ABSTRACT
Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient's bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures. POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists.
Subject(s)
Gastroenterology , Point-of-Care Systems , Humans , Ultrasonography/methods , Liver Cirrhosis , Physical ExaminationABSTRACT
Hepatitis B virus (HBV) reactivation results from increased viral replication in inactive carriers or patients with prior infection with HBV. Reactivation may occur spontaneously or secondary to immunomodulating or immunosuppressive chemotherapy. Reactivation may manifest with no symptoms but on occasion results in acute or even severe acute hepatitis. Prevention is the best management approach, hence HBV screening using serology should be performed for all patients undergoing any immunomodulating, immunosuppressive or chemotherapeutic treatment. Antiviral prophylaxis has proven effective in inactive carriers and in some patients with former infection with HBV undergoing selected immunosuppressive therapies.
Subject(s)
Hepatitis B/etiology , Hepatitis B/therapy , Algorithms , Biological Therapy , Hepatitis B/prevention & control , Humans , Recurrence , Risk FactorsABSTRACT
La reactivación del virus de la hepatitis B se debe a un aumento de la replicación del virus en pacientes portadores inactivos o con infecciones pasadas de VHB. La reactivación puede producirse espontáneamente o de manera secundaria a tratamientos de quimioterapia, inmunomoduladores o inmunosupresores. La reactivación puede manifestarse de manera asintomática pero en algunos casos puede causar hepatitis agudas e incluso hepatitis agudas graves. El mejor tratamiento es la prevención por lo que se debe realizar un cribado del VHB mediante una serología a todos los pacientes que vayan a someterse a cualquier tratamiento inmunomodulador, de quimioterapia o inmunosupresor. El tratamiento profiláctico antiviral ha demostrado ser eficaz en los pacientes portadores inactivos y en algunos pacientes con infecciones pasadas de VHB sometidos a ciertos tratamientos inmunosupresores(AU)
Subject(s)
Humans , Male , Female , Hepatitis B/epidemiology , Hepatitis B/prevention & control , Hepatitis B Antibodies/therapeutic use , Hepatitis B Antigens , Immunosuppressive Agents/therapeutic use , Hepatitis B virus/isolation & purification , Risk Factors , Cyclophosphamide/therapeutic use , Vincristine/therapeutic use , Hepatitis B virus , Hepatitis B virus/pathogenicity , Indicators of Morbidity and Mortality , Mass Screening/methods , Antibiotics, Antineoplastic/adverse effects , Antineoplastic Agents/adverse effects , Prospective Studies , Retrospective Studies , Doxorubicin/therapeutic useABSTRACT
No disponible
No disponible
Subject(s)
Female , Humans , Male , Therapeutics/instrumentation , Therapeutics/methods , Hepacivirus/genetics , Hepacivirus/metabolism , Ribavirin/analogs & derivatives , Ribavirin/pharmacology , DNA-Directed DNA Polymerase/pharmacology , Therapeutics/mortality , Therapeutics/nursing , Hepacivirus/physiology , Hepacivirus/pathogenicity , Ribavirin/metabolism , Ribavirin/therapeutic use , DNA-Directed DNA Polymerase/metabolismABSTRACT
Las causas más frecuentes de hemorragia digestiva alta (HDA) son la úlcera péptica y la hipertensión portal de la que no se trata en esta revisión. La úlcera péptica constituye el 37-50% de las causas, siendo más frecuente la duodenal que la gástrica. Los factores principales que influyen en su aparición son la infección por Helicobacter pylori y la administración de antiinflamatorios no esteroideos. Las lesiones agudas de la mucosa gástrica constituyen el 20% de las causas de HDA y se asocian a la toma de AINE, alcohol, o estado crítico del enfermo con ventilación mecánica, coagulopatía, lesiones neurológicas graves, politraumatizados, etc. La esofagitis, síndrome de Mallory-Weiss, lesiones vasculares, neoplasias esofagogástricas, fístula aortoentérica y hemobilia son causas menos frecuentes. Los procedimientos diagnósticos disponibles son la anamnesis y exploración física, hemograma, bioquímica, estudio de coagulación, colocación de sonda nasogástrica y lavados, panendoscopia oral, radiología baritada, angiografía, gammagrafía con sulfuro coloidal o hematíes marcados y la laparotomía exploradora. Se discute cada uno de ellos, resaltando la importancia de la panendoscopia oral (AU)
