Acta Medica Croatica最新文献

{"title":"[ACUTE PANCREATITIS IN FAMILY PHYSICIAN PRACTICE].","authors":"S Martinović Galijašević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute pancreatitis (AP) is a serious illness, defined as acute inflammation of the pancreas, which can result in damage to the\u0000surrounding tissue and other organ systems. It is considered as a set of dynamic, local and systemic pathophysiological changes,\u0000caused by sudden rush of lithic pancreatic enzymes into glandular parenchyma. AP is an inflammatory process caused by auto-digestion\u0000of pancreatic tissue due to early activation of the zymogen into the active proteolytic enzyme. The most common causes\u0000are biliary disease and alcohol abuse. Clinical presentation is predominated by severe upper abdominal pain. Depending on the\u0000disease severity, it may be associated with systemic complications and damage to distant organs. The majority of patients have\u0000multiply elevated serum concentrations of pancreatic enzymes, amylase and lipase. AP may have a variable course and prognosis,\u0000from mild to severe forms and potentially lethal disease; therefore, early assessment using different prognostic parameters\u0000is of utmost importance. Clinical signs vary from mild interstitial pancreatitis to severe pancreatitis with necrosis and associated\u0000multiple organ failure. The clinical course of mild AP is generally without complications and full recovery is expected. Treatment is\u0000conservative and/or surgical, and consists of pain control, fluid replacement, nutritional support, and prevention of complications.\u0000Key words:</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"357-64"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35650211","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}

{"title":"[QUALITY OF LIFE IN PATIENTS WITH FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL SYSTEM].","authors":"N Mrduljaš-Dujić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The characteristic of functional gastrointestinal disorders (FGID) is that, at least for now, their symptoms cannot be explained\u0000by structural or biochemical abnormalities. The most common functional gastrointestinal disorders are functional dyspepsia and\u0000irritable bowel syndrome. Stress-induced changes in the neuro-endocrine-immune pathways act on the brain-gut axis and cause\u0000symptoms. In these patients, the quality of life is significantly impaired and is associated with subjective assessment of symptom\u0000severity and psychological factors. Good doctor-patient relationship is important to control the symptoms of FGIDs.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"263-70"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505145","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}

{"title":"[PATIENT WITH PEPTIC ULCER DISEASE].","authors":"N Radošević Quadranti,&nbsp;I Diminić-Lisica,&nbsp;N Bašić Marković,&nbsp;B Popović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Peptic ulcer disease is represented by a lesion in the mucosa of the digestive tract due to imbalance of its aggressive and protective\u0000mechanisms. The main external factors of the development of peptic ulcers are Helicobacter pylori infection and the use of\u0000non-steroidal anti inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA). Symptoms of peptic ulcer disease are a common\u0000reason for visiting the family physician. All patients with symptoms of dyspepsia under the age of 50 and without the alarm symptoms\u0000should be tested whether H. pylori is present by performing the Urea Breath Test or stool antigene testing, and infection, if\u0000found, should be treated. Endoscopic examination is obligatory in patients older than 50 years and those with alarm symptoms.\u0000„Sequential therapy“ is recommended in Croatia as the first-line treatment of H. pylori infection, or triple therapy that comprises\u0000applying a proton pump inhibitor (PPI) in combination with amoxicillin and metronidazole. Four weeks after eradication therapy\u0000the control testing for H. pylori should be performed.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"287-91"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505148","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}

{"title":"[TRANSIENT ELASTOGRAPHY – FUTURE OF DIAGNOSIS OF LIVER LESIONS OR\u0000JUST AN ATTEMPT].","authors":"T Zavidić,&nbsp;Đ Lovrinić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Comprehensive care that each general practitioner offers to his patients includes familiarity with different methods of diagnosis.\u0000In diagnosis today there are frequent indications of various liver scarring which first need to be diagnosed correctly and then\u0000treated and monitored over time. Chronic liver diseases are among the top ten causes of death in developed countries and one\u0000of the leading public health issues in the world. In Croatia, fibrosis and cirrhosis ranked 10th among causes of death in 2013, accounting\u0000for 1.95% of all deaths and even 3.11% in men. The degree of liver fibrosis is the most direct and the best way to indicate\u0000the seriousness of liver scarring, while prognosis depends on advancement of fibrosis. In this paper, we attempted to explain a\u0000noninvasive method called transient elastography (TE), its basic properties, advantages and disadvantages, diagnostic precision,\u0000as well as its application in medical practice. Currently, TE may be used as a diagnostic method for elimination of cirrhosis and\u0000may help determine severe fibrosis in patients with alcohol liver disease. By using two noninvasive diagnostic methods, it is\u0000possible to assess the stage of fibrosis (F ≥2) with high accuracy and avoid up to three-fourths of biopsy procedures. However,\u0000before including TE in the algorithm of diagnosis, it is necessary to define the standardized cut off values for different stages of\u0000liver scarring.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"381-8"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505254","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}

