32 research outputs found
Assessment of nutritional status of gastroenterology patients in Croatia [Procjena nutritivnog statusa gastroenteroloŔkih 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 ugljiÄnog dioksida (ECCO2R) u lijeÄenju puerpere sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog bakterijskom upalom pluÄa
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 ugljiÄnog dioksida (ECCO2R) je metoda smanjenja viÅ”ka ugljiÄnog dioksida (CO2) u bolesnika koji su adekvatno oksigenirani putem mehaniÄke ventilacije. Iako je metoda trenutno u eksperimentalnoj fazi, prikazujemo bolesnicu sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog teÅ”kom bakterijskom upalom pluÄa u lijeÄenju koje je spomenuta metoda odabrana i uspjeÅ”no 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 ugljiÄnog dioksida (ECCO2R) u lijeÄenju puerpere sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog bakterijskom upalom pluÄa
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 ugljiÄnog dioksida (ECCO2R) je metoda smanjenja viÅ”ka ugljiÄnog dioksida (CO2) u bolesnika koji su adekvatno oksigenirani putem mehaniÄke ventilacije. Iako je metoda trenutno u eksperimentalnoj fazi, prikazujemo bolesnicu sa sindromom akutnog respiracijskog distresa (ARDS) uzrokovanog teÅ”kom bakterijskom upalom pluÄa u lijeÄenju koje je spomenuta metoda odabrana i uspjeÅ”no primijenjena
Autoimmune pancreatitis
Autoimuni pankreatitis (AIP) prepoznat je kao zaseban kliniÄki entitet u sklopu kroniÄnog
upalnog procesa guÅ”teraÄe Äija je podloga autoimuna bolest. HistoloÅ”ki i kliniÄki razlikuju
se dva tipa AIP-a: tip 1 ā limfoplazmocitni sklerozirajuÄi pankreatitis sa zahvaÄenoÅ”Äu
drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 ā fibroza glavnog guÅ”teraÄnog
kanala s infiltracijom epitela granulocitima. Ovaj oblik pogaÄa mlaÄe ljude, a drugi organski
sustavi obiÄno nisu zahvaÄeni. NajÄeÅ”Äi simptom bolesti je opstruktivni ikterus, dok se
oŔtri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine
i/ili egzokrine disfunkcije guÅ”teraÄe. Iako je antinuklearno antitijelo (ANA) pozitivno
u oko 40 % bolesnika, najosjetljivijim i najspecifiÄnijim markerom danas se joÅ” uvijek smatra
IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potjeÄu s
Mayo klinike ili Azijskih dijagnostiÄkih kriterija. Diferencijalno-dijagnostiÄki najvažnije je iskljuÄiti
karcinom guÅ”teraÄe, endosonografski voÄenom biopsijom. Iako se odliÄan kliniÄki odgovor
postiže primjenom kortikosteroida, Å”to je i dijagnostiÄki vrlo znaÄajno, buduÄi da postoji
mnogo sliÄnosti u kliniÄkoj prezentaciji bolesnika s karcinomom guÅ”teraÄe i AIP-a, joÅ”
uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik
kroniÄne upale guÅ”teraÄe smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno Äe
se u buduÄnosti ÄeÅ”Äe 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 ā 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, thereās 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 ā increasing number of patients having acute recurrence of
pain from autoimmune pancreatitis
Autoimmune pancreatitis
Autoimuni pankreatitis (AIP) prepoznat je kao zaseban kliniÄki entitet u sklopu kroniÄnog
upalnog procesa guÅ”teraÄe Äija je podloga autoimuna bolest. HistoloÅ”ki i kliniÄki razlikuju
se dva tipa AIP-a: tip 1 ā limfoplazmocitni sklerozirajuÄi pankreatitis sa zahvaÄenoÅ”Äu
drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 ā fibroza glavnog guÅ”teraÄnog
kanala s infiltracijom epitela granulocitima. Ovaj oblik pogaÄa mlaÄe ljude, a drugi organski
sustavi obiÄno nisu zahvaÄeni. NajÄeÅ”Äi simptom bolesti je opstruktivni ikterus, dok se
oŔtri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine
i/ili egzokrine disfunkcije guÅ”teraÄe. Iako je antinuklearno antitijelo (ANA) pozitivno
u oko 40 % bolesnika, najosjetljivijim i najspecifiÄnijim markerom danas se joÅ” uvijek smatra
IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potjeÄu s
Mayo klinike ili Azijskih dijagnostiÄkih kriterija. Diferencijalno-dijagnostiÄki najvažnije je iskljuÄiti
karcinom guÅ”teraÄe, endosonografski voÄenom biopsijom. Iako se odliÄan kliniÄki odgovor
postiže primjenom kortikosteroida, Å”to je i dijagnostiÄki vrlo znaÄajno, buduÄi da postoji
