ABSTRACT
Acute pancreatitis is a common and potentially severe disease where nutritional support does affect its development in a way it may be considered a treatment in severe cases. These include around 20% of patients and present mortality rates of 8%-39%. In mild acute pancreatitis patients are prescribed nil per os at admission and advance diet in a progressive manner the following days. Although early introduction of diet has proven to shorten the length of stay, it is still not clear when and how to introduce diet. Severe disease is a hypercatabolic situation which often appears in already malnourished patients. Early enteral nutrition has shown a significative benefit over parenteral nutrition in terms of infection rates, hyperglycemia and mortality rates. This benefit may be related to a decrease in bacterial intestinal translocation. Nasoyeyunal tube feeding is the preferred site, but there are trials supporting nasogastric tubes, a more feasible election. The following lines offer an up to date review of nutritional management in acute pancreatitis, trying to answer in a clear and practical way to the most frequent problems arising in the day to day management of this disease.
Subject(s)
Nutritional Support , Pancreatitis/diet therapy , Enteral Nutrition , Humans , Length of Stay , Pancreatitis/mortality , Pancreatitis/therapy , Parenteral NutritionABSTRACT
La pancreatitis aguda es una patología frecuente y potencialmente grave en la que el manejo nutricional influye de manera importante en su desarrollo, de tal forma que se puede considerar un tratamiento específico en los casos graves. Éstos suponen aproximadamente el 20% de los pacientes y presentan una mortalidad entre el 8-39%. En los casos leves se suele proceder a un ingreso en dieta absoluta y posterior reintroducción progresiva de la dieta. Aunque se ha demostrado que una reintroducción temprana acorta la duración del ingreso, existe incertidumbre acerca del momento y del tipo de dieta idóneos. Las pancreatitis graves son estados hipercatabólicos que se presentan en pacientes que frecuentemente presentan déficits nutricionales basales. El soporte nutricional iniciado precozmente por vía enteral ha demostrado un beneficio significativo respecto a la vía parenteral en cuanto a tasa de infección, control de glucemia y mortalidad. Este beneficio puede relacionarse con una disminución de la traslocación bacteriana. Si bien tradicionalmente se ha empleado la vía nasoyeyunal, existen estudios que apoyan la vía nasogástrica, mucho más accesible. En el siguiente texto ofrecemos una revisión actualizada del manejo nutricional en la pancreatitis aguda, intentando responder de manera clara y con un enfoque práctico a las preguntas que más frecuentemente se presentan en el manejo de esta patología (AU)
Acute pancreatitis is a common and potentially severe disease where nutritional support does affect its development in a way it may be considered a treatment in severe cases. These include around 20% of patients and present mortality rates of 8%-39%. In mild acute pancreatitis patients are prescribed nil per os at admission and advance diet in a progressive manner the following days. Although early introduction of diet has proven to shorten the length of stay, it is still not clear when and how to introduce diet. Severe disease is a hypercatabolic situation which often appears in already malnourished patients. Early enteral nutrition has shown a significative benefit over parenteral nutrition in terms of infection rates, hyperglycemia and mortality rates. This benefit may be related to a decrease in bacterial intestinal translocation. Nasoyeyunal tube feeding is the preferred site, but there are trials supporting nasogastric tubes, a more feasible election. The following lines offer an up to date review of nutritional management in acute pancreatitis, trying to answer in a clear and practical way to the most frequent problems arising in the day to day management of this disease (AU)
Subject(s)
Humans , Pancreatitis/diet therapy , Nutritional Support/methods , Enteral Nutrition/methods , Parenteral Nutrition/methods , Nutrition Disorders/diet therapy , Acute DiseaseABSTRACT
BACKGROUND: There are a lot of controversies related to the diagnostic and therapeutic management of Whipple s disease. PATIENTS: We present 4 cases of Whipple's disease, collected from the Gastroenterology Service of the Hospital Ramon y Cajal, from Madrid. RESULTS: The average age was 69. The first symptoms were in order of frequency, arthralgias, loss of weight, arthritis, diarrhoea, fever, epigastric pain and neurologic symptoms. Three were treated with trimethoprim-sulphamethoxazol and one with cefixime. There were no recurrences. CONCLUSIONS: The endoscopic appearance of the duodenum is fundamental for the suspicion of the disease. The initial parenteral treatment may consist of ceftriaxone and try to avoid using streptomycine because of its toxicity, followed by oral trimethoprim-sulphamethoxazol. As an alternative to the latter, cefixime is usually effective. The typical findings of the duodenum biopsy can persist several months or years after finishing the treatment, decreasing the value of endoscopic pursuit after treatment.
