Claves diagnósticas y terapéuticas para el manejo de la hemorragia digestiva alta no varicosa

La hemorragia digestiva alta tiene su origen en una lesión situada entre el esfínter esofágico superior y el ángulo de Treitz. Las causas más frecuentes son la úlcera péptica y la hipertensión portal. El diagnóstico de este síndrome se basa en la anamnesis, exploración física, los datos de laboratorio y la endoscopia oral. Se discute cada uno de ellos, resaltando la importancia de la endoscopia. El tratamiento inmediato en urgencias incluye algunas medidas generales del paciente en shock y medidas hemostáticas especiales. Una vez estabilizado el enfermo hay que administrar el tratamiento farmacológico específico en la hemorragia no varicosa.  PALABRAS CLAVE: Diagnóstico. Tratamiento. Hemorragia digestiva alta

Fotomontaje inducto-deductivo integrado

Con esta actividad, he intentado generar mayor motivación dentro del alumnado HCAP, perfil de alumno que necesita una especial atención en este aspecto. Son alumnos de mayor edad y experiencia que el resto, lo que genera niveles de exigencia muy altos. He pensado que jugar con ellos, podía ser una buena forma de complementar el curso. Para ello he elegido un formato a camino entre el método del caso, y concurso de televisión, léase “El tiempo es oro”. El alumno ha de realizar en equipo un fotomontaje de un archivo en 3D max que se encuentra en la web (un modelo sobre una obra de un arquitecto famoso), y ubicarlo en un contexto diferente, con materiales distintos. Para ello se da una serie de pistas, de manera que tiene que descubrir a lo largo de la práctica, de qué proyecto se trata, donde está el lugar elegido, y que texturas colocar. El planteamiento es en equipo, de manera que se pueden diversificar esfuerzos. Al final se realiza una votación para elegir el mejor trabajo. Se ha generado una tensión competitiva tanto a nivel personal, como de equipos muy alta que ha desembocado en trabajos de alta calidad. El formato concurso ha demostrado ser un incentivo altamente interesante como posible alternativa dentro de los métodos docentes.SIN FINANCIACIÓNNo data 2011UE

Bleeding risk in endoscopic retrograde cholangiopancreatography: impact of the use of antithrombotic drugs

Aims: To analyze the risk factors for hemorrhage during endoscopic retrograde cholangiopancreatography and the impact of antithrombotic drugs. Material and methods: Data sources: papers indexed in PubMed have been reviewed, as well as those found during the analysis of the bibliography of meta-analysis and reviews. Selection criteria: the references have been firstly evaluated by review of the abstract. After selecting the most significant articles (mainly randomized trials and well-designed case series) these have been deeply analyzed. Evaluation of the studies and synthesis: criteria by the Oxford Centre for Evidence-Based Medicine have been used for the analysis of the references and elaboration of evidence levels. Results: Seven hundred and sixty-five references were found, 753 in PubMed and the Cochrane Library. Twelve studies were selected during the analysis of other published articles (systematic reviews, meta-analysis and clinical practice guidelines). After analyzing the title or the abstract, 655 studies were excluded. Finally, 83 high quality trials or descriptive studies have been included in the analysis. Conclusions: Seven conclusions regarding the risk factors for bleeding and the impact of antithrombotic drugs have been defined

Management of refractory esophageal stenosis in the pediatric age

Introduction: Refractory esophageal stenosis (RES) is a major health problem in the pediatric population. Several techniques such as stent placement or C-mitomycin (CM) have been described as alternative treatments. We present our experience with both techniques, in our case with biodegradable stents (BS) and sometimes the association with stents and CM. Material and methods: Six patients have been included: 2 post-operative fistulas in patients with type I esophageal atresia; 1 operated atresia without fistula; and 3 caustic strictures. 5 BS were placed in 4 children: 3 of them in cases of atresia (2 prosthesis in one case) and the other one in a case of stricture. CM was used in 5 cases: in 2 of them from the beginning, and in the other 3 cases after failure of the stent. Results: When placed in fistulas, BS were fully covered. One of them successfully treated the fistula, but the other one was not effective. One stenosis was successfully treated with SB (in the case of persistent fistula), but recurrence was observed in the other 2 cases. One of these was solved with CM, and the other one needed a second stent. In the remaining 2 cases (one atresia and one caustic stricture) CM was effective after 1 and 2 sessions respectively. Overall, 5 out of 6 stenosis have been successfully treated (83.3%), and 1 out of 2 fistulas (50%). Conclusions: Association of BS and CM has been effective in the management of RES in children

Management of antithrombotic drugs in association with endoscopic procedures

The use of antithrombotic drugs (anticoagulants and antiplatelets) has increased significantly with our understanding of cardiovascular risk. Encountering patients on these therapies who require an endoscopic procedure is therefore increasingly common. At decision making the endoscopist must rely on other specialists (basically cardiologists and hematologists) as risk not only lies among increased bleeding odds but also in the possibility of thrombosis following dose discontinuation or change. Understanding the pharmacology, indications, and risks of endoscopic procedures is therefore essential if sound decisions are to be made. The efforts of four scientific societies have been brought together to provide clinical answers on the use of antiplatelets and anticoagulants, as well as action algorithms and a practical protocol proposal for endoscopy units

Diagnostic and therapeutic features of small bowel involvement in portal hypertension

Enteropathy is a lesser known complication of portal hypertension and consists of different changes in the mucosal layer of the small bowel which lead to the appearance of vascular and inflammatory lesions. It can be an important co-factor in the development of anemia in the cirrhotic population, and nowadays an easy and non-invasive diagnosis can be made thanks to capsule endoscopy. However, it is rarely considered in the management of patients with portal hypertension. Some aspects such as pathogenesis or incidence remain unclear and no specific recommendations are included in the guidelines regarding diagnosis or treatment. A review of the available literature was performed with regards to the most relevant aspects of this entity