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3.
Gastroenterol. hepatol. (Ed. impr.) ; 42(10): 657-676, dic. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188200

RESUMO

La enfermedad hepática alcohólica (EHA) es la causa más prevalente de enfermedad hepática avanzada y cirrosis hepática en Europa incluyendo a España. De acuerdo con la Organización Mundial de la Salud la fracción de cirrosis hepática atribuible al uso de alcohol en España es del 73,8% entre varones y del 56,3% entre mujeres. La EHA incluye diversos estadios como la esteatohepatitis, la cirrosis y el cáncer hepatocelular. Además, enfermos con EHA de base e ingesta abundante de alcohol pueden desarrollar hepatitis alcohólica, que cursa con una elevada mortalidad. Hasta la fecha, el único tratamiento efectivo para tratar la EHA es la abstinencia prolongada. No existen tratamientos específicos, y el único tratamiento que aumenta la esperanza de vida en la hepatitis alcohólica es la prednisolona. Para enfermos con hepatitis alcohólica que no responden al tratamiento, algunos centros ofrecen la posibilidad de un trasplante precoz. Estas guías de práctica clínica tienen como objetivo proponer recomendaciones sobre la EHA teniendo en cuenta su relevancia como causa de hepatopatía crónica avanzada y cirrosis hepática en nuestro medio. En el presente trabajo se propone como objetivo responder las preguntas claves para la práctica clínica de Gastroenterología, Hepatología, así como de Medicina Interna y centros de salud primaria, poniendo al servicio del profesional de la salud la información más actualizada respecto al manejo y tratamiento de la EHA. Estas guías proporcionan recomendaciones basadas en la evidencia para el manejo clínico de esta enfermedad


Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hepatite Alcoólica/epidemiologia , Consenso , Hepatopatias/epidemiologia , Alcoolismo/epidemiologia , Espanha/epidemiologia , Hepatopatias/diagnóstico , Hepatopatias/terapia , Saúde Pública , História Natural , Cirrose Hepática/complicações , Fatores de Risco
5.
Pediatr. aten. prim ; 21(82): 187-190, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184598

RESUMO

La presencia de calcificaciones hepáticas fetales puede ser advertida durante el seguimiento ecográfico gestacional. Pueden ser únicas o múltiples, y estar asociadas o no a problemas tales como infecciones connatales o cromosomopatías. Aquellas lesiones aisladas, sin otras alteraciones asociadas, tienen buen pronóstico y cursan en la mayoría de las ocasiones de forma asintomática. Comunicamos dos casos clínicos de pacientes con calcificaciones hepáticas congénitas múltiples. Se revisa el manejo y el pronóstico de esta patología


Fetal hepatic calcifications may be noticed during gestational ultrasound follow-up. They may be unique or multiple, and may be associated with or without problems such as chromosomopaties or prenatal infections. Isolated lesions have a good prognosis and are most often asymptomatic. We communicate two clinical cases of patients with multiple congenital hepatic calcifications. The management and prognosis of this pathology is reviewed


Assuntos
Humanos , Masculino , Lactente , Calcinose/diagnóstico , Hepatopatias/congênito , Diagnóstico Diferencial , Diagnóstico Pré-Natal/métodos
7.
Med. oral patol. oral cir. bucal (Internet) ; 24(3): e392-e397, mayo 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185649

RESUMO

Background: This study aimed to explore the associations between health-related quality of life and work ability with the oral health status of patients with chronic liver disease. Material and Methods: A cross-sectional study included 150 patients with chronic liver disease, consecutively seen at University Hospital, Salvador, Brazil. Oral health was evaluated by the Decayed, Missing, and Filled Teeth (DMFT) index and by the presence of gingivitis and periodontitis. Salivary flow was "reduced" when <1.0 mL/min. Health-related quality of life was evaluated by using the 36-Item Short Form Health Survey questionnaire (SF-36); work ability was evaluated by the Work Ability Index questionnaire. Results: All health-related quality of life indicators were systematically lower among the 99 patients with reduced salivary flow than among the 51 patients with normal salivary flow. Physical Functioning, Role-Physical, and Physical Component Summary scores were strongly correlated (P < 0.005 or less) with the number of Missing Teeth and with DMFT index. Reduced salivary flow was associated (P < 0.05) with poor work ability. Patients with poor or moderate work ability presented higher (P < 0.001) means of the DMFT index than those with good or excellent work ability. Conclusions: Patients with chronic liver disease who present poor oral health presented low health-related quality of life and poor work ability. These findings reinforce the need of these patients for specialized stomatological care


