Assessment of nutritional status of gastroenterology patients in Croatia [Procjena nutritivnog statusa gastroenteroloških bolesnika u Republici Hrvatskoj]

Malnutrition is a common feature of gastroenterological diseases. In this study, nutritional status of the patients admitted to Department of Gastroenterology at University Hospital Center Zagreb was assessed. Anthropometric, dietetic, biochemical methods and method of Subjective Global Assessment (SGA) was used. The study group included 284 patients admitted to the Hospital. Malnutrition, as defined by SGA, was found in 61.1% of the patients, of whom 75% were moderately and 25% severely malnourished. Those patients classified as moderately and extremely malnourished by SGA were found to have statistically lower values of BMI, albumin, total proteins, calcium, iron, triglycerides, cholesterol, vitamin A and lymphocytes as compared to those who were adequately nourished. The prevalence of malnutrition in hospitalized patients treated at the Department of Gastroenterology is high. The use of nutritional screening with multiple measures would be important in the early identification and treatment of these patients and would help decrease this high prevalence

Ekstrakorporalno uklanjanje ugljičnog dioksida (ECCO2R) u liječenju puerpere sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog bakterijskom upalom pluća

Extracorporeal carbon dioxide removal (ECCO2R) is a method of reducing surplus CO2 levels from patients who are adequately oxygenated via mechanical ventilation. Although the method is currently in an experimental stage, we present a case of acute respiratory distress syndrome (ARDS) caused by severe bacterial pneumonia in which before mentioned method was chosen and successfully utilized.Ekstrakorporalno uklanjanje ugljičnog dioksida (ECCO2R) je metoda smanjenja viška ugljičnog dioksida (CO2) u bolesnika koji su adekvatno oksigenirani putem mehaničke ventilacije. Iako je metoda trenutno u eksperimentalnoj fazi, prikazujemo bolesnicu sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog teškom bakterijskom upalom pluća u liječenju koje je spomenuta metoda odabrana i uspješno primijenjena

Assessment of Nutritional Status of Gastroenterology Patients in Croatia

Malnutrition is a common feature of gastroenterological diseases. In this study, nutritional status of the patients admitted to Department of Gastroenterology at University Hospital Center Zagreb was assessed. Anthropometric, dietetic, biochemical methods and method of Subjective Global Assessment (SGA) was used. The study group included 284 patients admitted to the Hospital. Malnutrition, as defined by SGA, was found in 61.1% of the patients, of whom 75% were moderately and 25% severely malnourished. Those patients classified as moderately and extremely malnourished by SGA were found to have statistically lower values of BMI, albumin, total proteins, calcium, iron, triglycerides, cholesterol, vitamin A and lymphocytes as compared to those who were adequately nourished. The prevalence of malnutrition in hospitalized patients treated at the Department of Gastroenterology is high. The use of nutritional screening with multiple measures would be important in the early identification and treatment of these patients and would help decrease this high prevalence

Ekstrakorporalno uklanjanje ugljičnog dioksida (ECCO2R) u liječenju puerpere sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog bakterijskom upalom pluća

Extracorporeal carbon dioxide removal (ECCO2R) is a method of reducing surplus CO2 levels from patients who are adequately oxygenated via mechanical ventilation. Although the method is currently in an experimental stage, we present a case of acute respiratory distress syndrome (ARDS) caused by severe bacterial pneumonia in which before mentioned method was chosen and successfully utilized.Ekstrakorporalno uklanjanje ugljičnog dioksida (ECCO2R) je metoda smanjenja viška ugljičnog dioksida (CO2) u bolesnika koji su adekvatno oksigenirani putem mehaničke ventilacije. Iako je metoda trenutno u eksperimentalnoj fazi, prikazujemo bolesnicu sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog teškom bakterijskom upalom pluća u liječenju koje je spomenuta metoda odabrana i uspješno primijenjena

