ABSTRACT
La hemorragia digestiva (HD) supone un problema diagnóstico tanto en su forma de presentación aguda, que requiere una rápida localización del punto de sangrado, como en la crónica, que precisa de exploraciones repetidas para determinar su etiología. El diagnóstico y tratamiento se basa en estudios endoscópicos, aunque los estudios radiológicos mediante angiografía por tomografía computarizada (TC) en la hemorragia aguda y mediante TC enterografía en la crónica son cada día más utilizados en la práctica clínica, a pesar de no estar incluidos todavía en las guías clínicas de la HD. La TC puede ser una exploración diagnóstica de primera elección en la hemorragia aguda masiva, sustituyendo a la angiografía, y una exploración diagnóstica complementaria a la cápsula endoscópica y la gammagrafía en la hemorragia crónica o recurrente cuando se sospecha un origen en el intestino delgado. La angiografía es actualmente un método terapéutico complementario a la endoscopia en el manejo de esta afección (AU)
Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding (AU)
Subject(s)
Humans , Male , Female , Gastrointestinal Hemorrhage , Angiography/methods , Angiography/trends , Endoscopy/methods , Endoscopy/trends , Endoscopy , Gastrointestinal Hemorrhage/epidemiology , Angiography/standards , Angiography , Gastrointestinal Hemorrhage/etiology , Nuclear Medicine/methods , Nuclear Medicine/trends , Magnetic Resonance Imaging/methodsABSTRACT
Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.
Subject(s)
Gastrointestinal Hemorrhage/diagnostic imaging , Acute Disease , Chronic Disease , Gastrointestinal Hemorrhage/classification , Humans , Recurrence , Tomography, X-Ray ComputedSubject(s)
Cutaneous Fistula/surgery , Gastric Fistula/surgery , Gastroscopy/instrumentation , Gastrostomy/adverse effects , Immunocompromised Host , Suture Techniques , Acquired Immunodeficiency Syndrome/diet therapy , Acquired Immunodeficiency Syndrome/immunology , Cutaneous Fistula/etiology , Gastric Fistula/etiology , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: Corticoid administration is the usual treatment of Crohns disease (CD) and ulcerative colitis (UC) attacks. However, information available on response rates and their predictive factors is scarce. OBJECTIVE: To establish response to steroidal treatment in an homogeneous group of patients with CD or UC during their first admission to hospital. METHODS: Restrospective analysis of 86 patients who received systemic steroidal treatment for a severe flare-up during their first hospital admission between 1995 and 2000. Patients were treated per protocol with fluid therapy, absolute diet, IV 6-methyl-prednisolone 1 mg/kg/day, and enoxaparin at prophylactic doses. Clinical response at 30 days was considered good in case of complete remission, and poor in case of partial or absent remission. Univariate and multivariate analyses according to non-parametric statistics were performed for sociodemographic and biologic variables. RESULTS: 45 patients with CD and 41 with UC were included. Good response rates were 64.4% for CD and 60.9% for UC. The univariate analysis showed that patients with good response have shorter evolution times and fewer previous flare-ups (p < 0.05) regarding CD. However, the multivariate analysis showed that none of the analyzed variables had predictive value. CONCLUSION: The response rate of severe inflammatory bowel disease attacks to corticoids is around 60% in CD and UC. Data resulting from the current study cannot predict which patients will ultimately respond to therapy.
Subject(s)
Glucocorticoids/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Methylprednisolone/therapeutic use , Adult , Female , Hospitalization , Humans , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
La atención a los síntomas del paciente y la observación son el punto de partida hacia el diagnóstico. Un paciente con dolor opresivo restrosternal, irradiado o no, acompañado de cortejo vegetativo es una orientación de hacia dónde se dirigirá nuestra investigación, sin olvidar la atipia del dolor e incluso su ausencia en los enfermos graves, mayores o diabéticos que pueden presentar como única manifestación dolor epigástrico o vómitos.Es importante recordar la presentación del infarto como un síncope, mareos o una inquietud no explicable e incluso como estado psicótico. El siguiente paso que se debe realizar, una vez en el centro hospitalario, es repetir el ECG y observar los cambios producidos con el registro realizado en el centro de atención primaria. Hay que tener en cuenta que los marcadores enzimáticos se deben solicitar en función del tiempo que ha transcurrido.En cuanto al tratamiento extrahospitalario es preferible empezarlo cuanto antes. Si se tienen los medios adecuados y un personal adecuadamente entrenado, se debe iniciar tratamiento trombolítico inmediatamente después de haber confirmado el diagnóstico. Si no es así, se debe facilitar el transporte lo más pronto posible hacia el centro hospitalario (AU)
Subject(s)
Humans , Fibrinolytic Agents/therapeutic use , Myocardial Ischemia/diagnosis , Myocardial Ischemia/drug therapy , Electrocardiography , Biomarkers/blood , Myocardial Ischemia/enzymology , Myoglobin/blood , Creatine Kinase/blood , Diagnosis, Differential , L-Lactate Dehydrogenase/blood , Creatine Kinase/bloodABSTRACT
La importancia del electrocardiograma en el ejercicio práctico de la medicina es indudable. Ningún otro método puede sustituirle por limpio, sencillo y eficaz. En este trabajo queremos poner de manifiesto algunas alteraciones electrocardiográficas (variantes normales) que se observan a menudo y que pueden causar dudas y confusiones a la hora de interpretar un electrocardiograma (AU)
