Biliary Tract Injuries

Injuries of the biliary system are rare. They can broadly be divided into traumatic biliary injuries and iatrogenic biliary injuries. Former are usually part of associated abdominal trauma, blunt or penetrating, and latter are consequence of surgical, endoscopic or invasive radiological diagnostic or therapeutic procedures done in various liver, pancreatic or disorders or the part of upper gastrointestinal system. They occur more commonly than traumatic injuries but still are rare. Those injuries represent important aspect in healthcare system because of their complexity and diversity in management, associated morbidity and mortality and expenditure in healthcare systems. This chapter will put focus on those injuries, including their classification, etiology and mechanism of occurrence, clinical presentation, diagnosis, treatment options, postoperative complications, and, when iatrogenic injuries are concerned, methods for prevention of those injuries

Colon examination with colon capsule

Endoskopija videokapsulom, VCE (prema engl. Video Capsule Endoscopy), postala je prva slikovna metoda za pregled cjelokupnog tankog crijeva. Prvi službeni pregled kapsulom učinjen je 2001. godine. Kapsula za pregled debelog crijeva najnovije je tehnološko dostignuće koje omogućava pregled tog dijela crijeva bez bolnosti i neugode. Najznačajnija indikacija za pregled je probir za kolorektalni karcinom. Prema do sada objavljenim studijama videokapsulska endoskopija za pregled debelog crijeva pruža zadovoljavajuću razinu pouzdanosti za otkrivanje polipa debelog crijeva, poglavito onih iznad 6 mm veličine. Ograničavajući čimbenici su još uvijek relativno visoka cijena te ovisnost o idealnoj očišćenosti crijeva.Video Capsule Endoscopy (VCE) has become the first imaging method for the complete examination of small bowel. The first official capsule examination was done in 2001. Colon capsule is the latest advance in capsule technology which provides painless examination of the colon. The main indication for this method is colorectal screening. According to the current published data colon capsule is a reliable tool for detecting colon polyps, especially those larger than 6 mm. Limiting factors are relatively high price and dependence on ideal colon preparation

Obesity and Gut Microbiota

Crijevna mikrobiota jest pojam koji se odnosi na cijelu populaciju mikroorganizama što koloniziraju određeno mjesto u probavnom traktu i uključuje ne samo bakterije već i druge mikrobe kao što su gljive, arheje, virusi i protozoe. Zdrava crijevna mikrobiota uglavnom se sastoji od Phyla firmicutes i bacteroidetes. Crijevna mikrobiota i njezina uloga u etiologiji debljine novo je područje istraživanja kojim se pokušava objasniti višak akumulacije energije u pretilih osoba, a može biti i potencijalni cilj terapeutske manipulacije za smanjenje skladištenja energije domaćina. Nekoliko je mehanizama predloženo kako bi se objasnila uloga crijevne mikrobiote u etiologiji pretilosti kao što su produkcija kratkolančanih masnih kiselina, stimulacija hormona, kronična upala niskog stupnja i sinteza specifčnih lipoproteina. Dokazi iz pokusa na životinjama sugeriraju da bi primjena probiotika mogla smanjiti dobiveni udio masti kao odgovor na prehranu s visokim udjelom masti (HFD). Pokazalo se da dodatak probiotika s Lactobacillus curvatus HY7601, Lactobacillus plantarum KY1032, Pediococcus pentosaceus LP28 i Lactobacillus rhamnosus GG utječe na smanjenje nastanka masnog tkiva i količine triglicerida u plazmi uz povećanje osjetljivosti na inzulin. Dokazi iz životinjskih i humanih studija upućuju na prijepore u određivanju uzročno-posljedičnog odnosa između crijevne mikrobiote i pretilosti.Gut microbiota refers to the entire population of microorganisms that colonize a specific location in the digestive tract. It includes not only bacteria, but also other microbes such as fungi, archaea, viruses and protozoa. Healthy gut microbiota comprises mostly of Phyla firmicutes and bacteroidetes. Gut microbiota and its role in the aetiology of obesity is a new area of research that is trying to explain the excess energy accumulation in obese people. Microbiota can also be a potential target of therapeutic manipulation aimed at reducing energy storage in the host. Several mechanisms have been proposed to explain the role of gut microbiota in the aetiology of obesity, including short-chain fatty acid production, hormone stimulation, chronic low-grade inZammation and specific lipoprotein synthesis. Evidence from animal testing suggests that the use of probiotics could reduce the amount of fat gained as a result of a high-fat diet (HFD). Probiotic supplements with Lactobacillus curvatus HY7601, Lactobacillus plantarum KY1032, Pediococcus pentosaceus LP28 and Lactobacillus rhamnosus GG have reduced adipose tissue accumulation and plasma triglyceride levels and have improved insulin sensitivity. Evidence from animal and human studies indicates controversies in determining the cause and eect relationship between gut microbiota and obesity