Peptic ulcer disease and portal hypertension are the most frequent etiology of high digestive tract hemorrhage (HDTH). Peptic ulcer disease accounts for 37-50% of all HDTH, being duodenal ulcer disease more frequent compared to gastric ulcer disease. Main determinants for the presence of HDTD are infection for Helicobacter pylori and use of non-steroidal antiinflammatory drugs (NSAID). Acute injuries of gastric mucose account for 20% HDTH and they are associated to NSAID or alcohol ingestion, critical state of the patient in mechanical ventilation, patients with coagulopathies or severe neurological and politraumatism injuries, etc. Less frequent causes of HDTD are esofagitis, Mallory-Weiss syndrome, vascular injuries, gastroesophagic cancer, aortoenteric fistula and hemobilia. The diagnostic procedures available currently are anamnesis and physical exploration, hemogram, blood biochemistry, study of coagulation, nasogastric probe and washes, oral panendoscopy, barium radiology, angiography, labelled eritrocyte or colloidal sulphur scintigraphy and exploratory laparotomy. Every approach is discussed, stressing the significance of oral panendoscopia (AU)
Subject(s)
Adult , Humans , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Helicobacter pylori/immunology , Helicobacter pylori/physiology , Peptic Ulcer/complications , Peptic Ulcer/diagnosis , Endoscopy, Gastrointestinal , Angiography , Peptic Ulcer/etiologySubject(s)
Hepatopulmonary Syndrome/etiology , Liver Cirrhosis/complications , Blood Gas Analysis , Cohort Studies , Disease Progression , Hepatopulmonary Syndrome/blood , Hepatopulmonary Syndrome/diagnosis , Hepatopulmonary Syndrome/physiopathology , Hepatopulmonary Syndrome/surgery , Humans , Liver Transplantation , Oxygen/blood , Partial Pressure , Prospective Studies , Severity of Illness Index , SyndromeABSTRACT
No disponible
Subject(s)
Humans , Liver Cirrhosis/complications , Liver Cirrhosis/diagnosis , Oxygenation , Liver Transplantation/pathology , Liver Transplantation/physiology , Lung/abnormalities , Lung/anatomy & histology , Lung/physiology , Liver Cirrhosis/pathology , Blood PressureSubject(s)
CA-19-9 Antigen/blood , Cysts/blood , Rectal Diseases/blood , Sacrococcygeal Region/pathology , Cysts/pathology , Cysts/surgery , Digestive System Surgical Procedures/methods , Endosonography , Female , Humans , Middle Aged , Rectal Diseases/pathology , Rectal Diseases/surgery , Sacrococcygeal Region/diagnostic imaging , Sacrococcygeal Region/surgeryABSTRACT
Los inhibidores de la bomba de protones son los fármacos disponibles más eficaces en el control e inhibición de la secreción gástrica. En España sólo existen dos para administración intravenosa: omeprazol y pantoprazol. El segundo tiene ventajas sobre el primero por la ausencia de interacciones farmacológicas, lo que le convierte en el ideal para enfermos polimedicados y con afecciones asociadas, como ocurre frecuentemente en Urgencias. La administración intravenosa consigue una inhibición más rápida y potente de la secreción ácida, o que puede ser importante en el tratamiento de la enfermedad por reflujo gastroesofágico y sus complicaciones, enfermedad ulcerosa péptica, hemorragia digestiva alta, obstrucción gástrica, síndromes de hipersecreción, profilaxis y tratamiento de la lesión por AINEs y en profilaxis de la úlcera de estrés y de la neumonía aspirativa (AU)
