EMC - Hépato-Gastroenterologie最新文献

Physiopathologie du reflux gastro-œsophagien

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/J.EMCHG.2005.09.001

P. Ducrotté, U. Chaput

引用次数: 4

Physiopathologie et traitement des troubles fonctionnels intestinaux 肠道功能障碍的病理生理学及治疗

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/j.emchg.2005.07.002

P. Ducrotté (Professeur des Universités, médecin des Hôpitaux)

{"title":"Physiopathologie et traitement des troubles fonctionnels intestinaux","authors":"P. Ducrotté (Professeur des Universités, médecin des Hôpitaux)","doi":"10.1016/j.emchg.2005.07.002","DOIUrl":"10.1016/j.emchg.2005.07.002","url":null,"abstract":"<div><p>Functional bowel disorders (FBD) are chronic digestive symptoms attributable to the lower gastrointestinal tract in the absence of any structural or biochemical explanation. The most common FBD is the irritable bowel syndrome (IBS), in which abdominal discomfort or pain is associated with disordered bowel habits (diarrhoea, constipation or both) or disturbed defecation. IBS pathophysiology is multifactorial and generally related to a “gut-brain axis” dysfunction. Serotonin (5-HT), a neurotransmitter found mainly in the gut, appears to represent a link in IBS pathophysiological processes. Recent studies have also highlighted the potential impact, in the onset of symptoms, of a micro-inflammatory condition and of an immunocompetent cell dysfunction, mainly mast cells, at the enteric nervous system level. In some patients, IBS appears as a post-infectious disorder, following an acute gastroenteritis. Traditional IBS management often relies on a combination of dietary measures, antispasmodic drugs and antidiarrhoeal or laxative drugs. Since it has been demonstrated that it is the main substratum of abdominal pain in a majority of IBS patients, visceral hypersensitivity appears the first therapeutic target. While tricyclic antidepressant agents given at low doses have become an option, the potential role of 5-HT has justified the development of new serotonergic agents, either 5-HT3 antagonists or 5-HT4 agonists, providing global relief of the multiple IBS symptoms. The influence of brain on gut-brain axis dysfunction cannot be omitted and psychotherapy, hypnosis or relaxation are useful, particularly in the most severe patients.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 400-412"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76415818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Infections bactériennes et cirrhose alcoolique 细菌感染和酒精性肝硬化

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/j.emchg.2005.07.003

C. Silvain (Professeur des Universités, praticien hospitalier), C. Chagneau-Derrode (Praticien hospitalier)

{"title":"Infections bactériennes et cirrhose alcoolique","authors":"C. Silvain (Professeur des Universités, praticien hospitalier), C. Chagneau-Derrode (Praticien hospitalier)","doi":"10.1016/j.emchg.2005.07.003","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.07.003","url":null,"abstract":"<div><p>Bacterial infections are frequent and severe complications of alcoholic cirrhosis. Their in-hospital incidence rate fluctuates between 30 and 50%. Spontaneous bacterial peritonitis (SBP) with or without bacteremia, urinary tract infections and pneumonia are the most frequent. SBP and bacterial pneumonia prognosis are the most severe (30 to 40% of death). These bacterial infections are almost always seen in the setting of advanced liver disease. Organisms normally found in the gastrointestinal tract are the predominant causative agents of SBP. The pathogenesis of these infections involves bacterial translocation and ascitis is colonised from an episode of bacteremia. Severe cellular insufficiency and low ascitis protid are predictive factors of SBP. Gastrointestinal bleeding is another predisposing factor and furthermore, infection predisposes to portal hypertension-related bleeding recurrence. Treatment of active infection is an emergency and is based on non nephrotoxic antibiotics such as IV cefotaxime or oral fluoroquinolones in patients with no encephalopathy or renal insufficiency. Antibiotic prophylaxis is justified in patients recovering from a first spontaneous bacterial peritonitis episode or admitted for variceal bleeding. Bacteremia is due to the same bacteria as spontaneous bacterial peritonitis and their treatment is based on the same antibiotics. Urinary tract infections are mainly due to E Coli and are responsible for 5 to 15% of SBP and bacteremia cases. The causative germs of pneumonia and meningitis are pneumococcus but also gram-negative organisms. When the SBP outcome is unusual the diagnosis of tuberculosi must be ruled out. Finally, early diagnosis and treatment have improved severe bacterial infections prognosis in alcoholic cirrhotic patients but survivors of SBP should be considered for liver transplantation.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 307-318"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.07.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91589052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conduite à tenir devant une ascite 在腹水前的行为