Autoimmune pancreatitis

Autoimuni pankreatitis (AIP) prepoznat je kao zaseban klinički entitet u sklopu kroničnog upalnog procesa gušterače čija je podloga autoimuna bolest. Histološki i klinički razlikuju se dva tipa AIP-a: tip 1 – limfoplazmocitni sklerozirajući pankreatitis sa zahvaćenošću drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 – fibroza glavnog gušteračnog kanala s infiltracijom epitela granulocitima. Ovaj oblik pogađa mlađe ljude, a drugi organski sustavi obično nisu zahvaćeni. Najčešći simptom bolesti je opstruktivni ikterus, dok se oštri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine i/ili egzokrine disfunkcije gušterače. Iako je antinuklearno antitijelo (ANA) pozitivno u oko 40 % bolesnika, najosjetljivijim i najspecifičnijim markerom danas se još uvijek smatra IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potječu s Mayo klinike ili Azijskih dijagnostičkih kriterija. Diferencijalno-dijagnostički najvažnije je isključiti karcinom gušterače, endosonografski vođenom biopsijom. Iako se odličan klinički odgovor postiže primjenom kortikosteroida, što je i dijagnostički vrlo značajno, budući da postoji mnogo sličnosti u kliničkoj prezentaciji bolesnika s karcinomom gušterače i AIP-a, još uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik kronične upale gušterače smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno će se u budućnosti češće postaviti dijagnoza autoimunog pankreatitisa u bolesnika s akutnim rekuretnim bolovima u trbuhu nejasne etiologije.Autoimmune pancreatitis (AIP) is recognised as a distinct clinical entity, identified as a chronic inflammatory process of the pancreas in which the autoimmune mechanism is involved. Histologycally and clinically we can differ two subsets: type 1 – lymphoplasmacytic sclerosing pancreatitis with other organ involvement and IgG4 positive cells infiltration and type 2- duct centric fibrosis, characterised by granulocyte epithelial lesions without systemic involvement, mostly in younger people. The major symptom at onset is obstructive jaundice, while severe abdominal pain is rare. About half patients with AIP have shown endocrine and exocrine disfunctions. The positive rate of antinuclear antibody is about 40 %, but the most sensitive and specific serologycal marker today is still IgG4. In the diagnosis of AIP two diagnostic criterions are used: the HISORt criteria (Mayo Clinic) and Asian diagnostic criteria. In differential diagnosis it is most importanat to exclude pancreatic cancer by endosonographically guided biopsy. Although high steroid responsiveness has a significant impact on the diagnosis of AIP, since patients with pancreatic cancer and AIP share many clinical features, there’s still no standardised steroid regimen. Even though the frequency of this disease seems to be quite low, by increasing knowledge on this subject in the future it will be possible to diagnose ever – increasing number of patients having acute recurrence of pain from autoimmune pancreatitis

Autoimmune pancreatitis

Autoimuni pankreatitis (AIP) prepoznat je kao zaseban klinički entitet u sklopu kroničnog upalnog procesa gušterače čija je podloga autoimuna bolest. Histološki i klinički razlikuju se dva tipa AIP-a: tip 1 – limfoplazmocitni sklerozirajući pankreatitis sa zahvaćenošću drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 – fibroza glavnog gušteračnog kanala s infiltracijom epitela granulocitima. Ovaj oblik pogađa mlađe ljude, a drugi organski sustavi obično nisu zahvaćeni. Najčešći simptom bolesti je opstruktivni ikterus, dok se oštri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine i/ili egzokrine disfunkcije gušterače. Iako je antinuklearno antitijelo (ANA) pozitivno u oko 40 % bolesnika, najosjetljivijim i najspecifičnijim markerom danas se još uvijek smatra IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potječu s Mayo klinike ili Azijskih dijagnostičkih kriterija. Diferencijalno-dijagnostički najvažnije je isključiti karcinom gušterače, endosonografski vođenom biopsijom. Iako se odličan klinički odgovor postiže primjenom kortikosteroida, što je i dijagnostički vrlo značajno, budući da postoji mnogo sličnosti u kliničkoj prezentaciji bolesnika s karcinomom gušterače i AIP-a, još uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik kronične upale gušterače smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno će se u budućnosti češće postaviti dijagnoza autoimunog pankreatitisa u bolesnika s akutnim rekuretnim bolovima u trbuhu nejasne etiologije.Autoimmune pancreatitis (AIP) is recognised as a distinct clinical entity, identified as a chronic inflammatory process of the pancreas in which the autoimmune mechanism is involved. Histologycally and clinically we can differ two subsets: type 1 – lymphoplasmacytic sclerosing pancreatitis with other organ involvement and IgG4 positive cells infiltration and type 2- duct centric fibrosis, characterised by granulocyte epithelial lesions without systemic involvement, mostly in younger people. The major symptom at onset is obstructive jaundice, while severe abdominal pain is rare. About half patients with AIP have shown endocrine and exocrine disfunctions. The positive rate of antinuclear antibody is about 40 %, but the most sensitive and specific serologycal marker today is still IgG4. In the diagnosis of AIP two diagnostic criterions are used: the HISORt criteria (Mayo Clinic) and Asian diagnostic criteria. In differential diagnosis it is most importanat to exclude pancreatic cancer by endosonographically guided biopsy. Although high steroid responsiveness has a significant impact on the diagnosis of AIP, since patients with pancreatic cancer and AIP share many clinical features, there’s still no standardised steroid regimen. Even though the frequency of this disease seems to be quite low, by increasing knowledge on this subject in the future it will be possible to diagnose ever – increasing number of patients having acute recurrence of pain from autoimmune pancreatitis