Subject(s)
Whipple Disease , Aged , Biopsy , Female , Humans , Male , Middle Aged , Whipple Disease/diagnosis , Whipple Disease/drug therapyABSTRACT
Fundamento: Existen muchas controversias relacionadas con el manejo diagnóstico y terapéutico de la enfermedad de Whipple. Pacientes: Se presentan cuatro casos de enfermedad de Whipple, recogidos del Servicio de Gastroenterología del Hospital Ramón y Cajal de Madrid. La edad media fue 69 años. Los síntomas de presentación fueron en orden de frecuencia artralgias, pérdida de peso, artritis, diarrea, fiebre, dolor epigástrico y síntomas neurológicos. Tres fueron tratados con trimetroprim-sulfametoxazol y uno con cefixima. No hubo recidivas. Conclusiones: El aspecto endoscópico del duodeno es decisivo para la sospecha de la enfermedad. El tratamiento inicial parenteral de la enfermedad debe realizarse con ceftriaxona e intentar evitar la estreptomicina por su toxicidad, seguido del trimetroprim-sulfametoxazol oral. Como alternativa la cefixima parece eficaz. Los hallazgos típicos de la biopsia pueden persistir meses y años después de finalizado el tratamiento, lo cual resta valor al seguimiento endoscópico de los pacientes tras el tratamiento (AU)
Subject(s)
Male , Middle Aged , Aged , Female , Humans , Whipple Disease , BiopsyABSTRACT
We describe a case of vasculitis with colonic involvement/alterations associated with hepatitis C virus infection. Both the association of hepatitis C with vasculitis type periarteritis nodosa and the prominent involvement of the colon are infrequent. The presentation of this case--fever of unknown origin--as well as the difficulties of treating a patient who is a hepatitis C virus carrier are discussed.
Subject(s)
Colonic Diseases/etiology , Hepatitis C, Chronic/complications , Vasculitis/etiology , Humans , Male , Middle AgedSubject(s)
Antiviral Agents/therapeutic use , Colitis, Ulcerative/epidemiology , Colonic Diseases/etiology , Cytomegalovirus Infections , Disease Outbreaks , Ganciclovir/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Biopsy , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/pathology , Colon/pathology , Colonic Diseases/drug therapy , Colonic Diseases/pathology , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/pathology , Humans , Spain/epidemiologyABSTRACT
Portal hypertension associated to Gaucher's disease type I with non cirrhotic liver involvement is a very in-equent finding. We report a case of Gaucher's disease type I without cirrhosis in which portal hypertension is the main manifestation. The mechanism of the portal hypertension is discussed in our report and can be related to an elevation in hepatic fluid resistance due to the Gaucher's cells compression on sinusoids.
Subject(s)
Gaucher Disease/complications , Hypertension, Portal/etiology , Adult , Gaucher Disease/diagnosis , Humans , MaleABSTRACT
Tetany is a rare form of presentation of adult celiac disease. We present three patients with spontaneous episodes of tetania who were finally diagnosed of celiac disease. All were women. In two of them an unexplained chronic anemia was previously detected. The origin of tetania was severe hypocalcemia and hypomagnesemia. After intravenous restoration of calcium and posterior free gluten diet with supplements, clinical and biological remission was achieved. In the presence of isolated tetania or unexplained anemia resistant to treatment an adult celiac disease must be disclosed.
Subject(s)
Celiac Disease/diagnosis , Tetany/etiology , Adult , Celiac Disease/pathology , Female , Humans , Hypocalcemia , Magnesium/blood , Middle AgedABSTRACT
A case of undiagnosed celiac disease associated with macrolipasemia and macroamylasemia is reported. This association is almost unique. To our knowledge, only one case has been previously diagnosed. Previous case reports about macroamylasemia and celiac disease, as well as macrolipasemia, are briefly discussed.
Subject(s)
Celiac Disease/blood , Lipase/blood , Amylases/blood , Celiac Disease/diet therapy , Female , Humans , Middle AgedABSTRACT
Laparoscopic, clinical and biological features of 51 patients admitted over a period of 22 years in two university hospitals of Madrid are analyzed. Mean age was 43 years, 30 patients were diagnosed in the period from 1967 to 1978 and in 32 of them, there was predisposing pathology. Main symptoms were abdominal pain, fever, general syndrome and ascites. Ascitic fluid was an exudate in 97% of cases, finding BAAR in one case, being the culture positive in four cases. Diagnostic was made through laparoscopy in 42 cases and using laparotomy in 9 cases, being confirmed with histological procedures in 38 cases and with microbiological procedures in 11 cases. Peritoneal tuberculosis is a non unfrequent tuberculosis localization. Laparoscopy is the more cost-effective diagnostic method of peritoneal tuberculosis.
Subject(s)
Peritonitis, Tuberculous/epidemiology , Age Factors , Biopsy , Humans , Incidence , Laparoscopy , Laparotomy , Peritoneum/pathology , Peritonitis, Tuberculous/diagnosis , Retrospective Studies , Sex Factors , Spain/epidemiology , Time FactorsABSTRACT
The high incidence of significant bacteriuria observed in 30 patients diagnosed of primary biliary cirrhosis in our department is studied. Although a significant increase in general infections has not been described in this type of liver disease, of probable autoimmune nature, the high incidence of bacteriuria in these patients has been previously reported. Possible predisposing factors are evaluated; we observed that there was a significant increase in the frequency of bacteriuria with age, but there was no relationship between the incidence of infection and the histologic stage of the disease.
