[Ethanol and the gastrointestinal tract]. / Etanol e o trato gastrointestinal.

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.

Colestase intra-hepática en situs inversus do fígado / Intrahepatic cholestasis with situs inversus of the liver

Em nossa pesquisa bibliográfica näo encontramos nenhum trabalho sobre colestase intra-hepática em situs inversus do fígado. OBJETIVO. Relatar um caso de seguimento por um de nós (MM) durante aproximadamente, 14 anos após o desaparecimento da mencionada colestase. MÉTODOS. Foram estudados aspectos clínicos, realizados diversos testes laboratoriais e efetuados três exames ultra-sonográficos e uma tomografia computadorizada. Tentou-se realizar colangiografias transparieto-hepática e endoscópica. RESULTADOS. Quatro dias após a paciente ter sido submetida à prótese aórtica (com circulaçäo extracorpórea) surgiu icterícia, urina escura e fezes claras. As bilirubinas, fosfatase alcalina, gamaglutamil transferase e colesterol séricos estavam muito elevados. Os exames ultra-sonográficos e a tomografia sem evidências de obstruçäo extra-hepática. Neste exame, em especial, ficou caracterizada a existência de situs inversus do estômago e fígado. Näo houve êxito na realizaçäo das colangiografias. Os dados clínicos e laboratoriais referentes à colestase normalizaron após quatro meses. Boa evoluçäo após 14 abos. CONCLUSAO. O diagnóstico diferencial entre colestase intra e extra-hepática em pacientes com situs inversus do fígado pode, realmente, ser dificil, exigindo associar dados clínicos e vários exames complementares, entre os quais a colangiopancreatografia endoscópica retrógrada. A realizaçäo desse exame pode, porém, ser difícil nos mencionados pacientes

[Intrahepatic cholestasis with situs inversus of the liver]. / Colestase intra-hepática em situs inversus do fígado.

Intrahepatic cholestasis with situs inversus of the liver has not been reported in the literature. PURPOSE--A follow-up case for approximately 14 years (by one of the authors, MM). METHODS--Clinical aspects were studied and several laboratory exams as well as three ultrasonography and one computerized tomography exams were performed. Percutaneous and endoscopic cholangiographies were attempted. RESULTS--Four days after the patient was submitted to a surgical replacement of the aortic valve (with extracorporeal circulation), she developed jaundice, severe pruritus, dark urine, and pale stools. Serum levels of bilirubin, alkaline phosphatase, gama-glutamil transferase, and cholesterol were very high. Ultrasonography and computerized tomography exams did not reveal any evidence of extrahepatic obstruction. The tomography exam confirmed the existence of situs inversus in the stomach and liver. We were not successful in performing the cholangiography exams. Clinical and laboratory data as to cholestasis returned to normal after 4 months with no recurrence or complication during the follow-up period (14 years). CONCLUSION--The differential diagnosis between intra and extra-hepatic cholestasis in patients with situs inversus of the liver may be difficult. Therefore it will be necessary to collect clinical data and various complementary exams such as endoscopic retrograde cholangiopancreatography which is very difficult to perform in these patients.

Hepatite pelo vírus A em adulto: ocorrência de formas prolongadas e polifásicas da doença / Hepatitis A in adults: occurrence of prolonged and polyphasic forms of the disease

Os autores estudaram a ocorrência de formas prolongadas e/ou polifásicas da infecçao, em 84 pacientes adultos com diagnóstico de hepatite aguda pelo vírus A. Foram prolongada de doença (duraçao superior a quatro meses) foi observada em 8/84 (9,5 por cento) dos pacientes. Padrao polifásico foi observado em 12/84 (14,3 por cento) dos casos. Observou-se ainda que indivíduos com mais de 18 anos tiveram tendência a demorar mais tempo para normalizar as transaminases, quando comparados com pacientes entre 12 e 18 anos, o mesmo ocorrendo com homens, quando comparados às mulheres. Entretanto, em todos os casos observou-se normalizaçao do quadro, em períodos que chegaram a ser tao longos quanto nove a dez meses de evoluçao.