Approach to the patient with suspected acute pancreatitis

Kliničke manifestacije akutnog pankreatitisa širokog su spektra i često predstavljaju diferencijalno dijagnostički problem. U pristupu bolesniku sa sumnjom na razvoj akutnog pankreatitisa nužna je iscrpna anamneza i detaljan fizikalni pregled, što nam uz najmanje trostruko povećanje aktivnosti amilaza i dvostruko povećanje aktivnosti lipaza s velikom vjerojatnošću upućuje na razvoj akutne upale gušterače. Nužno je potom procijeniti težinu akutnog pankreatitisa, kako bismo pravovremeno prepoznali one bolesnika kojima je neophodna 24-satna intenzivna skrb, a u svrhu smanjenja njihova mortaliteta.Clinical manifestations of acute pancreatitis are of wide spectra, and often represent diferential diagnostic problem. Bad prognosis and high costs of treatment demand early diagnosis and adequate treatment. In the approach to the patient with suspected acute pancreatitis the most important are detailed medical history and physical examination which together with suggestive laboratory findings points the diagnosis of acute pancreatitis. Early diagnosis can prevent the development of local and/or systemic complications and reduce mortallity

Assessment of Nutritional Status of Gastroenterology Patients in Croatia

Malnutrition is a common feature of gastroenterological diseases. In this study, nutritional status of the patients admitted to Department of Gastroenterology at University Hospital Center Zagreb was assessed. Anthropometric, dietetic, biochemical methods and method of Subjective Global Assessment (SGA) was used. The study group included 284 patients admitted to the Hospital. Malnutrition, as defined by SGA, was found in 61.1% of the patients, of whom 75% were moderately and 25% severely malnourished. Those patients classified as moderately and extremely malnourished by SGA were found to have statistically lower values of BMI, albumin, total proteins, calcium, iron, triglycerides, cholesterol, vitamin A and lymphocytes as compared to those who were adequately nourished. The prevalence of malnutrition in hospitalized patients treated at the Department of Gastroenterology is high. The use of nutritional screening with multiple measures would be important in the early identification and treatment of these patients and would help decrease this high prevalence

