RESUMO
Pneumobilia is a phenomenon associated with the presence of a biliary-enteric fistula or manipulation of the bile duct during procedures or surgical interventions that cause dysfunction of the sphincter of Oddi. A known, but infrequently reported event, is the increase in intraabdominal pressure after closed abdominal trauma, which causes pneumobilia due to a mechanism of retrograde air leakage towards the bile duct. Depending on the general compromise of each patient, the prognosis can vary from a benign condition that only requires conservative management, to being life threatening. We present the case of a 75-year-old male patient who, after suffering a closed thoraco-abdominal trauma, presented with rib fracture and, in addition, gallbladder wall rupture, pneumoperitoneum, pneumobilia, and pneumowirsung, having a favorable clinical course after receiving conservative management.
Assuntos
Fístula Biliar , Pneumoperitônio , Masculino , Humanos , Idoso , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ductos Biliares , Tratamento ConservadorRESUMO
Pneumobilia is a phenomenon associated with the presence of a biliary-enteric fistula or manipulation of the bile duct during procedures or surgical interventions that cause dysfunction of the sphincter of Oddi. A known, but infrequently reported event, is the increase in intraabdominal pressure after closed abdominal trauma, which causes pneumobilia due to a mechanism of retrograde air leakage towards the bile duct. Depending on the general compromise of each patient, the prognosis can vary from a benign condition that only requires conservative management, to being life threatening. We present the case of a 75-year-old male patient who, after suffering a closed thoraco-abdominal trauma, presented with rib fracture and, in addition, gallbladder wall rupture, pneumoperitoneum, pneumobilia, and pneumowirsung, having a favorable clinical course after receiving conservative management.
La neumobilia es un fenómeno asociado a presencia de fístula bilioentérica o manipulación de la vía biliar durante procedimientos o intervenciones quirúrgicas que condicionan disfunción del esfínter de Oddi. Un evento poco reportado, pero ya conocido, es el aumento de la presión intraabdominal tras un trauma abdominal cerrado, que condiciona neumobilia por un mecanismo retrógrado de fuga de aire hacia la vía biliar. Según el compromiso general de cada paciente, el pronóstico puede variar desde un cuadro benigno, que solo requiere un manejo conservador, hasta ser amenazante para la vida. Se presenta el caso de un paciente varón de 75 años, quien después de presentar un trauma toracoabdominal cerrado cursa con fractura costal y, además, ruptura de pared vesicular, neumoperitoneo, neumobilia, y neumowirsung, cursando con evolución favorable tras recibir manejo conservador.
RESUMO
RESUMEN Los antivirales de acción directa son drogas nuevas altamente efectivas y seguras para el tratamiento de la hepatitis C crónica. Sin embargo, a pesar de la erradicación del virus de hepatitis C en pacientes con cirrosis hepática descompensada, aun es controversial su efecto en la mejora del cuadro clínico, disminución de complicaciones asociadas, riesgo de desarrollo de hipertensión portal y hepatocarcinoma. Presentamos dos pacientes con cirrosis hepática descompensada Child B por hepatitis C quienes recibieron tratamiento con drogas antivirales de acción directa. Luego del tratamiento, y confirmada la carga viral indetectable - respuesta viral sostenida - ambos pacientes mostraron una mejora significativa del curso clínico de la cirrosis hepática - Child A - y disminución de los niveles de fibrosis hepática determinados por métodos no invasivos.
ABSTRACT Direct-acting antivirals are new drugs, highly effective and safe against chronic hepatitis C. However, despite of hepatitis C erradication in patients with decompensated liver cirrhosis, their effect in improving the clinical course, reducing liver-related complications and the risk of developing portal hypertension and hepatocellular carcinoma is still controversial. We present two patients with decompensated liver cirrhosis Child B due to hepatitis C who received treatment with direct-acting antiviral drugs. After treatment, and with the confirmation of undetectable viral load - sustained viral response - both patients showed significant improvement in the clinical course of liver cirrhosis - Child A - and a decrease in the amount of liver fibrosis measured with non invasive methods.
RESUMO
In lower gastrointestinal bleeding (LGIB), it is very important to stratify the risk of LGIB for a proper management. OBJECTIVE: Identity the independent risk factors to mortality and severity (require critical care, prolonged hospitalization, reebleding, re hospitalization, politrasfusion, surgery for bleeding control) in LGIB. MATERIALS AND METHODS: It is an analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. Independent factors were determined using binomial logistic regression. RESULTS: A total of 98 patients were included, of which 13 patients (13,3%) died, and 56 (57,1%) met severity criteria. The independent risk factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg, albumin lower than 2,8 g/dL. CONCLUSIONS: The frequency of mortality and severe LGIB is high in our population, the principal risk factors were systolic blood pressure under than 100 mm Hg, Glasgow score lower than 15, albumin lower than 2,8 g/dL. Identifying these associated factors would improve the management of LGB in the emergency room.
Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Enteropatias/diagnóstico , Enteropatias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
En hemorragia digestiva baja (HDB) es muy importante estratificar el riesgo de la misma para brindar un manejo adecuado. Objetivo: Identificar los factores predictores de mortalidad y severidad en pacientes con HDB (definida como: requerimiento de unidad de cuidados críticos, control de hemorragia en sala de operaciones, estancia prolongada mayor a 9 días, resangrado, reingreso, o politransfusión más de 5 paquetes globulares). Materiales y métodos: Es un estudio observacional analítico de cohorte prospectivo, realizado entre junio del 2016 y abril del 2018 en un hospital de nivel III. Se determinó los factores predictores de mortalidad y severidad. Se evalúo la sobrevida hasta los 30 días Resultados: Se incluyó un total de 98 pacientes de los cuales 13 pacientes (13,3%) fallecieron y 56 (57,1%) cumplen criterios de severidad. El factor predictor independiente de mortalidad fue escala de Glasgow menor a 15 y los factores independientes de severidad fueron un valor de albúmina menor a 2,8 g/dl y la presión arterial sistólica menor a 100 mmhg. Conclusiones: La frecuencia de mortalidad y HDB severa es alta en nuestro estudio. La presión arterial sistólica, la escala de Glasgow y la albúmina sérica son evaluaciones que pueden permitirnos predecir durante la primera evaluación en emergencia el riesgo de severidad y mortalidad de un paciente con HDB.
