Insuficiencia hepática por enfermedad hepática crónica agudizada / No disponible

No disponible

Encefalopatía hepática mínima: diagnóstico e implicaciones / No disponible

No disponible

Actualización en el tratamiento de la encefalopatía hepática / Update on the management of hepatic encephalopathy

No disponible

[Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists]. / Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos.

INTRODUCTION: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. AIM: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. MATERIAL AND METHODS: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. RESULTS: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. CONCLUSION: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis.

Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos / Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists

Introducción: La encefalopatía hepática es una complicación frecuente de la cirrosis hepática. Estudios recientes han cuestionado la eficacia de los disacáridos no absorbibles y han señalado que la restricción proteica podría tener riesgos en pacientes con cirrosis y encefalopatía hepática. Objetivo: Conocer los hábitos diagnósticos y terapéuticos de los médicos que tratan a pacientes con encefalopatía hepática. Material y métodos: Se elaboró un cuestionario de 20 preguntas que se envió por correo a los miembros de la Asociación Española para el Estudio del Hígado (AEEH). Resultados: Se recibieron 128 encuestas, completadas por médicos con larga experiencia. En referencia a la encefalopatía episódica, los encuestados consideraron que los factores precipitantes más frecuentes fueron las infecciones (22%), los diuréticos (21%) y la hemorragia digestiva (21%). El tratamiento habitual de la encefalopatía episódica consiste en la administración de disacáridos no absorbibles (90%) y en la restricción proteica (52%). La encefalopatía crónica también se trata habitualmente con disacáridos no absorbibles (94%), junto con restricción proteica (40%). Un 59% de los hepatólogos nunca realizan exploraciones neurofisiológicas o neuropsicológicas para el diagnóstico de la encefalopatía hepática mínima. Conclusión: A pesar de las dudas acerca de la eficacia de los disacáridos no absorbibles y de la restricción proteica, éstas son las medidas terapéuticas habituales en la encefalopatía hepática, lo que muestra la importancia de aclarar la eficacia y los riesgos de los disacáridos no absorbibles y de la restricción proteica. La mayoría de los hepatólogos no investigan nunca la encefalopatía hepática mínima en los pacientes con cirrosis hepática

Introduction: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. Aim: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. Material and methods: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. Results: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. Conclusion: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis

Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos / Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists

Introducción: La encefalopatía hepática es una complicación frecuente de la cirrosis hepática. Estudios recientes han cuestionado la eficacia de los disacáridos no absorbibles y han señalado que la restricción proteica podría tener riesgos en pacientes con cirrosis y encefalopatía hepática. Objetivo: Conocer los hábitos diagnósticos y terapéuticos de los médicos que tratan a pacientes con encefalopatía hepática. Material y métodos: Se elaboró un cuestionario de 20 preguntas que se envió por correo a los miembros de la Asociación Española para el Estudio del Hígado (AEEH). Resultados: Se recibieron 128 encuestas, completadas por médicos con larga experiencia. En referencia a la encefalopatía episódica, los encuestados consideraron que los factores precipitantes más frecuentes fueron las infecciones (22%), los diuréticos (21%) y la hemorragia digestiva (21%). El tratamiento habitual de la encefalopatía episódica consiste en la administración de disacáridos no absorbibles (90%) y en la restricción proteica (52%). La encefalopatía crónica también se trata habitualmente con disacáridos no absorbibles (94%), junto con restricción proteica (40%). Un 59% de los hepatólogos nunca realizan exploraciones neurofisiológicas o neuropsicológicas para el diagnóstico de la encefalopatía hepática mínima. Conclusión: A pesar de las dudas acerca de la eficacia de los disacáridos no absorbibles y de la restricción proteica, éstas son las medidas terapéuticas habituales en la encefalopatía hepática, lo que muestra la importancia de aclarar la eficacia y los riesgos de los disacáridos no absorbibles y de la restricción proteica. La mayoría de los hepatólogos no investigan nunca la encefalopatía hepática mínima en los pacientes con cirrosis hepática

Introduction: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. Aim: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. Material and methods: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. Results: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. Conclusion: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis

[A clinically unsuspected pheochromocytoma]. / Feocromocitoma clínicamente insospechado.

Pheochromocytomas are often unnoticed, and diagnosis is performed on autopsy examination, or more rarely it is noticed during surgery or abdominal exam for a different reason. In many of these patients the lack of hypertension is a characteristic feature. We contribute a singular case of a patient with pheochromocytoma found by chance during an abdominal exam and which in spite of secreting noradrenaline, did not provoke hypertension or other symptoms. We review literature on this stage form of presentation and the different physio-pharmacological hypothesis which could condition the absence of clinical manifestations. We discuss the preoperative management in patients without hypertension.