Hyponatraemia – diagnostic and therapeutic approach

Hiponatrijemija je najčešći poremećaj metabolizma tjelesnih tekućina i ravnoteže elektrolita u kliničkoj praksi. Prisutna je u oko 15 – 30 % hospitaliziranih pacijenata, a može se očitovati širokim spektrom kliničkih promjena, od vrlo blagih do po život opasnih. Hiponatrijemija je primarno poremećaj ravnoteže vode, obično uz relativni višak tjelesne vode u usporedbi s ukupnim tjelesnim sadržajem natrija i kalija. Hiponatrijemija ovisno o vremenu nastanka može biti akutna (< 48 h) ili kronična (≥ 48 h). S obzirom na vrijednost serumske koncentracije natrija razlikujemo blagu hiponatrijemiju (Na(s) 130 – 135 mmol/l), zatim umjerenu ili srednje tešku (Na(s) 125 – 129 mmol/l) i tešku hiponatrijemiju (Na(s) < 125 mmol/l). U pristupu pacijentu s hiponatrijemijom od životne je važnosti ustanoviti radi li se o akutnim, teškim simptomima hiponatrijemije, kako bi se na vrijeme počelo s terapijskim mjerama koncentriranom 3 % otopinom NaCl. U slučaju izostanka ovih simptoma, dijagnostički algoritam nas usmjerava prema određenim diferencijalno dijagnostičkim entitetima ovisno o vrijednosti urinske osmolalnosti i koncentracije Na u urinu, kako bi terapija bila što točnija i odgovarajuća uzročnom faktoru hiponatrijemije.Hyponatraemia is the most frequent disorder of body fluid and electrolyte balance in clinical practice. It is present in 15–30 % of hospitalized patients and can be manifested with a wide spectrum of clinical symptoms, ranging from very subtle to life threatening. Hyponatraemia is primarily a disbalance in water equilibrium, usually manifested as relative water overload in comparison to total body sodium and potassium concentration. Based on the time of development hyponatraemia can be defined as acute (< 48hrs) or chronic (≥48 hrs). Regarding serum sodium concentration, hyponatraemia can be mild (Na(s) 130–135 mmol/l), moderate (Na(s) 125–129 mmol/l) or profound (Na(s) < 125 mmol/l). When approaching a patient with hyponatraemia it is essential to determine whether hyponatraemia is acute or profound so we could immediately start giving a patient 3 % hypertonic saline. In absence of the above mentioned, the diagnostic algorithm, with emphasis on urine osmolality and urine sodium concentration, is guiding us towards more specific disorders which define proper therapeutic approach

Hyponatraemia – diagnostic and therapeutic approach

Hiponatrijemija je najčešći poremećaj metabolizma tjelesnih tekućina i ravnoteže elektrolita u kliničkoj praksi. Prisutna je u oko 15 – 30 % hospitaliziranih pacijenata, a može se očitovati širokim spektrom kliničkih promjena, od vrlo blagih do po život opasnih. Hiponatrijemija je primarno poremećaj ravnoteže vode, obično uz relativni višak tjelesne vode u usporedbi s ukupnim tjelesnim sadržajem natrija i kalija. Hiponatrijemija ovisno o vremenu nastanka može biti akutna (< 48 h) ili kronična (≥ 48 h). S obzirom na vrijednost serumske koncentracije natrija razlikujemo blagu hiponatrijemiju (Na(s) 130 – 135 mmol/l), zatim umjerenu ili srednje tešku (Na(s) 125 – 129 mmol/l) i tešku hiponatrijemiju (Na(s) < 125 mmol/l). U pristupu pacijentu s hiponatrijemijom od životne je važnosti ustanoviti radi li se o akutnim, teškim simptomima hiponatrijemije, kako bi se na vrijeme počelo s terapijskim mjerama koncentriranom 3 % otopinom NaCl. U slučaju izostanka ovih simptoma, dijagnostički algoritam nas usmjerava prema određenim diferencijalno dijagnostičkim entitetima ovisno o vrijednosti urinske osmolalnosti i koncentracije Na u urinu, kako bi terapija bila što točnija i odgovarajuća uzročnom faktoru hiponatrijemije.Hyponatraemia is the most frequent disorder of body fluid and electrolyte balance in clinical practice. It is present in 15–30 % of hospitalized patients and can be manifested with a wide spectrum of clinical symptoms, ranging from very subtle to life threatening. Hyponatraemia is primarily a disbalance in water equilibrium, usually manifested as relative water overload in comparison to total body sodium and potassium concentration. Based on the time of development hyponatraemia can be defined as acute (< 48hrs) or chronic (≥48 hrs). Regarding serum sodium concentration, hyponatraemia can be mild (Na(s) 130–135 mmol/l), moderate (Na(s) 125–129 mmol/l) or profound (Na(s) < 125 mmol/l). When approaching a patient with hyponatraemia it is essential to determine whether hyponatraemia is acute or profound so we could immediately start giving a patient 3 % hypertonic saline. In absence of the above mentioned, the diagnostic algorithm, with emphasis on urine osmolality and urine sodium concentration, is guiding us towards more specific disorders which define proper therapeutic approach