No disponible


Assuntos
Humanos , Hepatopatias , Saúde Bucal , Brasil , Estudos Transversais , Qualidade de Vida , Avaliação da Capacidade de Trabalho
10.
Gastroenterol. hepatol. (Ed. impr.) ; 42(2): 127-132, feb. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-182108

RESUMO

Aim: This research was conducted to obtain accurate information on the protective effects of Portulaca oleracea L. against hepatogastric diseases. Results: P. oleracea L. (Purslane) has traditionally been used for the treatment of hepatogastric diseases. However, the low number of research studies has shown that P. oleracea L. possesses protective effects against hepatotoxic agents. The safety of P. oleracea L. has been demonstrated in several clinical trials. Conclusion: Modern pharmacological studies have indicated the gastroprotective and hepatoprotective effects of P. oleracea L. by using in vivo and in vitro models. However, due to lack of information of its effects in humans, more studies should be conducted to confirm the efficacy of P. oleracea L. in humans


Objetivo: Se realizó esta investigación para disponer de información precisa sobre los efectos protectores de Portulaca oleracea L. frente a enfermedades hepatogástricas. Resultados: Portulaca oleracea L. (Purslane) se ha utilizado tradicionalmente para el tratamiento de enfermedades hepatogástricas. Sin embargo, las investigaciones limitadas han demostrado que Portulaca oleracea L. posee efectos protectores frente a sustancias hepatotóxicas. Varios ensayos clínicos han demostrado la seguridad de Portulaca oleracea L. Conclusión: Estudios farmacológicos modernos han revelado los efectos gastroprotectores y hepatoprotectores de Portulaca oleracea L. mediante el uso de modelos in vivo e in vitro. Sin embargo, debido a la falta de información sobre sus efectos en el ser humano, se deben realizar más estudios para confirmar la eficacia de Portulaca oleracea L. en el ser humano


Assuntos
Humanos , Animais , Hepatopatias/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Portulaca , Gastropatias/tratamento farmacológico
13.
Gastroenterol. hepatol. (Ed. impr.) ; 41(9): 544-552, nov. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178115

RESUMO

INTRODUCCIÓN: La hepatitis autoinmune (HAI) con características de colangitis biliar primaria (CBP) es conocida como síndrome de superposición. Su prevalencia y pronóstico aún no han sido determinados comparativamente con aquellos con HAI. MÉTODOS: Se realizó un estudio de cohorte retrospectiva comparando pacientes con diagnóstico de HAI y síndrome de superposición por HAI-CBP, seguidos por 7años en un hospital universitario de Colombia, hasta el 31 de diciembre de 2016. RESULTADOS: Se incluyeron 210 pacientes (195 mujeres, edad media 48,5 años), de los cuales 32 (15,2%) tenían síndrome de superposición HAI-CBP. Al diagnóstico no se hallaron diferencias significativas por perfil demográfico, autoanticuerpos positivos (ANA, ASMA) excepto AMA (81,2% vs 3,9%; p < 0,001) y grado histológico de fibrosis. La presentación clínica más frecuente en HAI-CBP fueron síntomas inespecíficos y en HAI, hepatitis aguda. Aunque con diferencias no significativas, en HAI se presentó mayor respuesta bioquímica al manejo inmunosupresor (87,3% vs 74,2%; p = 0,061) y mayor número de recaídas en quienes lograron remisión parcial o completa durante tratamiento (12,4% vs 7,63%; p = 0,727). Los pacientes con HAI-CBP tuvieron mayor progresión a cirrosis (22,2% vs 13,1%; p = 0,038), incluso quienes lograron remisión bioquímica parcial o completa sin recaída, mayor indicación de TOH (p = 0,009), pero no retrasplante (p = 0,183); no hubo diferencias en la mortalidad. CONCLUSIÓN: El síndrome de superposición HAI-CBP constituye una proporción no despreciable entre aquellos con HAI, con mayor progresión a cirrosis, indicación de trasplante hepático y posiblemente retrasplante. Este mayor riesgo de desenlaces adversos sugiere seguimiento más estricto, probablemente con seguimiento hasta remisión histopatológica confirmada


