Assuntos
Colite Ulcerativa , Colite Ulcerativa/tratamento farmacológico , Humanos , Indanos , OxidiazóisAssuntos
Doença de Crohn , Nutrição Enteral , Estudos de Coortes , Alimentos Formulados , Humanos , Indução de RemissãoRESUMO
Iron overload disorders represent a variety of conditions that lead to increased total body iron stores and resultant end-organ damage. An elevated ferritin and transferrin-iron saturation can be commonly encountered in the evaluation of elevated liver enzymes. Confirmatory homeostatic iron regulator (HFE) genetic testing for C282Y and H63D, mutations most encountered in hereditary hemochromatosis, should be pursued in evaluation of hyperferritinemia. Magnetic resonance imaging with quantitative assessment of iron content or liver biopsy (especially if liver disease is a cause of iron overload) should be used as appropriate. A secondary cause for iron overload should be considered if HFE genetic testing is negative for the C282Y homozygous or C282Y/H63D compound heterozygous mutations. Differential diagnosis of secondary iron overload includes hematologic disorders, iatrogenic causes, or chronic liver diseases. More common hematologic disorders include thalassemia syndromes, myelodysplastic syndrome, myelofibrosis, sideroblastic anemias, sickle cell disease, or pyruvate kinase deficiency. If iron overload has been excluded, evaluation for causes of hyperferritinemia should be pursued. Causes of hyperferritinemia include chronic liver disease, malignancy, infections, kidney failure, and rheumatic conditions, such as adult-onset Still's disease or hemophagocytic lymphohistiocytosis. In this review, we describe the diagnostic testing of patients with suspected hereditary hemochromatosis, the evaluation of patients with elevated serum ferritin levels, and signs of secondary overload and treatment options for those with secondary iron overload.
Assuntos
Hemocromatose , Hiperferritinemia , Sobrecarga de Ferro , Hepatopatias , Adulto , Hemocromatose/diagnóstico , Proteína da Hemocromatose , Antígenos de Histocompatibilidade Classe I/genética , Humanos , Ferro , Sobrecarga de Ferro/diagnóstico , Hepatopatias/diagnóstico , Proteínas de Membrana/genéticaRESUMO
Foreign body ingestion is common in patients with psychiatric diagnoses. Ingested objects can become impacted in the upper and lower gastrointestinal tract, causing serious complications. We report a case of a schizophrenic who ingested large pieces of computer circuit boards, which impacted at the mid-esophagus, in the stomach, and in the cecum. Endoscopic removal of the esophageal object was unsuccessful, and the foreign objects were removed by esophagotomy and laparotomy. Expeditious removal through endoscopic or surgical means is extremely important, as complications can be life-threatening. This is the first report of ingestion of a computer printed circuit board.