{"title":"[TUMORS OF THE PANCREAS IN FAMILY PHYSICIAN PRACTICE].","authors":"D Ivezić-Lalić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the past few decades, tumors of the pancreas have been recorded to increase. The incidence increases with age and peaks in\u00007th and 8th decades of life. Late onset of symptoms and inability of early detection are the reasons why the disease is diagnosed\u0000at a stage when cure is no longer possible. There are no specific tests for early detection of pancreatic tumors. The low absolute\u0000risk of developing the most common form of cancer, ductal adenocarcinoma, does not justify early screening of general population.\u0000The recognition and treatment of symptoms related to the disease are priorities, approaching the patient as a whole person.\u0000It is important to alleviate the symptoms and side effects of treatment. The most common symptoms are pain, intestinal obstruction,\u0000bile duct obstruction, pancreatic insufficiency, anorexia-cachexia, and depression. Pain is the symptom most disturbing for\u0000patients regardless of the stage and type of malignancy, and it is a symptom patients are most afraid of. Modern pharmacotherapy\u0000of pain is based on the concept of ‘three steps in the treatment of pain’, issued by the World Health Organization, which is\u0000universally applicable and allows for flexibility in the selection and application of analgesics. There are also non-pharmacological\u0000modalities of pain treatment, as well as the ‘elevator model’. Family physician has a responsible role in helping the patient and his\u0000family in the organization of palliative care and providing support for its coordination and implementation.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"405-9"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35555221","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}

{"title":"[APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].","authors":"M Nikolić,&nbsp;M Hanževački,&nbsp;P Jurčić,&nbsp;I Budimir,&nbsp;N Ljubičić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal\u0000bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of\u0000hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population,\u0000increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic\u0000resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The\u0000aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also\u0000to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic\u0000modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases,\u0000we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included\u0000results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the\u0000European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the\u0000state-of-the-art on gastrointestinal bleeding, new classification of gastrointestinal bleeding from the upper, mid and lower gut,\u0000controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding\u0000from the upper tract, restrictive transfusion strategy, useful clinical stratification of the severity of bleeding, indications for\u0000hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic\u0000ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed liver cirrhosis, primary and secondary prophylaxis of\u0000variceal bleeding, new endoscopic hemostatic modality, and radiological and surgical treatment of gastrointestinal bleeding. The\u0000educational nature of this review could serve for establishing Croatian guideline for the management of gastrointestinal bleeding.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"293-304"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505149","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}

{"title":"[FUNCTIONAL BLOATING, CONSTIPATION AND DIARRHEA].","authors":"S Beckić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Functional disorders and diseases are usually diagnosed by exclusion when there is no clear presence of inflammatory, anatomic,\u0000metabolic, or neoplastic processes which would explain the symptoms and difficulties of the patient. The Rome III Diagnostic\u0000Criteria for Functional Gastrointestinal Disorders (FGID) are used in clinical and scientific medicine. Functional disorders of the\u0000upper gastrointestinal system in adults are classified into six groups. Group C are functional bowel disorders which include irritable\u0000bowel syndrome (C1), functional bloating (C2), functional constipation (C3) and functional diarrhea (4). The symptoms of\u0000functional gastrointestinal disorders are often a combination of disrupted physiological functions, such as an increase in motor\u0000reactivity of the intestine, visceral hypersensitivity, impaired immune functions and inflammatory intestinal mucosa followed by\u0000change in the intestinal bacterial flora and disrupted central nervous system-enteric nervous system regulation because of exposure\u0000to different psychosocial and sociocultural factors. The symptoms must be present for at least six months before clinical\u0000manifestation of the disease and also must be currently present and diagnostically confirmed in the last three months. Diagnostic\u0000procedures are targeted individually, depending on the patient age, nature of symptoms, and other clinical and laboratory characteristics.\u0000Treatment is based on health education, nutrition counseling, medication and psychological support.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"253-62"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35504743","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}