BACKGROUND: Autoimmune hepatitis (AIH) with characteristics of primary biliary cholangitis (PBC) is known as overlap syndrome. Its prevalence and prognosis have not yet been determined comparatively with AIH. METHODS: A retrospective cohort study was conducted comparing patients diagnosed with AIH and AIH-PBC overlap syndrome, followed-up for seven years in a university hospital in Colombia, until 31 December 2016. RESULTS: A total of 210 patients were included (195 women, mean age 48.5 years). Of these, 32 (15.2%) had AIH-PBC overlap syndrome. At diagnosis, no significant differences were found by demographic profile, positive autoantibodies (ANA, ASMA), except AMA (81.2% vs 3.9%, P < .001), and histological grade of fibrosis. The most frequent clinical presentations were nonspecific symptoms in AIH-PBC and acute hepatitis in AIH. Although there were no significant differences, AIH showed a greater biochemical response to immunosuppressive management (87.3% vs 74.2%, P = .061) and a greater number of relapses in those who achieved partial or complete remission during treatment (12.4% vs 7.63%; P = .727). Patients with AIH-PBC had greater progression to cirrhosis (22.2% vs 13.1%, P = .038), even in those who achieved partial or complete biochemical remission without relapse, with greater indication of orthotopic liver transplantation (P = .009), but not retransplantation (P = .183); there were no differences in mortality. CONCLUSIONS: AIH-PBC overlap syndrome accounts for a significant proportion of patients with AIH, with greater progression to cirrhosis, indication of liver transplantation and possibly retransplantation. This higher risk of adverse outcomes suggests closer monitoring, probably with follow-up until confirmed histopathological remission


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hepatite Autoimune/diagnóstico , Colangite/diagnóstico , Estudos de Coortes , Hepatite Autoimune/fisiopatologia , Colangite/complicações , Hepatite Autoimune/complicações , Colangite/fisiopatologia , Prevalência , Estudos Retrospectivos , Colômbia , Hepatopatias/tratamento farmacológico
14.
Gastroenterol. hepatol. (Ed. impr.) ; 41(6): 377-388, jun.-jul. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-180619

RESUMO

Immune cells play an important role in controlling liver tumorigenesis, viral hepatitis, liver fibrosis and contribute to pathogenesis of liver inflammation and injury. Accumulating evidence suggests the effectiveness of natural killer (NK) cells and Kupffer cells (KCs) against viral hepatitis, hepatocellular damage, liver fibrosis, and carcinogenesis. Activation of natural killer cells provides a novel therapeutic strategy to cure liver related diseases. This review discusses the emerging roles of immune cells in liver disorders and it will provide baseline data to scientists to design better therapies for treatment


Los inmunocitos o células inmunitarias desempeñan un papel importante en el control de la carcinogénesis hepática, la hepatitis vírica, la fibrosis hepática y contribuyen a la patogénesis de la inflamación y la lesión hepáticas. La creciente evidencia sugiere la efectividad de los linfocitos citolíticos naturales (NK, natural killer) y las células de Kupffer (KC, Kupffer cells) frente a la hepatitis vírica, la lesión hepatocelular, la fibrosis hepática y la carcinogénesis. La activación de linfocitos citolíticos naturales ofrece una nueva estrategia terapéutica para curar enfermedades relacionadas con el hígado. Esta revisión trata de las nuevas funciones de los inmunocitos en los trastornos hepáticos y ofrecerá datos básicos a los científicos para diseñar mejores terapias para el tratamiento


Assuntos
Humanos , Animais , Sistema Imunitário/citologia , Sistema Imunitário/imunologia , Hepatopatias/imunologia , Modelos Animais de Doenças
15.
Cir. Esp. (Ed. impr.) ; 96(5): 268-275, mayo 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176335

RESUMO

Desde 1991 a 2013 se realizaron en el Hospital Virgen del Rocío 1.000 trasplantes hepáticos. Se realizó un estudio retrospectivo, en el que se analizaron las características de los donantes y los receptores, las indicaciones, la técnica quirúrgica, las complicaciones y la supervivencia en 2 etapas diferentes (1991-2002 vs. 2003-2013), coincidiendo con la implantación del MELD como modelo de priorización. La indicación más frecuente fue la hepatopatía de origen hepatocelular en 48,8%. Hubo un incremento significativo en las indicaciones por hepatocarcinoma (8,6% y 24,1% p = 0,03), y de la tasa retrasplantes (5,9% Vs 9,6%, p = 0,04). Se apreció un cambio en la edad de donación, pasando de 27,7 años en 1990 a 62,9 años en 2012 (p = 0,001). El porcentaje de pacientes que no precisaron transfusión de hemoderivados se duplicó (6,16 vs. 14,31%, p = 0,001). La supervivencia de todos los pacientes a uno, 5 y 10 años fue del 77, 63,5 y 51,3%, respectivamente


Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991-2002 vs. 2003-2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication were of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P = 0.03), and the rate of retransplantation (5.9% vs 9.6%, P = 0.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P = 0.001). The percentage of patients who did not require blood transfusion doubled (6.16 vs. 14.31%, P = .001). Survival of all patients after one, 5 and 10 years was 77, 63.5 and 51.3%, respectively


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Hepatopatias/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/métodos , Transplante de Fígado/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
16.
Aten. prim. (Barc., Ed. impr.) ; 50(5): 306-315, mayo 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-178972

RESUMO

La ecografía es una técnica segura y fiable que aumenta la capacidad diagnóstica, agiliza y mejora la toma de decisiones de los profesionales de la medicina en cualquier ámbito de ejercicio. El médico de familia (MF), que debe ser competente para abordar la práctica totalidad de los problemas de salud de las personas, es un especialista idóneo para incorporar esta herramienta a su actividad, dotándose con ella de una capacidad de manejo hasta ahora desconocida, al ser muy numerosas las situaciones clínicas de la práctica habitual en las cuales se puede beneficiar de ella de modo fiable, eficiente y eficaz. Al tratarse de una tecnología muy dependiente del explorador, se hace necesario asegurar la competencia de quienes la practican, definir los beneficios y los potenciales riesgos que su uso puede generar, así como sus escenarios de aplicación, en aras de evitar exploraciones innecesarias y minimizar el coste oportunidad que puede suponer incorporar esta actividad a una agenda de por sí desbordada. Este trabajo pretende resumir el estado actual de la ecografía clínica abdominal y su utilidad para el MF en aquellos escenarios en los que resulta fiable y eficaz


Ultrasound is a safe and reliable way to increase diagnosis capabilities, as well as an improving and speed up method for taking decisions for healthcare professionals of every medical specialty. Family doctor, who must be ready to address all kind of health problems for his patients, is the key person to incorporate this tool to his daily activity, acquiring the best managing skill, unknown nowadays, being quite large the clinical situations in the day by day practice, in which he can obtain benefit in a reliable and effective way. Due to this practice is explorer dependent, it's needed to assure the best competence of the professional who practice it, and define the benefits and potential risks its use can create, as well as its application scenarios, in order to avoid unnecessary explorations and minimize opportunity costs that this activity can add to a currently saturated agenda. This work pretends to summarize the current state of abdominal point of care ultrasound, and its utility for the family doctor, in those scenarios that can be potentially reliable and effective


Assuntos
Humanos , Hepatopatias/diagnóstico por imagem , Doenças Biliares/diagnóstico por imagem , Pancreatopatias/diagnóstico por imagem , Ultrassonografia/métodos , Medicina Baseada em Evidências , Sensibilidade e Especificidade , Atenção Primária à Saúde , Medicina de Família e Comunidade
17.
J. physiol. biochem ; 74(2): 345-358, mayo 2018. ^f345^l358
Artigo em Inglês | IBECS | ID: ibc-178990

RESUMO

Chronic inflammation plays an essential role in the development of diabetic complications. Understanding the molecular mechanisms that support inflammation is a prerequisite for the design of novel anti-inflammatory therapies. These would take into consideration circulating levels of cytokines and damage-associated molecular patterns (DAMPs) that include the high mobility group box 1 (HMGB1) protein which, in part, promotes the inflammatory response through TLR4 signaling. The liver, as the source of circulating cytokines and acute-phase proteins, contributes to the control of systemic inflammation. We previously found that liver injury in streptozotocin-induced diabetic rats correlated with the level of oxidative stress, increased expression of HMGB1, and with the activation of TLR4-mediated cell death pathways. In the present work, we examined the effects of ethyl pyruvate (EP), an inhibitor of HMGB1 release/expression, on the modulation of activation of the HMGB1/TLR4 inflammatory cascade in diabetic liver. We observed that increased expression of inflammatory markers, TNF-α, IL-6, and haptoglobin in diabetic liver was associated with increased HMGB1/TLR4 interaction, activation of MAPK (p38, ERK, JNK)/NF-κB p65 and JAK1/STAT3 signaling pathways, and with decreased expression of Nrf2-regulated antioxidative enzymes. The reduction in HMGB1 expression as the result of EP administration reduced the pro-inflammatory activity of HMGB1 and exerted a protective effect on diabetic liver, which was observed as improved liver histology and antioxidant and inflammatory statuses. Our results suggest that prevention of HMGB1 release and blockage of the HMGB/TLR4 axis represents a potentially effective therapeutic strategy aimed at ameliorating diabetes-induced inflammation and ensuing liver injury