mnogo sliÄnosti u kliniÄkoj prezentaciji bolesnika s karcinomom guÅ”teraÄe i AIP-a, joÅ”
uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik
kroniÄne upale guÅ”teraÄe smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno Äe
se u buduÄnosti ÄeÅ”Äe 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 ā 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, thereās 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 ā increasing number of patients having acute recurrence of
pain from autoimmune pancreatitis
Approach to the patient with suspected acute pancreatitis
KliniÄke manifestacije akutnog pankreatitisa Å”irokog su spektra i Äesto predstavljaju
diferencijalno dijagnostiÄki problem. U pristupu bolesniku sa sumnjom na razvoj akutnog
pankreatitisa nužna je iscrpna anamneza i detaljan fizikalni pregled, Ŕto nam uz najmanje
trostruko poveÄanje aktivnosti amilaza i dvostruko poveÄanje aktivnosti lipaza s velikom vjerojatnoÅ”Äu
upuÄuje na razvoj akutne upale guÅ”teraÄe. 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 ā diagnostic and therapeutic approach
Hiponatrijemija je najÄeÅ”Äi poremeÄaj metabolizma tjelesnih tekuÄina i ravnoteže elektrolita u kliniÄkoj praksi. Prisutna je u oko 15 ā 30 % hospitaliziranih pacijenata, a može se oÄitovati Å”irokim spektrom kliniÄkih promjena, od vrlo blagih do po život opasnih. Hiponatrijemija je primarno poremeÄaj ravnoteže vode, obiÄno uz relativni viÅ”ak tjelesne vode u usporedbi s ukupnim tjelesnim sadržajem natrija i kalija. Hiponatrijemija ovisno o vremenu nastanka može biti akutna (< 48 h) ili kroniÄna (ā„ 48 h). S obzirom na vrijednost serumske koncentracije natrija razlikujemo blagu hiponatrijemiju (Na(s) 130 ā 135 mmol/l), zatim umjerenu ili srednje teÅ”ku (Na(s) 125 ā 129 mmol/l) i teÅ”ku hiponatrijemiju (Na(s) < 125 mmol/l). U pristupu pacijentu s hiponatrijemijom od životne je važnosti ustanoviti radi li se o akutnim, teÅ”kim simptomima hiponatrijemije, kako bi se na vrijeme poÄelo s terapijskim mjerama koncentriranom 3 % otopinom NaCl. U sluÄaju izostanka ovih simptoma, dijagnostiÄki algoritam nas usmjerava prema odreÄenim diferencijalno dijagnostiÄkim entitetima ovisno o vrijednosti urinske osmolalnosti i koncentracije Na u urinu, kako bi terapija bila Å”to toÄnija i odgovarajuÄa uzroÄnom faktoru hiponatrijemije.Hyponatraemia is the most frequent disorder of body fluid and electrolyte balance in clinical practice. It is present in 15ā30 % 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 (ā„48 hrs). Regarding serum sodium concentration, hyponatraemia can be mild (Na(s) 130ā135 mmol/l), moderate (Na(s) 125ā129 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 ā diagnostic and therapeutic approach
Hiponatrijemija je najÄeÅ”Äi poremeÄaj metabolizma tjelesnih tekuÄina i ravnoteže elektrolita u kliniÄkoj praksi. Prisutna je u oko 15 ā 30 % hospitaliziranih pacijenata, a može se oÄitovati Å”irokim spektrom kliniÄkih promjena, od vrlo blagih do po život opasnih. Hiponatrijemija je primarno poremeÄaj ravnoteže vode, obiÄno uz relativni viÅ”ak tjelesne vode u usporedbi s ukupnim tjelesnim sadržajem natrija i kalija. Hiponatrijemija ovisno o vremenu nastanka može biti akutna (< 48 h) ili kroniÄna (ā„ 48 h). S obzirom na vrijednost serumske koncentracije natrija razlikujemo blagu hiponatrijemiju (Na(s) 130 ā 135 mmol/l), zatim umjerenu ili srednje teÅ”ku (Na(s) 125 ā 129 mmol/l) i teÅ”ku hiponatrijemiju (Na(s) < 125 mmol/l). U pristupu pacijentu s hiponatrijemijom od životne je važnosti ustanoviti radi li se o akutnim, teÅ”kim simptomima hiponatrijemije, kako bi se na vrijeme poÄelo s terapijskim mjerama koncentriranom 3 % otopinom NaCl. U sluÄaju izostanka ovih simptoma, dijagnostiÄki algoritam nas usmjerava prema odreÄenim diferencijalno dijagnostiÄkim entitetima ovisno o vrijednosti urinske osmolalnosti i koncentracije Na u urinu, kako bi terapija bila Å”to toÄnija i odgovarajuÄa uzroÄnom faktoru hiponatrijemije.Hyponatraemia is the most frequent disorder of body fluid and electrolyte balance in clinical practice. It is present in 15ā30 % 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 (ā„48 hrs). Regarding serum sodium concentration, hyponatraemia can be mild (Na(s) 130ā135 mmol/l), moderate (Na(s) 125ā129 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