{"title":"[GASTROESOPHAGEAL REFLUX DISEASE – A MULTIFACETED DISEASE].","authors":"N Bašić-Marković,&nbsp;R Marković,&nbsp;I Diminić-Lisica,&nbsp;N Radošević-Quadranti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastric content reflux to the esophagus is a physiological phenomenon that occasionally occurs after meal. Gastroesophageal\u0000reflux disease (GERD) is a state that appears when the quantity of gastric content surpasses its physiological elimination from\u0000the esophagus and causes difficulties with or without associated esophageal mucosa damage, as well as alarming symptoms.\u0000The symptoms are defined as alarming if they disturb the patient’s well-being and are the reason for a visit to the physician. The\u0000prevalence of GERD in the Western world is 10%-20% and is based on the estimation of the heartburn incidence as the leading\u0000symptom. The dominant symptoms are heartburn and regurgitation, especially after a heavy meal, and are highly specific for\u0000GERD. Extraesophageal reflux disease represents a wide range of symptoms connected to the upper and lower respiratory system,\u0000such as cough, laryngitis, asthma, chronic obstructive pulmonary disease, hoarseness, sinusitis-postnasal drip syndrome,\u0000otitis media, recurrent pneumonia and laryngeal carcinoma. The following tests are used in the reflux differential diagnosis:\u0000esophagogastroscopy, laryngoscopy and 24-hour pH monitoring. Patients suspected to suffer from GERD are initially treated with\u0000empirical proton pump inhibitor therapy twice a day for one to two months.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"279-85"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505147","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}

{"title":"[ACCUSTOMING TO HELICOBACTER PYLORI BACTERIUM IN FAMILY PRACTICE].","authors":"M Vrca Botica,&nbsp;I Zelić,&nbsp;I Borovečki Žuti,&nbsp;I Botica,&nbsp;Ana Gačina,&nbsp;D Haralović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Today, antibiotic resistance of Helicobacter pylori (HP) is a worldwide problem. The ‘test and treat’ strategy is the recommended\u0000approach in family medicine, as family medicine doctors make decisions on treating gastrointestinal conditions without endoscopic\u0000findings or HP testing. In treatment strategy, family medicine doctor has to answer several questions: whether the patient\u0000has HP infection, is it necessary to evaluate HP infection, which diagnostic test to use in evaluation of HP infection, should he\u0000proscribe antibiotic, and which antibiotic to prescribe. In this article, we present three common clinical cases to determine which\u0000approach to use in daily practice: dyspepsia, gastroesophageal reflux disease (GERD), and extragastric diseases associated with\u0000HP infection. Serology test, stool antigen test and urea breath test are described. It is required from family medicine doctors not\u0000only to rationalize antibiotic prescription but also to eradicate HP infection at the same time. We need to have in mind that disease\u0000is a result of the host-agent (bacterium) interaction that varies in time and possible damage/impairment from the disease.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"389-94"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505255","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}

{"title":"[CHRONIC INFLAMMATORY BOWEL DISEASES – SPECIFIC ASPECTS OF FAMILY PHYSICIAN CARE].","authors":"N Vinter-Repalust","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with chronic inflammatory bowel diseases have lower quality of life compared to general population. Aside from disease\u0000symptoms, the quality of life is additionally lowered by frequent admissions, more frequent follow up, and the like. From a long\u0000term perspective, problems also arise in patients worrying about the disease outcome, fear from developing a malignant disease\u0000arising from chronic inflammatory bowel disease, and family planning. The purpose of this article is to present some of the specific\u0000situations faced by people with chronic inflammatory bowel disease and review the state-of-the-art in the field of providing care\u0000for people with chronic inflammatory bowel disease. The following specific problems are tackled: chronic inflammatory bowel\u0000disease in children/adolescents, pregnancy, chronic inflammatory bowel disease and nutrition, surgery, psychosocial factors and\u0000inflammatory bowel disease, and self-help. The role of family medicine consists not only of helping diagnosing the disease as\u0000early as possible in order to enable early treatment, but also to advise patients how to live with the disease and offer answers to\u0000their questions arising from everyday life with the disease.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":"69 4","pages":"395-9"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35555219","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}