Cristales biliares en Pancreatitis Aguda Idiopática (PAI) / Biliary crystals in idiopathic acute pancreatitis

Entre los casos de Pancreatitis Aguda Idiopática (PAI), una de las causas más frecuentes, es la presencia de microlitiasis, etiología que se observa más frecuentemente en países donde la colelitiasis es más común. Es conocido que la presencia de microlitiasis en la vesícula biliar puede ser difícil de demostrar con los métodos habituales de imágenes. Se ha descrito que el análisis microscópico de la bilis (estudio de cristales), después de la estimulación duodenal, con el objeto de observar microcristales de colesterol, contribuye a la confirmación del diagnóstico en estos casos, en un porcentaje de alrededor del 75 por ciento (dos terceras partes) de casos de PAI. En el presente artículo, se describe la metodología recomendable para el estudio de sedimento biliar (SB) y de cristales en la bilis.

Pólipos vesiculares: segundo taller de consenso de la Asociación Chilena de Hepatología / Gallbladder polyps: second consensus workshop of the chilean hepatology association

During workshop, hepatologists analyzed and gave recomendations about gallbladder polyps. They arrived to the following agreements: gallbladder polyps of less than 10 mm should be followed with ultrasonography at 3, 6 and 12 months if there is no enlargement. If there is enlargement, a cholecystectomy should be performed. Polyps larger than 10 mm should be subjected to cholecystectomy

Asociación de colesterolosis y litiasis de la vesícula biliar: implicancia patogénica y efecto sobre la historia natural de la colelitiasis / Association between cholesterolosis and lithiasis of gallbladder: pathogenic implication and effect over natural history of cholelithiasis

We studied 793 patients subjected to cholecystectomy to determine a) the relative frequency of cholesterolosis and cholelithiasis b) the effect of their association on the natural history of biliary disease, c) the characteristics of gallstones associated to cholesterolosis and d) factors potentially associated to their pathogenesis. The gallbladders of all patients were examined and in 289 subjects a preoperative clinical history was taken. We observed that cholesterolosis is associated to earlier clinical manifestations of biliary disease and cholecystectomy, to a greater frequency of single calculus and to a higher weight/height index. It is concluded that there are relationships between the pathogenesis of cholesterolosis and cholelithiasis and that their association favors the development of clinical manifestations

Síndrome de falla orgánica múltiple en el curso de la insuficiencia hepática fulminante / Multiple systems organ failures in fulminant hepatic failure

Background: in fulminant hepatic failure, different organs systems become involved and a multiple systems organic failure may ensue. Aim: to perform a retrospective analysis of patients with fulminant hepatic failure admitted to UC Hospital Intensive Care Unit. Patients and methods: the charts of 14 patients (8 male) were analyzed. Multiple systems organic failure was defined as the presence of 2 or more organic dysfunctions. The evolution and mortality of these patients was analyzed. Results: patients` ages ranged from 30 to 74 years. The etiology of hepatic failure was B hepatitis in 4, non A non B hepatitis in 5, acute fatty liver of pregnancy in 3 and use of halothane and HIN in 2. ICU stay ranged from 1 to 44 days and 2 patients survived (one with drug induced liver failure and 1 with acute fatty liver of pregnancy). Mean prothrombin time was 19 ñ 9.5 per cent , total bilirrubin as 24 ñ 8.9 mg/dl and 12 patients reached grade IV encephalopathy. Mean admission APACHE II score was 21.5 ñ 6. Twelve patients developed multiple systems organic failure, that appeared 1.5 days or was already present at ICU admission; it lasted a mean of 2.5 days and all these 12 patients died. Neurologic involvement occured in 13 patients, renal in 10, cardiovascular in 9, respiratory in 5 and hematological involvement in 1. Conclusions: multiple systems organic failure is frequent in fulminant hepatic failure and is associated with a high mortality