Colon examination with colon capsule

Endoskopija videokapsulom, VCE (prema engl. Video Capsule Endoscopy), postala je prva slikovna metoda za pregled cjelokupnog tankog crijeva. Prvi službeni pregled kapsulom učinjen je 2001. godine. Kapsula za pregled debelog crijeva najnovije je tehnološko dostignuće koje omogućava pregled tog dijela crijeva bez bolnosti i neugode. Najznačajnija indikacija za pregled je probir za kolorektalni karcinom. Prema do sada objavljenim studijama videokapsulska endoskopija za pregled debelog crijeva pruža zadovoljavajuću razinu pouzdanosti za otkrivanje polipa debelog crijeva, poglavito onih iznad 6 mm veličine. Ograničavajući čimbenici su još uvijek relativno visoka cijena te ovisnost o idealnoj očišćenosti crijeva.Video Capsule Endoscopy (VCE) has become the first imaging method for the complete examination of small bowel. The first official capsule examination was done in 2001. Colon capsule is the latest advance in capsule technology which provides painless examination of the colon. The main indication for this method is colorectal screening. According to the current published data colon capsule is a reliable tool for detecting colon polyps, especially those larger than 6 mm. Limiting factors are relatively high price and dependence on ideal colon preparation

Obesity and Gut Microbiota

Crijevna mikrobiota jest pojam koji se odnosi na cijelu populaciju mikroorganizama što koloniziraju određeno mjesto u probavnom traktu i uključuje ne samo bakterije već i druge mikrobe kao što su gljive, arheje, virusi i protozoe. Zdrava crijevna mikrobiota uglavnom se sastoji od Phyla firmicutes i bacteroidetes. Crijevna mikrobiota i njezina uloga u etiologiji debljine novo je područje istraživanja kojim se pokušava objasniti višak akumulacije energije u pretilih osoba, a može biti i potencijalni cilj terapeutske manipulacije za smanjenje skladištenja energije domaćina. Nekoliko je mehanizama predloženo kako bi se objasnila uloga crijevne mikrobiote u etiologiji pretilosti kao što su produkcija kratkolančanih masnih kiselina, stimulacija hormona, kronična upala niskog stupnja i sinteza specifčnih lipoproteina. Dokazi iz pokusa na životinjama sugeriraju da bi primjena probiotika mogla smanjiti dobiveni udio masti kao odgovor na prehranu s visokim udjelom masti (HFD). Pokazalo se da dodatak probiotika s Lactobacillus curvatus HY7601, Lactobacillus plantarum KY1032, Pediococcus pentosaceus LP28 i Lactobacillus rhamnosus GG utječe na smanjenje nastanka masnog tkiva i količine triglicerida u plazmi uz povećanje osjetljivosti na inzulin. Dokazi iz životinjskih i humanih studija upućuju na prijepore u određivanju uzročno-posljedičnog odnosa između crijevne mikrobiote i pretilosti.Gut microbiota refers to the entire population of microorganisms that colonize a specific location in the digestive tract. It includes not only bacteria, but also other microbes such as fungi, archaea, viruses and protozoa. Healthy gut microbiota comprises mostly of Phyla firmicutes and bacteroidetes. Gut microbiota and its role in the aetiology of obesity is a new area of research that is trying to explain the excess energy accumulation in obese people. Microbiota can also be a potential target of therapeutic manipulation aimed at reducing energy storage in the host. Several mechanisms have been proposed to explain the role of gut microbiota in the aetiology of obesity, including short-chain fatty acid production, hormone stimulation, chronic low-grade inZammation and specific lipoprotein synthesis. Evidence from animal testing suggests that the use of probiotics could reduce the amount of fat gained as a result of a high-fat diet (HFD). Probiotic supplements with Lactobacillus curvatus HY7601, Lactobacillus plantarum KY1032, Pediococcus pentosaceus LP28 and Lactobacillus rhamnosus GG have reduced adipose tissue accumulation and plasma triglyceride levels and have improved insulin sensitivity. Evidence from animal and human studies indicates controversies in determining the cause and eect relationship between gut microbiota and obesity