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/J.EMCHG.2005.07.005

Jacques Grangé

引用次数: 0

Assistance nutritionnelle au cours des insuffisances hépatocellulaires 肝细胞衰竭期间的营养援助

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/J.EMCHG.2005.08.001

X. Hébuterne

引用次数: 0

Gaz digestifs 消化不良气体

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/j.emchg.2005.07.001

L. Peyrin-Biroulet (Interne des Hôpitaux), M.-A. Bigard (Professeur des Universités, chef de service)

{"title":"Gaz digestifs","authors":"L. Peyrin-Biroulet (Interne des Hôpitaux), M.-A. Bigard (Professeur des Universités, chef de service)","doi":"10.1016/j.emchg.2005.07.001","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.07.001","url":null,"abstract":"<div><p>Many patients believe their excessive rectal gas to constitute a major handicap for their social life and/or to result from a medical disorder. As a result, physicians tend to prescribe multiple laboratory, radiological and endoscopic investigations which may not explain the symptoms despite their usefulness to rule out an organic aetiology. Moreover, such diagnostic approach commonly results in an inadequate therapeutic management. This review proposes a rational approach of such complaints. Particular emphasis is placed upon a sequential strategy consisting of 1) a daily count of flatulent manifestations (normal < 20 /day); 2) an analysis, when possible, of the flatus in terms of gas composition in order to determine whether the increased flatulence results from swallowed air (predominantly nitrogen N<sub>2</sub>) or from intraluminal production (carbon dioxide CO<sub>2</sub>, hydrogen H<sub>2</sub> and methane CH<sub>4</sub>); and 3) an adaptation of the treatment to the rectal gas origin. Currently, only dietetic measures have proven some efficacy, but probiotics seem likely to have role in the management of the diseases associated with digestive gas.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 370-387"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Index des mots clés 关键词索引

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/S1769-6763(05)00032-7

引用次数: 0

Kystes biliaires 囊肿胆汁酸

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/j.emchg.2005.08.002

T. Abita (Chef de clinique), F. Lachachi (Praticien hospitalier), F. Maisonnette (Praticien hospitalier), S. Durand-Fontanier (Maître de conférence universitaire, praticien hospitalier), D. Valleix (Professeur des Universités, praticien hospitalier, chef du département d'anatomie), B. Descottes (Professeur des Universités, praticien hospitalier, chef de service de chirurgie viscérale et transplantations)

{"title":"Kystes biliaires","authors":"T. Abita (Chef de clinique), F. Lachachi (Praticien hospitalier), F. Maisonnette (Praticien hospitalier), S. Durand-Fontanier (Maître de conférence universitaire, praticien hospitalier), D. Valleix (Professeur des Universités, praticien hospitalier, chef du département d'anatomie), B. Descottes (Professeur des Universités, praticien hospitalier, chef de service de chirurgie viscérale et transplantations)","doi":"10.1016/j.emchg.2005.08.002","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.08.002","url":null,"abstract":"<div><p>Biliary cysts are frequent hepatic manifestations. They are benign, single or multiple congenital lesions, with a female predominance. In more than half the cases, they remain asymptomatic; fortuitously detected during abdominal investigations, they are observable either by imaging (ultrasonography, CT scanning, MRI), either by surgery (laparoscopy or laparotomy). However, they may evolve and induce various complications: congestive attacks, intracystic hemorrhage, ruptures, infection, compression of the surrounding intra- or extrahepatic tissues. Treatment is indicated only in case of complication or pain. Although laparoscopic resection of the dome is the most frequently used treatment for about twelve years, the recurrence rate remains high. Besides, other therapeutic means exist, such as surgery (cystectomy, hepatic resection, hepatic transplantation) or non-surgical treatments (percutaneous radiological drainage, intracystic injection of sclerotic substances). All these methods have to be carefully discussed before selection, owing to various associated advantages, disadvantages and results.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 339-347"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91589051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Index des auteurs 作者索引

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/S1769-6763(05)00031-5

引用次数: 0

Kystes biliairesBiliary cysts

EMC - Hépato-Gastroenterologie Pub Date : 2005-10-01 DOI: 10.1016/j.emchg.2005.08.002

T. Abita, F. Lachachi, F. Maisonnette, S. Durand-Fontanier, D. Valleix, B. Descottes

引用次数: 0