ABSTRACT
Introducción: la Guía Práctica se basa en la actual guía científica de la ESPEN sobre nutrición clínica en las enfermedades hepáticas. Métodos: se ha reducido y transformado en diagramas de flujo para facilitar su uso en la práctica clínica. La guía está dedicada a todos los profesionales, incluidos médicos, dietistas, Nutriciónistas y enfermeras, que trabajan con pacientes con enfermedad hepática crónica. Resultados: la guía presenta un total de 103 pronunciamientos y recomendaciones con breves comentarios para el manejo Nutricional y metabólico de pacientes con (i) insuficiencia hepática aguda grave, (ii) esteatohepatitis alcohólica, (iii) enfermedad hepática grasa no alcohólica, (iv) cirrosis hepática, y (v) cirugía o trasplante de hígado. Conclusión: las recomendaciones relacionadas con enfermedades están precedidas por recomendaciones generales sobre el diagnóstico del estado Nutricional en los pacientes hepáticos y sobre las complicaciones hepáticas asociadas a la nutrición médica (AU)
Background: the Practical Guideline is based on the current scientific ESPEN guide on Clinical Nutrition in Liver Disease Methods: it has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. Results: a total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. Disease-related recommendations are preceded by general recommendations on the diagnosis of nutritional status in liver patients and on liver complications associated with medical nutrition. Conclusion: this Practical Guideline gives guidance to health care providers involved in the management of liver disease on how to offer optimal nutritional care (AU)
Subject(s)
Humans , Liver Diseases , Nutritional Status , Liver Cirrhosis , Liver Failure, Acute , Fatty Liver , Liver TransplantationABSTRACT
The need to create a stoma is frequent in the daily clinical practice. Usually ileostomies work well within the first 24 hours. However, many times they are associated with important morbidity up to 76%. Although the complications derived from this technique may be surgical, metabolic complications, which are preceded by large losses through the stoma, are the ones going undetected. It is not rare to see patients carrying an ileostomy that come repeatedly to the hospital with severe metabolic impairments and in whom the underlying cause remains untreated. The case reported herein is just one of a series published in this journal making us aware of the need for a multidisciplinary approach of the ileostomies and the prevention of major complications derived from their poor functioning.
Subject(s)
Ileostomy/adverse effects , Magnesium Deficiency/etiology , Colectomy , Diarrhea/etiology , Diet , Female , Food, Formulated , Humans , Magnesium Deficiency/diet therapy , Magnesium Deficiency/prevention & control , Middle Aged , Nutritional Support , Potassium Deficiency/complications , Potassium Deficiency/etiology , ReoperationABSTRACT
La necesidad de construcción de un estoma es frecuente en la práctica clínica habitual. Las ileostomías por lo general funcionan adecuadamente en las siguientes 24horas. Sin embrago, muchas veces, están asociadas a una morbilidad importante de hasta el 76%. Aunque las complicaciones derivadas de esta técnica pueden ser quirúrgicas, son las metabólicas precedidas por grandes pérdidas a través del estoma las que pasan más inadvertidas. No es infrecuente encontrarnos con pacientes portadores de ileostomías que acuden en repetidas ocasiones a los centros hospitalarios con serias alteraciones metabólicas en los que no se trata la causa subyacente. El caso que presentamos aquí es uno más de una serie publicada en esta misma revista que nos sensibiliza ante la necesidad del manejo multidisciplinar de las ileostomías y de la prevención de complicaciones mayores derivadas del mal funcionamiento de las mismas (AU)
The need to create a stoma is frequent in the daily clinical practice. Usually ileostomies work well within the first24 hours. However, many times they are associated with important morbidity up to 76%. Although the complications derived from this technique may be surgical, metabolic complications, which are preceded by large losses through the stoma, are the ones going undetected. It is not rare to see patients carrying an ileostomy that come repeatedly to the hospital with severe metabolic impairments and in whom the underlying cause remains untreated. The case reported herein is just one of a series published in this journal making us aware of the need for a multidisciplinary approach of the ileostomies and the prevention of major complications derived from their poor functioning (AU)
Subject(s)
Humans , Male , Middle Aged , Ileostomy/adverse effects , Magnesium Deficiency/etiology , Surgical Stomas , Metabolic Diseases/etiology , Risk Factors , Tetany/etiologySubject(s)
