ABSTRACT
Los síndromes de malabsorsión son una de las principales causas de diarrea crónica de tipo entérico y con compromiso del estado general. Los tres principales síndromes de malabsorción son la enfermedad celíaca; la insuficiencia pancreática exocrina y los síndromes de asa ciega con proliferación de la flora intestinal y colonización del intestino delgado. La sospecha diagnóstica inicial de malabsorción es clínica y luego se comprueba mediante la demostración de esteatorrea y con el test de absorsión de D-xylosa. El diagnóstico se confirma finalmente mediante el estudio histológico de la biopsia de intestino delgado, que revela la existencia de atrofia vellositaria y microvellositaria. Ultimamente han adquirido importancia los exámenes inmunológicos (anticuerpos antiendomisio), los que son altamente sensibles y específicos. El tratamiento es propio de cada variedad fisiopatológica de malabsorción y consiste en: - Régimen sin gluten (enfermedad celíaca)- Antibióticos (síndrome de asa ciega)- Pancreatina o extractos pancreáticos (insuficiencia pancreática exocrina).
Subject(s)
Humans , Celiac Disease/diagnosis , Steatorrhea/diagnosis , Malabsorption Syndromes/diagnosis , Exocrine Pancreatic Insufficiency/physiopathology , Blind Loop Syndrome/diagnosisABSTRACT
A pancreatite crônica (PC) é um processo inflamatório crônico do pâncreas, no qual há destruição irreversível do tecido pancreático endócrino e exócrino. A principal forma é a PC calcificante, causada na imensa maioria dos pacientes pelo alcoolismo. A terapêutica visa então abstinência alcoólica, controle da dor abdominal e das insuficiências endócrina (diabetes) e exócrina (esteatorréia). O médico deve estar atento também para possíveis complicações, a exemplo do pseudocisto pancreático.
Subject(s)
Male , Female , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/physiopathology , Pancreatitis, Chronic/therapy , Pancreatic Cyst/therapy , Exocrine Pancreatic Insufficiency/physiopathology , Pancreatic Pseudocyst/complications , Pancreatic Pseudocyst/therapy , Alcohol-Induced Disorders/complicationsABSTRACT
Background: One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. Aim: To study pancreatic exocrine function in diabetics patients. Material and methods: Seventy two diabetic patients were included in the protocol, but two were withdrawn because an abdominal CAT scan showed a chronic calcified pancreatitis, previously undiagnosed. Fecal elastase was measured by ELISA and the presence of fat in feces was assessed using the steatocrit. Results: Mean age was 60±12 years and 67 (96%) patients had a type 2 diabetes. Fecal elastase was normal (elastase >200 µg/g) in 47 (67%) patients, mildly decreased (100-200 µg/g) in 10 (14%) and severely decreased in 13 (19%). There was a significant association between elastase levels and time of evolution of diabetes (p=0.049) and between lower elastase levels and the presence of a positive steatocrit (p=0.042). No significant association was found between elastase levels and other chronic complications of diabetes such as retinopathy, nephropathy, neuropathy, microangiopathy or with insulin requirement. Conclusions: One third of this group of diabetic patients had decreased levels of fecal elastase, that was associated with the time of evolution of diabetes. Patients with lower levels of elastase have significantly more steatorrhea. Among diabetics it is possible to find a group of patients with non diagnosed chronic pancreatitis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 1/enzymology , /enzymology , Exocrine Pancreatic Insufficiency/enzymology , Feces/enzymology , Pancreatic Elastase/analysis , Biomarkers/analysis , Body Mass Index , Case-Control Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/physiopathology , /complications , /physiopathology , Enzyme-Linked Immunosorbent Assay , Exocrine Pancreatic Insufficiency/physiopathology , Pancreatic Function Tests , Pancreatitis, Chronic/enzymology , Pancreatitis, Chronic/physiopathology , Time FactorsABSTRACT
Antecedentes: El síndrome de Shwachman es considerado como la segunda causa de insuficiencia pancreática en niños, se acompaña de disfunción de la médula ósea así como de alteraciones esqueléticas. Objetivo: Conocer e identificar las manifestaciones clínicas, de laboratorio y gabinete en los pacientes con síndrome de Shwachman. Material y métodos: Se estudió a paciente femenino de un año cuatro meses realizándole historia clínica tomándose para el estudio peso y talla, percentilas y examen físico. Exámenes de laboratorio: biometría hemática, hemoglobina fetal, ferrocinética, de terminación de vitamina B12 y folatos, aspirado de médula ósea, pruebas de absorción intestinal, coproparasitoscópicos y coprocultivos, coproantígeno para Giardia, transaminasas séricas, perfíl viral para hepatitis, electrólitos en sudor. Gabinete: Radiografía de huesos largos, cadera, ultrasonido abdominal y tomografía axial computarizada pancreática. Biopsia hepática e intestinal. Resultados: En la paciente se corroboró la presencia de insuficiencia pancreática, alteración de la médula ósea, alteraciones óseas compatibles con el síndrome de Shwachman.
Subject(s)
Humans , Female , Infant , Child, Preschool , Cartilage/physiopathology , Clinical Laboratory Techniques , Hepatomegaly , Hyperostosis, Diffuse Idiopathic Skeletal/physiopathology , Exocrine Pancreatic Insufficiency/diagnosis , Exocrine Pancreatic Insufficiency/physiopathology , Bone Marrow/physiopathology , Neutropenia , Signs and SymptomsSubject(s)
Humans , Male , Female , Child, Preschool , Cystic Fibrosis/diagnosis , Exocrine Glands/abnormalities , Sodium/deficiency , Bronchial Diseases/physiopathology , Bronchial Diseases/drug therapy , Chlorine/deficiency , Cystic Fibrosis/diet therapy , Cystic Fibrosis/physiopathology , Cystic Fibrosis/drug therapy , Exocrine Pancreatic Insufficiency/diet therapy , Exocrine Pancreatic Insufficiency/physiopathologyABSTRACT
Fazem-se uma abordagem sucinta sobre a fisiologia pancreática, analisam-se as causas de insuficiência pancreática e traçam um esquema terapêutico para as diversas circunstâncias que esta insuficiência ocorre, quer por lesäo do próprio pâncreas, quer por fatores extrapancreáticos que interferem na ótima açäo das enzimas da glândula
Subject(s)
Exocrine Pancreatic Insufficiency/physiopathology , Exocrine Pancreatic Insufficiency/therapyABSTRACT
Expöem-se os mecanismos fisiológicos pelos quais o pâncreas regula a digestäo. Analisam-se as principais causas de insuficiência pancreática exócrina e a sua fisiopatologia, e propöem-se as medidas terapêuticas de base, dos sintomas e das complicaçöes, e da insuficiência pancreática exócrina e endócrina