Academic literature on the topic 'Hepatomegalie'

Atendendo à elevada frequência de doentes com hepatomegalia (HM) e/ ou esplenomegalia (SM) observada nos serviços de Medicina e Gastroenterologia do Hospital Américo Boavida, em Luanda, Angola, o presente estudo teve como objetivo identificar os principais fatores causais destes sinais e os potenciais fatores de risco, de modo a serem implementadas as medidas mais adequadas à sua prevenção. Foi efetuado um estudo retrospetivo, transversal, com base nos processos clínicos referentes ao período compreendido entre 2013 a 2015. Os dados foram obtidos nos processos dos doentes após autorização da direção do hospital (dados demográficos, dados relativos à sintomatologia do doente, exame físico, fatores de risco para hepatomegalia e/ ou esplenomegalia, dados dos exames complementares de diagnóstico e estado dos doentes à saída). Os dados foram analisados com apoio do programa SPSS, versão 23. Foram analisados 804 processos de doentes com hepatomegalia e/ou esplenomegalia, com idade média de 37,2 anos, metade do género masculino e 41,5% naturais de Luanda. Destes doentes, 42,4% tinham iniciado sintomas até uma semana antes do internamento e 30% entre uma e quatro semanas antes. Os sintomas mais referidos foram dor abdominal (66,9%), febre (56,1%), emagrecimento (43,8%); ao exame objetivo observou-se mucosas descoradas (69,3%), hepatomegalia (49,8%), esplenomegalia (18,5%), hepatoesplenomegalia (5,8%); A maioria dos doentes apresentava anemia e provas de função hepática alteradas. Três quartos realizou exames imagiológicos e um quarto realizou endoscopia digestiva alta. Das principais causas de hepatomegalia e/ ou esplenomegalia encontradas, salientam-se a malária (13,3%), schistosomose (13,2%), insuficiência cardíaca congestiva (12,2%), doença hepática crónica alcoólica (10,3%), hepatocarcinoma (8,8%). Em relação à mortalidade ocorrida nestes doentes, no total de 122, verificou-se que o hepatocarcinoma, síndrome de imunodeficiência adquirida associada a tuberculose e doença hepática alcoólica foram as principais causas de morte, com 36%, 10,7% e 10,7%, respetivamente. Considerando o mecanismo fisiopatológico das doenças, o grupo etário dos 30-39 anos apresentou a maior percentagem de casos de doença inflamatória (25%) e doença congestiva (22%) e o grupo etário dos 50-59 anos apresentou a maior percentagem (25%) de casos de doença infiltrativa, refletindo, provavelmente, doença oncológica. A maioria dos doentes era originária das províncias de Luanda, Uíge e Malange, sendo a schistosomose hepatoesplénica predominante nos doentes do Uíge, devendo ser um diagnóstico a considerar nos doentes oriundos desta região. Quanto aos potenciais fatores de risco, salientam-se os hábitos etílicos, banho no rio e hemotransfusão. Será importante reforçar a prevenção destas doenças através de, por exemplo, medidas de controlo de mosquitos vetores, saneamento básico e água tratada, educação para saúde, aumento da literacia em saúde na população e maior acesso a serviços de saúde.<br>Considering the high frequency of patients with hepatomegaly and/or splenomegaly observed in the Medicine and Gastroenterology departments of Américo Boavida Hospital, in Luanda, Angola, the present study aimed to identify the main causal factors of these signs and the potential risk factors, to be implemented the most appropriate measures for their prevention. A cross-sectional retrospective study was carried out based on the clinical processes during the period from 2013 to 2015. Data were obtained from patients' files following hospital authorization (demographic data, patient symptoms, physical examination, risk factors, data from complementary diagnostic tests, and status of outgoing patients). The data were analysed with the support of the SPSS program, version 23. We analysed 804 cases of patients with hepatomegaly, splenomegaly or hepatosplenomegaly, with a mean age of 37.2 years, almost half of the patients were male and 41.5% from Luanda. Of these patients, 42.4% started symptoms up to one week before admission and 30% between one and four weeks before. The most commonly reported symptoms were abdominal pain (66.9%), fever (56.1%), weight loss (43.8%); discoloured mucous membranes was observed in 69.3%, hepatomegaly (55.5%), splenomegaly (24.5%) and hepatosplenomegaly (20%); Most patients had anemia and abnormal liver function tests. About 75% performed imaging exams and almost 25% performed upper endoscopy. The main