No disponible


Assuntos
Humanos , Animais , Diabetes Mellitus Experimental/complicações , Proteína HMGB1/metabolismo , Inflamação/metabolismo , Hepatopatias/complicações , Receptor 4 Toll-Like/metabolismo , Biomarcadores/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Haptoglobinas/metabolismo , Interleucina-6/metabolismo , Hepatopatias/metabolismo , Hepatopatias/patologia , Fator 2 Relacionado a NF-E2/metabolismo , Ratos Wistar
20.
Bol. pediatr ; 58(246): 250-258, 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-179857

RESUMO

La patología quirúrgica hepatobiliar en la infancia posee una gran relevancia debido a la repercusión que presenta en los niños afectados, razón por la que el correcto conocimiento de la misma se correlaciona con un diagnóstico temprano y un manejo oportuno que redunda en beneficio para nuestros pacientes. la presente revisión es una actualización centrada en las cuatro principales patologías hepatobiliares pediátricas. en primer lugar, se considera la atresia de vías biliares (aVB), que es la causa quirúrgica más común de enfermedad colestásica neonatal y la primera indicación de trasplante hepático infantil. es de resaltar la evolución en el concepto de la aVB en la última década, que recientemente se ha definido como un fenotipo caracterizado por la obliteración o ausencia de las vías biliares extrahepáticas, asociado a una alteración en la formación de los conductos biliares intrahepáticos, que puede deberse a múltiples etiologías. en segundo lugar, se revisa la dilatación de la vía biliar extrahepática y/o intrahepática, que afecta con mayor frecuencia al colédoco, conocida como quiste de colédoco. Se hace énfasis en su clasificación anatómica y etiológica, en el papel relevante de la colangiorresonancia en la evaluación preoperatoria de la lesión y en el tratamiento oportuno en función del tipo de dilatación y de la condición clínica del niño. en tercer lugar, se analiza el incremento de la presión del sistema venoso portal, denominado como hipertensión portal. dicho aumento de presión puede encontrar su origen en una obstrucción venosa a nivel prehepático, hepático y posthepático. Se destaca la singularidad de la hipertensión portal en la infancia que, a diferencia de los adultos, muestran una gran proporción de pacientes con una causa prehepática, los cuales desarrollan hiperesplenismo y hemorragia secundaria a várices esofagogástricas con mayor frecuencia, pero con una baja mortalidad atribuible a dicha hemorragia y ausencia de progresión a cirrosis hepática. Finalmente, se habla de la litiasis biliar en la infancia, destacando el amplio espectro clínico que presentan los niños afectados y la variedad en la composición de los cálculos biliares en pediatría, remarcando las estrategias terapéuticas a seguir en cada caso


Pediatric hepatobiliary surgery pathology is of great relevance due to its repercussion in the affected children. For this reason, correct knowledge about it is correlated with an early diagnosis and pertinent management that results in a benefit for our patients. This review is an update focused on the four main pediatric hepatobiliary pathologies. Bile duct atresia (BVA) is considered in the first place, this being the most common surgical cause of neonatal cholestatic disease and the first indication of child liver transplant. the evolution in the concept of BVa in the last decade should be emphasized, which has recently been defined as a phenotype characterized by the obliteration or absence of the extrahepatic bile ducts, associated to an alteration in the formation of the intrahepatic bile ducts, which can be due to multiple etiologies. in the second place, dilatation of the extrahepatic and/or intrahepatic bile ducts, that with greater frequency affects the choledoch, known as choledochal cyst, is reviewed. emphasis is placed on their anatomical and etiological classification, on the relevant role of the cholangioresonance in the pre-operative evaluation of the lesion and on the pertinent treatment based on the type of dilatation and on the clinical condition of the child. in the third place, an analysis is made of the increase of the pressure of the portal venous system, called portal hypertension. Said increase in pressure can originate in a venous obstruction on the prehepatic, hepatic or post-hepatic level. the singularity of portal hypertension in children stands out which, on the contrary to in adults, shows a large proportion of patients with a prehepatic cause, these developing hypersplenism and hemorrhaging secondary to esophagogastric varices more frequently. However, they have a low mortality attributable to said hemorrhaging and absence of progression to hepatic cirrhosis. Finally, mention is made of gallstones in children, stressing the wide clinical spectrum that the affected children have and the variety in the composition of the gallstones in pediatrics, emphasizing the therapeutic strategies to follow in each case


Assuntos
Humanos , Criança , Hepatopatias/diagnóstico , Hepatopatias/terapia , Doenças Biliares/diagnóstico , Doenças Biliares/terapia , Hepatopatias/etiologia , Doenças Biliares/etiologia , Índice de Gravidade de Doença
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