ABSTRACT
Acute acalculous cholecystitis is a very rare clinical presentation of Q fever. We report the case of a 38-year-old man who presented with fever associated with elevation of liver enzyme levels and thickening of the gallbladder wall on abdominal ultrasonography and who was initially diagnosed with acute acalculous cholecystitis. Due to the persistence of fever and transaminase elevation despite antibiotic treatment, a liver biopsy was performed. Characteristic "doughnut" epithelioid granulomas were observed, suggesting a diagnosis of granulomatous hepatitis caused by Q fever, which was confirmed by serological methods. Treatment with doxycycline was commenced and the patient subsequently showed rapid clinical improvement, with disappearance of fever and normalization of liver enzyme levels. We review 8 cases of acute cholecystitis associated with Q fever published in the literature and stress the importance of liver biopsy in the etiological diagnosis of patients with prolonged fever and abnormal liver function tests.
Subject(s)
Acalculous Cholecystitis/etiology , Q Fever/complications , Acalculous Cholecystitis/diagnosis , Adult , Humans , Male , Q Fever/diagnosisABSTRACT
La colecistitis aguda alitiásica es una forma infrecuente depresentación de la fiebre Q. Se expone el caso clínico de unpaciente varón de 38 años con un síndrome febril asociado aalteraciones en las pruebas de función hepática y un engrosamientode la pared vesicular en la ecografía abdominal,que permitió establecer un diagnóstico inicial de colecistitisalitiásica. La falta de respuesta al tratamiento habitual, juntocon la persistencia de la fiebre e hipertransaminasemia,motivó la realización de una biopsia hepática que mostró lapresencia de granulomas de células epitelioides «en rosquilla» típicos de la hepatitis granulomatosa por fiebre Q. Eldiagnóstico se confirmó posteriormente mediante serología.El tratamiento con doxiciclina fue altamente efectivo, conrápida desaparición de la fiebre y normalización de laspruebas de función hepática.Además, se realiza una revisión de los 8 casos de colecistitisaguda asociada a fiebre Q descritos en la bibliografía y sesubraya el papel de la biopsia hepática en el diagnósticoetiológico de los cuadros de fiebre prolongada asociada a alteracionesen el perfil hepático
Acute acalculous cholecystitis is a very rare clinical presentationof Q fever. We report the case of a 38-year-old manwho presented with fever associated with elevation of liverenzyme levels and thickening of the gallbladder wall on abdominalultrasonography and who was initially diagnosedwith acute acalculous cholecystitis. Due to the persistence offever and transaminase elevation despite antibiotic treatment,a liver biopsy was performed. Characteristic «doughnut epithelioid granulomas were observed, suggesting adiagnosis of granulomatous hepatitis caused by Q fever,which was confirmed by serological methods. Treatmentwith doxycycline was commenced and the patient subsequentlyshowed rapid clinical improvement, with disappearanceof fever and normalization of liver enzyme levels.We review 8 cases of acute cholecystitis associated with Q feverpublished in the literature and stress the importance ofliver biopsy in the etiological diagnosis of patients with prolongedfever and abnormal liver function tests
Subject(s)
Male , Humans , Acalculous Cholecystitis/etiology , Q Fever/complications , Acalculous Cholecystitis/diagnosis , Q Fever/diagnosisABSTRACT
Ménétrier's disease is an infrequent clinical entity characterized by thickening of the gastric folds secondary to hyperplasia of the foveolar mucosa cells, frequently associated with loss of enteric proteins and hypoalbuminemia. Its etiology is unknown, although in the last few years it has been related to Helicobacter pylori infection. We present the case of a 38-year-old man with protein-losing gastroenteropathy caused by Ménétrier's disease, in whom eradication of H. pylori infection was followed by symptom improvement and resolution of hypoalbuminemia. In agreement with the criteria of other authors, we investigate the presence of H. pylori infection in all patients with Ménétrier's disease. When positive, the first-line treatment consists of eradication therapy.
