RESUMO
INTRODUCCIÓN: En la enfermedad celíaca las manifestaciones extraintestinales, con ausencia de las intestinales clásicas, son cada vez más frecuentes. La ataxia por gluten es una manifestación frecuente en adultos con celiaquía, pero en pediatría se considera excepcional. CASO CLÍNICO: Presentamos un caso de un niño de 11 años con ataxia progresiva de difícil diagnóstico, con marcadores serológicos de celiaquía prácticamente normales y con diagnóstico por biopsia intestinal, y con respuesta positiva a inmunoglobulinas intravenosas y dieta libre de gluten. CONCLUSIÓN: Puede resultar recomendable en pacientes con ataxia cerebelosa realizar un tipado de HLA junto a valoración de serología de celiaquía, y en caso de sospecha realizar panendoscopia digestiva oral
INTRODUCTION: Extraintestinal manifestations in the celiac disease, in absence of the classic intestinal ones, are increasingly frequent. Gluten ataxia is a frequent manifestation in adults with celiac disease. It is, nonetheless, considered exceptional in pediatrics. CASE REPORT: We present a case of an 11-year-old boy with progressive ataxia difficult to diagnose, with practically normal serologic markers of celiac disease, diagnosed by intestinal biopsy and with a positive response to intravenous immunoglobulins and a gluten-free diet. CONCLUSION: It may be advisable in patients with cerebellar ataxia to perform an HLA typing along with an assessment of celiac disease serology, and in case of suspicion of performing oral digestive panendoscopy
Assuntos
Humanos , Masculino , Criança , Ataxia Cerebelar/patologia , Doença Celíaca/complicações , Doença Celíaca/patologia , Ataxia Cerebelar/etiologia , Doença Celíaca/sangue , Ataxia Cerebelar/sangue , gama-Globulinas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Ataxia Cerebelar/tratamento farmacológico , Diagnóstico DiferencialRESUMO
This article identifies the most significant elements of the process of nurse attention to the last days and hours of life in the context of a disease previously diagnosed like a terminal situation. For this object, we have reviewed the main clinical guidelines on comprehensive care and, especially, the guideline that was designed by the Saint John of God Hospital in Seville. We conclude that it is necessary to know how to identify the phase of agony to apply, therefore a default care plan that, allows to respond customized to the specific needs that occur in the last hours of the life of a terminal patient. A continued and coordinated interprofessional assistance to patient and family following standardized standards allows achieving a peaceful death and free from avoidable suffering.
Assuntos
Assistência Integral à Saúde , Enfermagem , Assistência Terminal , HumanosRESUMO
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