causes of hepatomegaly, splenomegaly or hepatosplenomegaly were malaria (13.3%), schistosomiasis (13.2%), congestive heart failure (12.2%), chronic alcoholic liver disease (10.3%) and hepatic cancer (8.8%). In relation to the mortality in these patients, in a total of 122, hepatic cancer, acquired immunodeficiency syndrome associated with tuberculosis and alcoholic liver disease were the main causes of death, with 36%, 10.7% and 10.7% %, respectively. Considering the pathophysiological mechanism of the diseases, the 30-39 years’ age group presented the highest percentage of cases of inflammatory disease (25%) and congestive disease (22%) whereas the 50-59 age group had the highest percentage (25 %) of cases of infiltrative disease, probably reflecting oncological disease. Most of the patients came from the provinces of Luanda, Uíge and Malange, and hepatosplenic schistosomiasis was predominant in patients from Uíge and should be further considered in patients from this region. Potential risk factors include ethylic habits, bathing in the river and blood transfusion. Reinforcement of preventive measures are highly recommended through, for example, vector control measures, improvement of sanitation and treated water, health education and literacy in the population and increased access to health service

Introducción: Existe poca evidencia sobre la competencia clínica del médico de familia (MF) en la consulta real en Atención Primaria (APS), especialmente en exploración física. Objetivos: Evaluar la competencia clínica del MF en su práctica real ( 4ºescalón de Miller) mediante un instrumento aplicable en APS integrando varias herramientas de evaluación. Medir la Calidad Global del encuentro (CGE) con estándares de calidad para cada componente competencial. Establecer la variación y correlación de los componentes competenciales entre ellos y con la CGE Establecer la influencia de factores del profesional y de la organización en la competencia del MF. Determinar la sensibilidad de la EF para detectar Hepatomegalia y su influencia sobre el manejo clínico posterior Métodos: Estudio observacional descriptivo de evaluación de competencias con una paciente con hepatomegalia constatada, estandarizada e infiltrada (PEI) en las consultas de MF. La PEI visitó por dolor abdominal a 61 MF en 12 centros de salud (CS) en Barcelona. 57 encuentros fueron evaluados a partir de la audiograbación oculta, un listado evaluativo sobre Exploración Física que completaba la PEI tras la consulta, las anotaciones en la historia clínica y las derivaciones. Se midió la competencia en Anamnesis, Exploración Física, pruebas complementarias y diagnóstico con estándares diseñados por expertos y revisión de la evidencia, y la competencia en comunicación con el cuestionario GATHA-audio. Se definieron estándares de Calidad según determinado nivel de competencia en cada área. Resultados: Los MF evaluados fueron mayoritariamente mujeres, de edad media, especialistas en MF y tutores de residentes. Ninguno detectó a la PEI. Realizaban muchas consultas al dia con tiempo escaso, raramente acompañados de otro profesional. Las visitas de la PEI son 3 minutos más largas que las del promedio. La mitad fueron interrumpidas durante más de 2 minutos. 84% de los MF accedieron a recetar un medicamento de sanidad privada a nuestra PEI, 75% sin negociar ni explicar. La competencia de los MF fué mejor en Anamnesis y en Pruebas Complementarias, peor en Exploración Física y diagnóstico. Sólo 4 MF detectaron la hepatomegalia. La competencia en comunicación fué mejor en habilidades que en actitudes o tareas. En Calidad, 2 médicos cumplen estándares óptimos para todas las competencias y 17 médicos cumplen estándares aceptables. Mejor anamnesis se asoció con: antigüedad, ser especialista, vía MIR, entrevistas más largas, en CS docentes e interrupciones. La edad, la experiencia y antigüedad del MF, las entrevistas más largas, en CS docentes se asociaron a mejores Exploración Física. Mayor precisión diagnóstica se asoció a la edad. La comunicación fue mejor en MF, vía MIR, tutores en CS docentes, en entrevistas más largas y con interrupciones. Hallamos correlación entre: Anamnesis con diagnóstico, Anamnesis y comunicación, Pruebas Complementarias y diagnóstico. Conclusiones: Se ha diseñado e implementado un sistema de evaluación aplicable y útil para medir la competencia del MF en su práctica real. Los MF evaluados puntúan mejor en Anamnesis y Pruebas Complementarias, y sólo 1/3 de ellos cumplen