Cochrane group from Rijeka – review of activities and results

Dugogodišnja suradnja riječkih gastroenterologa sa specifičnim grupama u sklopu Cochrane kolaboracije rezultirala je značajnim napretkom na polju znanstveno-istraživačke djelatnosti i brojnim publikacijama. Spoznaje i zaključci dosegnuti u Cochrane sustavnim pregledima predstavljaju pouzdane stručne dokaze u raznim područjima gastroenterologije, posebno kronične hepatitis C infekcije, kolestatskih bolesti jetre i akutnog pankreatitisa. Navedene publikacije visoko su citirani radovi, koji su implementirani i u nekim međunarodnim smjernicama, odnosno preporukama liječenja. Doprinosom riječke Cochrane grupe otvorena su vrata suradnje s brojnim inozemnim stručnjacima i suradnicima, pokrenuto je organiziranje tečajeva medicine temeljene na dokazima i unaprijeđena je suradnja s Hrvatskim Cochrane centrom te drugim domaćim znanstvenicima. Ovaj pregledni članak predstavlja pregled dosadašnjih postignuća riječkih autora u sklopu Cochrane kolaboracije uz sažeti prikaz najznačajnijih rezultata i zaključaka u objavljenim Cochrane sustavnim pregledima s ciljem upoznavanja javnosti s mogućnostima rada u Cochrane kolaboraciji i vrstom znanstveno-istraživačke djelatnosti koja se u sklopu iste provodi te promocije i popularizacije medicine temeljene na dokazima u široj znanstvenoj i stručnoj zajednici.The long-term cooperation of gastroenterologists from Rijeka with specific groups within the Cochrane Collaboration has resulted in significant progress in the field of scientific research and numerous publications. The findings and conclusions reached in the published Cochrane systematic reviews represent reliable evidence in various gastroenterology fields, particularly chronic hepatitis C infection, cholestatic liver disease and acute pancreatitis. The aforementioned publications are highly quoted papers, which are cited in different international guidelines and treatment recommendations. With the contribution of authors from Rijeka, a door to cooperation with several foreign experts and associates has been opened, courses in evidence-based medicine have been organized, and the collaboration with the Croatian Cochrane Center and other domestic scientists has been enhanced. This review article presents an overiew of the achievements of authors from Rijeka within the Cochrane Collaboration with a summary of the most important results and conclusions from the systematic reviews aiming to inform the public of the opportunities given by the Cochrane Collaboration and the type of scientific research implemented by it, as well as, to promote and popularize evidence-based medicine in a broad scientific and professional community

Clinical Utility of Red Cell Distribution Width in Alcoholic and Non-alcoholic Liver Cirrhosis

Red blood cell distribution width (RDW) is a measure of the variation of red blood cell width that is reported as a part of standard complete blood count. Red blood cell distribution width results are often used together with mean corpuscular volume (MCV) results to figure out mixed anemia. The aim of our study was to compare the values of RDW in alcoholic and non-alcoholic liver cirrhosis and to determine if RDW follows the severity of disease according to Child-Pugh score. We retrospectively analyzed 241 patients (176 men and 65 women) with liver cirrhosis and anemia, defined as a hemoglobin value <130 g/L in men and <120 g/L in women, which were hospitalized in our Division in a period between 2006 and 2008. Patients were divided in two groups; in first were patients with alcoholic liver cirrhosis, and in second with non-alcoholic cirrhosis. Severity of disease was determined according to Child-Pugh score. Red blood cells distribution width Normal reference range is 11–15%. Alcoholic liver cirrhosis had 204 patients (85%) while non-alcoholic cirrhosis had 37 patients (15%). In group of alcoholic cirrhosis the average RDW was 16.8%. In relation to severity of disease the average RDW for Child-Pugh A was 16.80%, for Child-Pugh B was 16.92%, for Child-Pugh C was 17.10%. In the group of non-alcoholic cirrhosis the average RDW was 16.73% and in relation to severity of disease for Child-Pugh A was 16.25%, for Child-Pugh B 17.01% and for Child-Pugh C was 16.87%. We didn’t find statistically significant difference of RDW between alcoholic and non alcoholic cirrhosis (p>0.05) and we didn’t proved any statistically significant increase of RDW in relation to severity of disease in group of alcoholic cirrhosis (p=0.915) nor in group of patients with non-alcoholic cirrhosis (p=0.697). Our study showed that RDW had not any clinical value in differentiation of anemia neither in alcoholic and non-alcoholic liver cirrhosis nor in severity of liver disease