Subject(s)
Anti-Ulcer Agents/therapeutic use , Gastritis, Hypertrophic/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Adult , Gastric Mucosa/microbiology , Gastritis, Hypertrophic/etiology , Helicobacter Infections/complications , Humans , Male , Protein-Losing Enteropathies/etiology , Treatment OutcomeABSTRACT
El síndrome de distensión visceral es el diagnóstico más frecuente en nuestro medio en pacientes ancianos que acuden a Urgencias por presentar dolor abdominal agudo (DAA). La oclusión intestinal representa el 59,6 por ciento de estos pacientes y el carcinoma colorrectal es la primera causa (46,6 por ciento) en la población de edad avanzada. Objetivos: Una exhaustiva revisión de la bibliografía nos ha llevado a verificar la escasez de trabajos que hacen referencia a la sensibilidad de la historia clínica en el proceso diagnóstico del dolor abdominal agudo en el anciano en general y en la oclusión intestinal por carcinoma colorrectal en particular, siendo éste el objetivo fundamental de nuestro estudio. Métodos: Cirujanos, gastroenterólogos y expertos en Medicina de Urgencia elaboramos un cuestionario especialmente diseñado para evaluar la semiología del DAA y que aplicamos a pacientes de edad igual o mayor a 65 años que acudían a Urgencias por este motivo. Resultados: Una historia clínica y examen físico efectuados con rigor es capaz de predecir con acierto el diagnóstico en más de la mitad de los casos de los pacientes ancianos que acuden a Urgencias presentando una oclusión intestinal por carcinoma colorrectal. Este porcentaje se eleva al 75 por ciento cuando sumamos la aportación de las pruebas complementarias rutinarias. Conclusiones: La historia clínica, aún con las limitaciones que comporta en este grupo de edad, constituye el documento principal del proceso diagnóstico en el DAA (AU)
Subject(s)
Aged , Female , Male , Humans , Intestinal Obstruction/etiology , Colorectal Neoplasms/diagnosis , Clinical Protocols , Abdomen, Acute/etiology , Medical History Taking/standards , Data Collection/standardsABSTRACT
Dada la frecuencia de la enfermedad por reflujo gastroesofágico, su tratamiento no puede ser una competencia exclusiva del gastroenterólogo. Los médicos de Atención Primaria con unos conocimientos adecuados podrán resolver con éxito la mayoría de los problemas que plantean este tipo de pacientes, y podrá discernir aquellos que requieran una atención más especializada. A continuación, tras un breve repaso de las manifestaciones clínicas y métodos diagnósticos, desarrollaremos de forma detallada cuáles son las diferentes opciones de tratamiento de que disponemos en el momento actual, así como su adecuada utilización en las diferentes formas de presentación de la enfermedad por reflujo gastroesofágico (AU)
Subject(s)
Humans , Gastroesophageal Reflux , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Primary Health CareABSTRACT
TIPSS is a new therapeutic modality for decompressing the portal tree and its use has broadened in the last five years. From February 1993 to August 1994 a prospective study was performed to evaluate its efficacy and safety. Nineteen cirrhotic patients (Child A-5, B-10, and C-4) with a TIPSS placed were included. The mean follow-up was 7.2 months. The indication was therapy of esophageal variceal bleeding in 18 patients (acutely in 8 and elective in 10 patients) and refractory ascites in one. In all cases could the "stent" be placed and the portocaval gradient decreased from 22.8 +/- 3.71 to 9.3 +/- 2.27 mmHg. In the first thirty days the mortality rate was 10.5%, with the following complications: two portal thromboses, two acute non-lithiasic cholecystitis, one hemoperitoneum, one spontaneous bacterial peritonitis, and one hepatic encephalopathy. During the follow-up period two patients developed hemorrhagic relapses and two additional patients subclinical encephalopathy. TIPSS dysfunction was observed in 57.8%.
