Gastroenterologia
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Browsing Gastroenterologia by Author "Alberto, S"
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- Abordagem clínica da cirrose hepática: protocolos de atuaçãoPublication . Reis, J; Alves, N; Martins, A; Horta, D; Alberto, S; Santos, L; Carvalho, R; Rodrigues, C; Oliveira, A; Costa, M; Lourenço, L; Branco, J; Cardoso, M; Anapaz, V; Alexandrino, G; Figueiredo, L; Rafael, M
- Actinomycosis Causing Recurrent Perianal FistulaePublication . Cardoso, M; Carneiro, C; Lourenço, L; Rodrigues, C; Alberto, S; João, A; Rocha, R; Geraldes, V; Costa, A; Reis, J; Nunes, VActinomycosis is a rare but easily curable infection that should be considered in the differential diagnosis of perianal fistulizing disease. We present the case of a 26-year-old woman with complex perianal fistulae, including trans-sphincteric and suprasphincteric fistulous tracts and a rectovaginal fistula, requiring multiple abscess drainages, seton placement, and antibiotic courses, with little improvement. After extensive investigation, Actinomyces spp. was identified in anal cytology. The patient underwent a 6-week course of intravenous penicillin followed by oral amoxicillin, with remarkable improvement. This case illustrates the importance of pursuing less common diagnoses in refractory complex perianal disease, such as actinomycosis.
- Celiac disease and upper tract Crohn's disease: a rare associationPublication . Alberto, S; Martins, A; Deus, JRThe authors present the case of a 47 years old female, with no past or familial history, hospitalized due to vomiting and significant weight loss over the last 9 months, without abdominal pain, blood loss, constipation or diarrhea. Blood tests results revealed iron deficiency anaemia, seropositivity for ASCA, anti-transglutaminase antibody and HLA-DQ2. Upper GI endoscopy showed several ulcers in duodenal mucosa and an ulcerated stricture in D3; biopsies were taken and histopathology revealed transmural inflammatory chronic infiltrate, crypt loss and some areas of villous atrophy and intraepithelial lymphocytosis. The small bowel follow through confirmed 2 main strictures in duodenum and proximal jejunum. She was started on prednisolone, azathioprine and a gluten-free diet with an initial good response although relapse was detected one month later. In this last admission, parenteral nutrition was necessary due to her deteriorated nutritional state and she also started infliximab, with subsequent significant clinical and endoscopic improvement.
- Corpo estranho no cólon como causa de hematoquéziasPublication . Alberto, S
- Critérios diagnósticos na hepatite auto-imunePublication . Alberto, S
- Dieulafoy’s lesion in Treitz’s anglePublication . Alberto, S; Oro, I; Pires, E; Alves, N; Godinho, A; Figueiredo, A; Deus, JR
- Hepatic abscess induced by foreign body: case report and literature reviewPublication . Santos, S; Alberto, S; Cruz, E; Pires, E; Figueira, T; Coimbra, E; Estevez, J; Oliveira, M; Novais, L; Deus, JRHepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is diffi cult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
- Hepatocellular carcinoma presenting with Budd-Chiari syndrome, right atrial thrombus and pulmonary emboliPublication . Lourenço, L; Horta, D; Alberto, S; Reis, JA 47-year-old patient presented with a two-week history of right upper quadrant pain, abdominal distention and new onset of shortness of breath. He had a history of intravenous drug abuse, no alcohol consumption and denied any known liver disease. On physical examination, he was tachypneic and had dullness in the flanks. His blood analysis at admission was as follows: hemoglobin, 12.9 g/dL; leukocyte count, 6,800/uL; platelet count, 63,000/uL; INR, 2.1; serum creatinine, 1.27 mg/dL; liver biochemistry tests were notable for marginal derangement, HBsAg was negative, anti-HCV was positive, HCV RNA was 367,498 IU/ml and alpha-fetoprotein was 992 mg/dL. Abdominal ultrasound showed a right liver lobe mass (13 cm in diameter) with inferior vena cava (IVC) thrombosis and mild peri-hepatic ascites. A 2D echocardiogram showed a presumed right atrial tumor thrombus. A multiphasic contrast-enhanced abdominal tomography (CT) confirmed a hepatocellular carcinoma (HCC) with IVC obstruction and extensive tumoral thrombus to the right atrium (14 cm long).
- Insuficiência hepática agudaPublication . Alberto, S; Pires, S; Figueiredo, A; Deus, JRIntrodução: Define-se como insuficiência hepática aguda o desenvolvimento rápido de falência hepática em indivíduos sem doença hepática prévia ou com doença hepática crónica compensada. Etiologia: É variada e é o principal indicador do prognóstico, pelo que a sua rápida identificação é vital. Avaliação inicial e diagnóstico: Atendendo a uma possível progressão para falência multiorgânica é necessário o internamento destes doentes numa Unidade de Cuidados Intensivos. A primeira abordagem terapêutica inclui medidas intensivas de suporte até determinar a etiologia exacta, para um tratamento dirigido. Para além da encefalopatia porto-sistémica podem ocorrer um conjunto de complicações sistémicas responsáveis pela alta morbilidade e mortalidade desta entidade e que exigem uma vigilância e terapêutica rigorosas. Os sistemas artificiais de suporte hepático são alternativas de tratamento ainda em estudo e sem influência comprovada a longo prazo, sendo o transplante hepático a terapêutica final. Atendendo às limitações inerentes a este procedimento, a sua decisão depende de um prognóstico correcto baseado em vários modelos estatísticos de previsão.
- Is there a proximal shift in the distribution of colorectal adenomas?Publication . Oliveira, AM; Anapaz, V; Lourenço, L; Rodrigues, C; Alberto, S; Martins, A; Deus, JR; Reis, JINTRODUCTION: Several studies have shown a proximal shift of colorectal cancer (CRC) during the last decades. However, few have analyzed the changing distribution of adenomas over time. AIM: The aim of this study was to compare the site and the characteristics of colorectal adenomas, in a single center, during two periods. METHODS: We conducted a retrospective, observational study in a single hospital of adenomas removed during a total colonoscopy in two one-year periods: 2003 (period 1) and 2012 (period 2). Patients with inflammatory bowel disease, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome, or history of CRC were excluded from the study. The χ(2) statistical test was performed. P values less than 0.05 were considered statistically significant. RESULTS: During the two considered periods, a total of 864 adenomas from 2394 complete colonoscopies were analyzed: 333 adenomas from 998 colonoscopies during period 1 and 531 adenomas from 1396 colonoscopies during period 2. There was a significant increase in the proportion of adenomatous polyps in the proximal colon from period 1 to 2 (30.6% to 38.8% (p = 0.015)). Comparing the advanced features of adenomas between the two periods, it was noted that in period 2, the number of adenomas with size ≥1 cm (p = 0.001), high-grade dysplasia (p = 0.001), and villous features (p < 0.0001) had a significant increase compared to period 1. CONCLUSION: Incidence of adenomatous polyps in the proximal colon as well as adenomas with advanced features has increased in the last years. This finding may have important implications regarding methods of CRC screening.