estándares óptimos o aceptables en todas las competencias. La capacidad de los MF para detectar hepatomegalia es baja, aunque esto no influye en el manejo posterior, ya que la mayoría cumple aceptablemente en Diagnóstico y Pruebas Complementarias. Los componentes competenciales no se correlacionan globalmente. La competencia de los MF se asocia a la edad, la experiencia, la formación (especialidad y vía MIR) y la docencia postgrado, entrevistas más largas y con interrupciones. La Comunicación de los MF evaluados corresponde a un modelo biomédico de atención al paciente. La puntuación en comunicación centrada en el paciente y negociación es menor que en otras habilidades.<br>Background: Little is known about clinical competence of family doctors in daily practice in Primary Health Care (PHC), especially in physical examination . Objectives: To assess the clinical competence of family physicians (FPs) in actual practice (4th Miller’s step) by an instrument integrating various assessment tools. To measure the Overall Quality of the encounter (OQE) by standards for each competency component. Set variation and correlation of components of competence among themselves and with the OQE. Set the influence of professional and organizational variables on FPs competence. To determine the sensitivity of PE to detect hepatomegaly and to relate this result with the subsequent clinical management. Methods: Descriptive observational study assessing clinical competence in actual practice with a unannounced standardized patient (USP) with hepatomegaly and hidden audio recording. 104 FPs accepted to participate in 12 Health Centers (CS) in Barcelona. The USP presented with hepatomegaly and mild abdominal pain to 61 FPs who were finally included. 57 encounters were evaluated from audiotapes, a physical examination checklist from the USP after consultation, medical notes and referrals. Medical competence in history taking, physical examination, final tests requested, and diagnosis impression was evaluated by standards designed by experts and review of the evidence. Communication competence was measured with the audio-GATHA questionnaire test. Quality standards were defined according to certain level of competence in each area. Results: FPs evaluated were mostly women, middle-aged, specialists and tutoring family medicine residents. None of the participants detected USP. They had high number of visitations a day with limited time, rarely accompanied by another professional. Visits of USP were about 3 minutes longer than the average. Half of them were interrupted for more than 2 minutes. 84% of FPs agreed to prescribe a medication from private healthcare to the USP, 75% without negotiating or explain. Physicians scored better at History taking and final tests requested than diagnosis impression and Physical examination. Only 4 FPs detected hepatomegaly. Communication competence was better in attitudes than in skills or tasks. About quality, 2 doctors meet optimal standards for all competencies and 17 doctors meet acceptable standards. Best history taking was associated with: age, being a specialist, longer interviews, tutoring residents and interruptions in encounters. Aged and experienced physicians, working on accredited Health Centers, and longer interviews related to better physical examination. Diagnostic accuracy was associated with age. Communication score was better in residency trained and experienced FPs, tutoring residents, and in longer and interrupted encounters. We found correlation between History taking and diagnostic , History taking and communication, final tests requested and diagnosis impression. Conclusions: We designed and implemented a competency evaluation system, applicable and useful for FPs in actual practice. Physicians evaluated score better in History taking and final tests requested. Only 1/3 of them meet optimal or acceptable standards in all competencies. The FPs ability to detect hepatomegaly is low, although this does not influence clinical management: most of physicians meet acceptable quality standards in test requested and diagnosis impression Competence’ components does not globally correlate. The competence of the MF is associated with age, experience, training (specialty and MIR) and postgraduate teaching, longer interviews and interruptions. Communication of MF evaluated corresponds to a biomedical model of patient care. The score in patient-centered communication and negotiation is lower than in other skills.

Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS), manufactured for a variety of industrial and consumer applications, are ubiquitous environmental pollutants. Their accumulation in humans and wildlife raises serious health concerns. Here, we examined the potential effects of PFOA and PFOS on the innate immune system in mice. Short-term dietary exposure to high doses reduces the total number and subpopulations of circulating white blood cells. Moreover, production of proinflammatory cytokines by macrophages in the peritoneal cavity and bone marrow, but not in the spleen following exposure to in vitro or in vivo stimulation by bacterial lipopolysaccharides is enhanced. With respect to adaptive immunity, PFOS reduces the total numbers of thymocytes and splenocytes and subpopulations thereof in a dose dependent fashion. Furthermore, comparison of wild-type mice and the corresponding knock-out strain lacking peroxisome proliferator-activated receptor-alpha revealed that these immunological changes are partially dependent on this receptor. Our further studies also show that sub-chronic dietary exposure to an environmentally relevant dose of PFOS does not alter the cellularity of the thymus and spleen and exerts no influence on humoral immune responses. To facilitate examination of the effects of PFOA and PFOS on the hepatic immune system, we developed a procedure for mechanical disruption that yields a larger number of functionally competent immune cells from this organ. In our last study, lower doses of PFOA or PFOS induced hypertrophy of hepatocytes and altered the hepatic immune status. Thus, we find that short-term, high- and low-dose exposure of mice to these fluorochemicals is immunohepatotoxic.<br>Perfluorooktanat (PFOA) och perfluorooktansulfonat (PFOS) som tillverkas för många olika industri och konsumentprodukter, är globalt förekommande miljögifter. Deras ackumulering i människor och djur ger upphov till en stark oro för hälsoproblem. Vi har granskat effekterna av PFOA och PFOS på det medfödda, ospecifika immunförsvaret. Exponering för höga doser via maten under kort tid minskar det totala antalet cirkulerande vita blodkroppar samt delpopulationerna.. Immunsvaret ökar dock efter stimulering med bakteriella lipopolysaccharider både in vitro och in vivo , dvs produktionen av proinflammatoriska cytokiner av makrofager i bukhålan och benmärgen, men inte i mjälten ökar.. När det gäller adaptiv, specifik immunitet minskar PFOS det totala antalet tymocyter och splenocyter och deras olika subpopulationer. Vid exponering för lägre doser av PFOS induceras hepatomegali utan att påverka tymus eller mjälten.   Vi kunde visa att peroxisomal proliferator-aktiverad receptor-alfa medierar effekterna utav PFOS i tymus samt delar av effekterna av PFOS i mjälten genom att använda möss som saknade denna receptor. . Dettastöds av vår studie med subkronisk exponering för en miljömässig dos av PFOS vilken inte ändrade den cellulära sammansättningen i vare sig  tymus eller mjälte och inte hade  något inflytande på det humorala immunsvaret. För att underlätta studier av hur PFOA och PFOS påverkar immunsystemet i levern utvecklade vi en metod för framrening av immunceller via mekanisk sönderdelning av levern, vilket gavett större antal av funktionella  immunceller från detta organ. I vår sista studie kunde vi påvisa att lägre doser av PFOA eller PFOS inducerade hypertrofi av hepatocyter samt en påverkan av leverns immunförsvar.