Prevalencia de la esteatosis hepática no alcohólica en población con hipertransaminasemia y grado de adecuación del diagnóstico registrado en atención primaria / Prevalence of non-alcoholic fatty liver disease in a population with elevated transaminases and level of accuracy of the diagnosis in Primary Care

La esteatosis hepática no alcohólica (EHNA) es la causa más frecuente de elevación de transaminasas en el adulto. OBJETIVOS: Determinar la prevalencia de EHNA en pacientes con hipertransaminasemia mantenida, y conocer el grado de adecuación del diagnóstico registrado en Atención Primaria (AP). MATERIAL Y MÉTODOS: 1) Estudio descriptivo transversal con muestra aleatoria de pacientes con elevación de la enzima alanina aminotransferasa (ALT) mantenida (ALT > 32 durante ≥ 6 meses), descartadas otras causas de hepatopatía, siguiendo criterios clínicos, analíticos y ecográficos en AP, y 2) descriptivo transversal sobre todos los casos con diagnóstico de EHNA registrado (K76 - CIE10) con análisis de adecuación diagnóstica según criterios estándar. RESULTADOS: Se analizaron 290 pacientes, 76 fueron diagnosticados de EHNA (26,1%), 44 mujeres (57,9%). El análisis multivariado ajustado por edad y sexo mostró asociación entre EHNA y sexo masculino (OR: 0,5; IC 95%: 0,3-0,9), diabetes mellitus (DM) (OR: 2,42; IC 95%: 1,2-4,9) e hipertensión arterial (HTA) (OR: 3,07; IC 95%: 1,6-5,6). De los 209 con registro diagnóstico de EHNA: 51 (24,4%) cumplían criterios de EHNA. El resto carecían de registros suficientes. Destacan: 53,1% carecían de hipertransaminasemia mantenida; 48% de serologías víricas; 11% de ecografía abdominal compatible y 53,1% de registro del consumo de alcohol. CONCLUSIONES: La EHNA severa es frecuente entre los pacientes con hipertransaminasemia mantenida. La DM y la HTA incrementan significativamente el riesgo de EHNA. El diagnóstico de EHNA se registra sin considerar todos los criterios de EHNA y se hace mayoritariamente por ecografía. Se deberían unificar criterios diagnósticos en el registro de la EHNA

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated transaminases in adults. AIM: Determine the prevalence of NASH in patients with sustained hypertransaminasemia, and Know the adequacy of the registered in Primary Care (AP) diagnosis. MATERIAL AND METHODS: 1) Cross-sectional study with a random sample of patients with elevated alanine aminotransferase (ALT) held (ALT> 32 for ≥6 months), ruling out other causes of liver disease, according to clinical, laboratory and ultrasound scan criteria in AP and 2) cross-sectional description of all cases diagnosed with NASH recorded (K76 - ICD10) with diagnostic adequacy analysis according to standard criteria. RESULTS: 290 patients were analyzed: 76 were diagnosed as NASH (26.1%), 44 women (57.9%). Multivariate analysis adjusted for age and sex showed no association between NASH and male gender (OR: 0.5; CI95%: 0.3-0.9), diabetes mellitus (DM) (OR: 2.42; CI95%: 1.2-4.9) and hypertension blood pressure (HBP) (OR: 3.07; CI 95% 1.6-5.6). Of the 209 diagnosed with NASH record: 51 (24.4%) met the criteria for NASH. The rest had insufficient records. Highlights: 53.1% lacked sustained hypertransaminasemia; 48% of viral serology; 11% supported and 53.1% abdominal ultrasound registration of alcohol. CONCLUSIONS: Severe NASH is frequent among patients with sustained hypertransaminasemia. The DM and hypertension significantly increase the risk of NASH. The diagnosis of NASH is recorded without considering all criteria and mainly NASH made by ultrasonography. They should unify diagnostic criteria in the register of NASH (AU)

[Prevalence of non-alcoholic fatty liver disease in a population with elevated transaminases and level of accuracy of the diagnosis in Primary Care]. / Prevalencia de la esteatosis hepática no alcohólica en población con hipertransaminasemia y grado de adecuación del diagnóstico registrado en atención primaria.

UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated transaminases in adults. AIM: Determine the prevalence of NASH in patients with sustained hypertransaminasemia, and Know the adequacy of the registered in Primary Care (AP) diagnosis. MATERIAL AND METHODS: 1) Cross-sectional study with a random sample of patients with elevated alanine aminotransferase (ALT) held (ALT> 32 for ≥6 months), ruling out other causes of liver disease, according to clinical, laboratory and ultrasound scan criteria in AP and 2) cross-sectional description of all cases diagnosed with NASH recorded (K76 - ICD10) with diagnostic adequacy analysis according to standard criteria. RESULTS: 290 patients were analyzed: 76 were diagnosed as NASH (26.1%), 44 women (57.9%). Multivariate analysis adjusted for age and sex showed no association between NASH and male gender (OR: 0.5; CI95%: 0.3-0.9), diabetes mellitus (DM) (OR: 2.42; CI95%: 1.2-4.9) and hypertension blood pressure (HBP) (OR: 3.07; CI 95% 1.6-5.6). Of the 209 diagnosed with NASH record: 51 (24.4%) met the criteria for NASH. The rest had insufficient records. HIGHLIGHTS: 53.1% lacked sustained hypertransaminasemia; 48% of viral serology; 11% supported and 53.1% abdominal ultrasound registration of alcohol. CONCLUSIONS: Severe NASH is frequent among patients with sustained hypertransaminasemia. The DM and hypertension significantly increase the risk of NASH. The diagnosis of NASH is recorded without considering all criteria and mainly NASH made by ultrasonography. They should unify diagnostic criteria in the register of NASH.

Rápida progresión de hepatocarcinoma tras cirugía; a propósito de un caso y revisión de la literatura / Rapid progression of hepatocellular carcinoma after surgery: apropos of a case and review of the literature

Presentamos el caso de un joven afecto de hepatitis crónica por virus B de probable adquisición perinatal que se diagnosticó de un carcinoma hepatocelular en estadío muy inicial (BCLC 0) con un pronóstico a priori muy favorable. Sin embargo, presentó una evolución rápidamente progresiva siendo exitus en pocos meses. Se conocen pocos datos que ayuden a detectar aquellos casos de rápida progresión que puedan propiciar el inicio de terapias más agresivas que impidan o controlen dicha progresión (AU)

We report the case of a young man with chronic hepatitis B infection of probable perinatal acquisition who was diagnosed with hepatocellular carcinoma at a very early stage (BCLC 0) with a highly favorable prognosis. However, the tumor progressed rapidly and the patient died within months. Currently, there are few data that could help to identify cases likely to show rapid progression and which could prompt initiation of aggressive therapies that might prevent or control such progression (AU)

[Rapid progression of hepatocellular carcinoma after surgery: apropos of a case and review of the literature]. / Rápida progresión de hepatocarcinoma tras cirugía; a propósito de un caso y revisión de la literatura.

We report the case of a young man with chronic hepatitis B infection of probable perinatal acquisition who was diagnosed with hepatocellular carcinoma at a very early stage (BCLC 0) with a highly favorable prognosis. However, the tumor progressed rapidly and the patient died within months. Currently, there are few data that could help to identify cases likely to show rapid progression and which could prompt initiation of aggressive therapies that might prevent or control such progression.

Unidad de atención continuada y hospital de día como alternativa a la hospitalización convencional: experiencia de 10 años en un hospital comarcal / Continuing care unit and day hospital as an alternative to conventional hospitalization: 10 years’ experience in a district hospital

La unidad de atención continuada y hospital de día permite el manejo ambulatorio de los pacientes con una enfermedad digestiva. Objetivo: Disminuir los ingresos hospitalarios y el número de pacientes con una enfermedad digestiva que acude a urgencias. Material y métodos: Los pacientes se atienden según dos niveles asistenciales: a) atención continuada, en que se visitan de forma urgente los pacientes con una descompensación aguda de su enfermedad digestiva, y b) atención programada, en que se realizan procedimientos que por su complejidad requieren personal de enfermería, sin ser necesario el ingreso hospitalario. Resultados: En el período comprendido entre 1995 y 2005 se ha pasado de realizar 118 visitas en atención continuada en 1995 a 784 en 2005. En atención programada las paracentesis han aumentado de 237 en 1995 a 687 en 2006 y las infusiones de hierro intravenoso de 111 en 2004 a 519 en 2006. El número de ingresos hospitalarios pasó inicialmente de 605 en 1995 a 430 en 2000, para posteriormente aumentar. El número de pacientes con una enfermedad digestiva que acudió a urgencias disminuyó un 75% estos años. Conclusiones: La unidad de atención continuada y hospital de día permite una disminución inicial del número de ingresos en el área de hospitalización convencional y en el porcentaje de pacientes con patología digestiva que acuden a urgencias

The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. Aim: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. Material and methods: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. Results: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. Conclusions: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department

[Continuing care unit and day hospital as an alternative to conventional hospitalization: 10 years' experience in a district hospital]. / Unidad de atención continuada y hospital de día como alternativa a la hospitalización convencional: experiencia de 10 años en un hospital comarcal.

UNLABELLED: The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. AIM: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. MATERIAL AND METHODS: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. RESULTS: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. CONCLUSIONS: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department.