, who began to present fatigue, abdominal discomfort, pruritus, weight loss, jaundice and choluria. She develops hepatomegaly. The diagnosis of primary sclerosing cholangitis was made by lab tests, immunological tests, retrograde endoscopic cholangiopancreatography and liver biopsy. Liver transplantation remains the only effective therapeutic option for these kinds of patients with end-stage liver disease, although high dose ursodeoxycholic acid may have a beneficial effect

Cólico renoureteral producido por gusano redondo (Ascaris lumbricoides) / Renoureteral colic produced by round worm (Ascaris lumbricoides)

Se presentó un caso de un paciente del sexo masculino de 57 años de edad que acudió al cuerpo de guardia de nuestro centro por presentar dolor intenso en región lumbar derecha con irradiación a flanco y genitales externos, acompañado de náuseas, vómitos y escalofríos, por lo que necesitó analgésico. Se estudió y se le orientó tratamiento médico. En su evolución a los 4 días expulsó parásito por uretra que fue llevado al laboratorio de parasitología. Se diagnostica Ascaris lumbricoides, y se le orienta tratamiento médico específico y estudios de laboratorio. Se hizo interconsulta con servicio de gastroenterología y el paciente ha evolucionado satisfactoriamente.

The case of a male patient aged 57 that received attention at the emergency department of our center for presenting acute pain on the right lumbar region that went to the flank and genitalia, accompanied with nausea, vomits and shills, that made necessary the administration of analgesics, was presented. The patient was studied and medical treatment was applied. At the four days of evolution the patient expelled a parasite through the urethra that was taken to the parasitology laboratory. Ascaris lumbricoides was diagnosed and specific medical treatment and lab studies were indicated. Interconsultation with the gastroenterology service was made and the patient has evolved satisfactorily.