Aneurysm, False/complications , Embolization, Therapeutic , Gastrointestinal Hemorrhage/etiology , Splenic Artery , Aneurysm, False/diagnostic imaging , Aneurysm, False/therapy , Colectomy , Colon/blood supply , Colon/surgery , Gastrointestinal Hemorrhage/therapy , Humans , Male , Middle Aged , Pancreatectomy , Radiography , Rectum , Rupture, Spontaneous/complications , SplenectomySubject(s)
Hepatitis/microbiology , Syphilis , Hepatitis/diagnosis , Humans , Male , Syphilis/diagnosisSubject(s)
Humans , Male , Adult , Hepatitis/complications , Hepatitis/diagnosis , Syphilis/complications , Syphilis/diagnosis , Asthenia/complications , Asthenia/diagnosis , Jaundice/complications , Enzyme-Linked Immunosorbent Assay/methods , Penicillin G Benzathine/therapeutic use , Hepatitis/drug therapy , Hepatitis/physiopathology , Syphilis/drug therapy , Syphilis/physiopathology , Diagnosis, Differential , Risk Factors , Treponema pallidum/isolation & purification , Treponema pallidum/pathogenicitySubject(s)
Humans , Female , Aged, 80 and over , Ischemia/diagnosis , Laparotomy/methods , Mesentery/blood supply , Mesenteric Vascular Occlusion/diagnosis , Abdominal Pain/etiology , Acute Disease , Disease Progression , Emergencies , Treatment Outcome , Mesenteric Arteries/pathology , Time FactorsSubject(s)
Cysts , Liver Diseases , Cysts/diagnosis , Humans , Liver Diseases/diagnosis , Male , Middle AgedABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Cysts/diagnosis , Liver Diseases/diagnosis , Low Back Pain/etiology , Hepatomegaly/diagnosisABSTRACT
INTRODUCCIÓN. El documento de interconsulta P111 es, en nuestro medio, el formulario clínico utilizado en la comunicación entre Atención Primaria y el segundo nivel asistencial. El objetivo general de este estudio es valorar la calidad de la información recogida en el documento de derivación. MATERIAL Y MÉTODOS. Se realizó un estudio descriptivo observacional donde fueron analizados los documentos de interconsulta recogidos por el servicio de admisión en un centro de salud urbano durante 7 días laborables. Se utilizaron criterios de calidad previamente definidos por Irazábal et al. RESULTADOS. En el estudio se incluyeron 428 documentos de interconsulta. El 38,8% de los pacientes derivados fueron varones. La edad media fue de 42 años. Respecto al cumplimiento del documento: el 95,3% era legible, el 56,3% hacía referencia a antecedentes personales, el 19,2% a tratamiento habitual, el 88,1% a síntomas o enfermedad actual, el 32% a exploración física, el 18,2% a pruebas complementarias, el 16,8% a tratamiento de la enfermedad actual y el 86,7% al motivo de derivación. Según la calidad de la información médica: el 16,6% fue considerado como bueno, el 62,9% fue aceptable y el 20,5% malo. Las especialidades más demandadas fueron: Traumatología, Oftalmología, Dermatología y Otorrinolaringología. El 82,4% de las derivaciones se realizaron al hospital de referencia. CONCLUSIONES. Los resultados sugieren que hay posibilidades de mejora en el cumplimiento de los documentos de interconsulta, fundamentalmente en relación a antecedentes personales, tratamiento habitual, exploración física y tratamiento de la enfermedad actual. Un documento estándar que incluya todas estas variables podría ayudar
NTRODUCTION. In our setting the referral letter P111is the interclinical form used for communication between Primary Health Care and second care level. The main objective of this study is to evaluate the quality of the information transmitted by the referral letter. MATERIAL AND METHODS. A descriptive observational study was made where the referral letters gathered from the admission service in an urban health center during 7 working days were analyzed. Quality criteria previously defined by Irazábal et al were used. RESULTS. Four hundred twenty eight referral letters were included in the study, 38.8% of the referral patients being men. Mean age was 42 years. Regarding the filling out of the documents, 95.3% were legible, 56.3% mentioned personal background, 19.2% mentioned usual treatment, 88.1% symptoms, 32% physical examination, 18.2% complementary tests, 16.8% treatment of the disease and 86.7% the referral reason. According to the quality of the medical information: 16.6% were considered to be good referral letters, 62.9% acceptable and 20.6% bad. The specialties requested most were traumatology, ophthalmology, dermatology and otorhinolaryngology. A total of 82.4% of the referrals were made to the reference hospital. CONCLUSIONS. The results suggest that there are possibilities of improvement in the filling out of the referral letters, mainly in relationship to personal background, usual treatment, physical examination and treatment of the present disease. A standardized referral letter which includes all these variables could be useful
Subject(s)
Humans , Intersectoral Collaboration , Outcome and Process Assessment, Health Care , Health Care Levels/trends , Form/standards , Referral and Consultation/trends , Primary Health Care/methods , Tertiary Healthcare , Hospital Information Systems/standardsABSTRACT
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