In lower gastrointestinal bleeding (LGIB), it is very important to stratify the risk of LGIB for a proper management. Objective: Identity the independent risk factors to mortality and severity (require critical care, prolonged hospitalization, reebleding, re hospitalization, politrasfusion, surgery for bleeding control) in LGIB. Materials and methods: It is an analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. Independent factors were determined using binomial logistic regression. Results: A total of 98 patients were included, of which 13 patients (13,3%) died, and 56 (57,1%) met severity criteria. The independent risk factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg, albumin lower than 2,8 g/dL. Conclusions: The frequency of mortality and severe LGIB is high in our population, the principal risk factors were systolic blood pressure under than 100 mm Hg, Glasgow score lower than 15, albumin lower than 2,8 g/dL. Identifying these associated factors would improve the management of LGB in the emergency room.
RESUMO
OBJECTIVE: The ideal therapy for chronic hepatitis C is the use of direct acting antivirals (DAA). In Peru there is no data in this aspect, in that sense it is necessary to report real life experience with these drugs. MATERIAL AND METHODS: A digital survey was sent through e-mail to hepatologists, and the data of four is considered in this study. Statistical analysis was descriptive. RESULTS: We included 63 patients, mean age was 59 years, 49.21% were male, cirrhosis was present in 49.21%, and 34.92% was non-responder to PEGIFN and Ribavirin. Genotype 1 was present in 93.65%, and subtype 1a was 58.73%, there were only 2 cases with Gt 2 and one with Gt 3. There were 10 different DAA combinations used, and the most effective were Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir, in all these cases the Sustained Viral Response (SVR) was 100%. The other combinations had SVR < 90% or only 1-2 patients included. All patients tolerated treatments and no serious adverse events occurred. CONCLUSIONS: In real life antiviral treatment for hepatitis C with AAD is effective and well tolerated. The best SVR was obtained with Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir. This report may be useful to consider treatment strategies with focus in public health.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/administração & dosagem , Avaliação de Medicamentos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/efeitos dos fármacos , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/virologia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Peru , Resultado do Tratamento , Adulto JovemRESUMO
Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.
Assuntos
Dissecção Aórtica/complicações , Hepatite/etiologia , Isquemia/etiologia , Fígado/irrigação sanguínea , Dor Abdominal/etiologia , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/fisiopatologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dispneia/etiologia , Emergências , Evolução Fatal , Hepatite/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Objetivos: La terapia ideal para la hepatitis crónica C consiste en el uso de drogas antivirales de acción directa (DAA). En el Perú la experiencia en vida real con DAA no se conoce, por lo que el objetivo del presente estudio es reportar la alta eficacia terapéutica con estos esquemas. Material y métodos: Mediante correo electrónico se invitó a participar a través de una encuesta a médicos hepatólogos a nivel nacional. Se incluyeron los datos de 4 médicos. Los resultados fueron analizados con estadística descriptiva. Resultados: Se incluyeron 63 pacientes, la edad promedio fue 59 años, varones fueron 49,21%, cirrosis estuvo presente en el 49,21% (31/63), 34,92% había sido no respondedor a terapia con PEGIFN/RBV. El Genotipo 1 estuvo presente en 93,65% de casos, siendo el 1a el predominante (58,73%). Solo hubo dos casos de genotipo 2 y uno de genotipo 3. Se utilizaron 10 esquemas de combinación con DAA, siendo los más eficaces, Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/ Ribavirina y Sofosbuvir/Simeprevir, en todos ellos se logró Respuesta Viral Sostenida (RVS) de 100%. Con los otros 7 esquemas la RVS fue menor a 90% o solo se había incluido uno o dos pacientes. La tolerancia a la terapia fue adecuada y todos los pacientes culminaron la terapia. Conclusiones: En vida real los esquemas de terapia antiviral para hepatitis C con DAA tienen alta eficacia y seguridad. Las mejores respuestas se obtuvieron con Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina y Sofosbuvir/Simeprevir. Esta data puede ser útil para considerar estrategias de tratamiento con el enfoque de salud pública.
Objective: The ideal therapy for chronic hepatitis C is the use of direct acting antivirals (DAA). In Peru there is no data in this aspect, in that sense it is necessary to report real life experience with these drugs. Material and methods: A digital survey was sent through e-mail to hepatologists, and the data of four is considered in this study. Statistical analysis was descriptive. Results: We included 63 patients, mean age was 59 years, 49.21% were male, cirrhosis was present in 49.21%, and 34.92% was non-responder to PEGIFN and Ribavirin. Genotype 1 was present in 93.65%, and subtype 1a was 58.73%, there were only 2 cases with Gt 2 and one with Gt 3. There were 10 different DAA combinations used, and the most effective were Sofosbuvir/ Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir, in all these cases the Sustained Viral Response (SVR) was 100%. The other combinations had SVR < 90% or only 1-2 patients included. All patients tolerated treatments and no serious adverse events occurred. Conclusions: In real life antiviral treatment for hepatitis C with AAD is effective and well tolerated. The best SVR was obtained with Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir. This report may be useful to consider treatment strategies with focus in public health.