Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.

Caracterizar epidemiológicamente y clínicamente a los pacientes con diagnóstico de cirrosis hepática en región Caribe Colombiana, que reciben atención en la Unidad de Gastroenterología y Hepatología de la Clínica General del Norte, durante el periodo enero de 2012 a marzo de 2017. Materiales y Métod...

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Autores:: Escorcia Charris, Edgardo José
Marrugo Balceiro, Wilson Rafael

Tipo de recurso:: Trabajo de grado de pregrado

Fecha de publicación:: 2017

Institución:: Universidad Libre

Repositorio:: RIU - Repositorio Institucional UniLibre

Idioma:: spa

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dc.title.spa.fl_str_mv	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
title	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
spellingShingle	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017. Cirrosis hepática Epidemiologia Medicina Liver cirrhosis. Epidemiology Epidemiología Cirrosis Hepática Cirrosis Hepática Epidemiología
title_short	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
title_full	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
title_fullStr	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
title_full_unstemmed	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
title_sort	Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.
dc.creator.fl_str_mv	Escorcia Charris, Edgardo José Marrugo Balceiro, Wilson Rafael
dc.contributor.advisor.none.fl_str_mv	Ortega, Rolando Iglesias Acosta, Jesús E.
dc.contributor.author.none.fl_str_mv	Escorcia Charris, Edgardo José Marrugo Balceiro, Wilson Rafael
dc.subject.spa.fl_str_mv	Cirrosis hepática Epidemiologia Medicina
topic	Cirrosis hepática Epidemiologia Medicina Liver cirrhosis. Epidemiology Epidemiología Cirrosis Hepática Cirrosis Hepática Epidemiología
dc.subject.subjectenglish.eng.fl_str_mv	Liver cirrhosis. Epidemiology
dc.subject.lemb.spa.fl_str_mv	Epidemiología Cirrosis Hepática
dc.subject.proposal.spa.fl_str_mv	Cirrosis Hepática Epidemiología
description	Caracterizar epidemiológicamente y clínicamente a los pacientes con diagnóstico de cirrosis hepática en región Caribe Colombiana, que reciben atención en la Unidad de Gastroenterología y Hepatología de la Clínica General del Norte, durante el periodo enero de 2012 a marzo de 2017. Materiales y Métodos: Estudio descriptivo transversal y retrospectivo; muestra por conveniencia de 284 pacientes con diagnóstico de cirrosis hepática, ya sea clínico, de laboratorio, imagenológico o histopatológico. La tabulación de la información se realizó en programa Epi-Info 7.0; se valoraron parámetros estadísticos descriptivos. Resultados: El 70.4% de los pacientes procedían del departamento del Atlántico, el principal motivo de consulta fue la imagen hepática alterada en estudios de imagen 36,2%; la etiología de mayor frecuencia fue por virus C con el 28,5%, el 66.2% presentó enfermedad bien compensada (CHILD-A). Conclusiones: La etiología por virus de hepatitis C es la de mayor prevalencia en el medio local, le siguen en frecuencia el hígado graso no alcohólico, la hepatitis autoinmune, la cirrosis biliar primaria, el alcohol, viral hepatitis B y otras etiologías.
publishDate	2017
dc.date.accessioned.none.fl_str_mv	2017-10-25T20:23:07Z
dc.date.available.none.fl_str_mv	2017-10-25T20:23:07Z
dc.date.created.none.fl_str_mv	2017
dc.type.local.spa.fl_str_mv	Tesis de Especialización
dc.type.hasversion.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
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dc.identifier.instname.spa.fl_str_mv	instname:Universidad Libre
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional Universidad Libre
url	https://hdl.handle.net/10901/10705
identifier_str_mv	instname:Universidad Libre reponame:Repositorio Institucional Universidad Libre
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language	spa
dc.relation.references.SPA.fl_str_mv	Samada M, Hernández J, Barroso L, Chao L, González M, Fernández I. Identificación de factores de riesgo de presencia de várices esofágicas en pacientes con cirrosis hepática. Rev Cub Med Mil. 2008;37(1):1-8 Alonso F, Garmendia M, De Aguirre M, Searte J. Análisis de la Tendencia de la Mortalidad por Cirrosis hepática en Chile. Re Med Chile 2010; 138:1253-8 Lebroc D, Reina A, Camacho J, Massip M. Caracterización Clínica de los Pacientes con Cirrosis Hepática en el Hospital Provincial Docente “Doctor Antonio Luaces Iraola”. MediCiego 2011, 17(2) Torre A. Complicaciones de la cirrosis hepática: ascitis, encefalopatía, síndrome hepatorrenal y estado nutricional. Revista de Gastroenterología de México. 2014;79(1):5-7 Campollo O, Valencia J, Berumen A, Perez M, Pandero A, Segura J. Características epidemiológicas de la cirrosis hepática en el Hospital Civil de Guadalajara. Salud pública de México.1997;39(3):195-200 Bustios C, Davalos M, Roman R, Zumaeta E. Características Epidemiológicas y Clínicas de la Cirrosis Hepática en la Unidad de Hígado del HNERM Es-Salud. Rev. gastroenterol. 2007;27(3):238-245. Giraldo A, Barraza M, Villa H, Martínez J, García G. Caracterización epidemiológica de pacientes con cirrosis en una consulta de gastroenterología en Pereira, Colombia, 2009-2012. Rev. Méd. Risaralda 2014; 20 (2):86-94 Prieto J, Sánchez S, Prieto R, Rojas E, González L, Mendivelso F. Características clínicas y descompensación en pacientes con cirrosis hepática atendidos en dos centros de hepatología en la ciudad de Bogotá D.C., 2010-2014. Rev Col Gastroenterol 2016;31(1):1-8 Martirani, A; Wajchenberg, B; Souza, R; Carvalho, A; et al. Toxic (postnecrotis) cirrosis of the liver in childhood. Gastroenterology. 1957;32:304 More E. Características clínicas y epidemiológicas de la cirrosis hepática en un hospital de la ciudad de Lima. Tesis de gradop en Gastroenterologia. Fac Med Hum. 2015; 1-92
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In Monga SPS, editor: Molecular pathology of liver diseases, New York, 2011, Springer, pp 411–425. Lee UE, Friedman SL: Mechanisms of hepatic fibrogenesis. Best Pract Res Clin Gastroenterol 25(2):195–206, 2011 Iwaisako K, Brenner DA, Kisseleva T: What’s new in liver fibrosis? The origin of myofibroblasts in liver fibrosis. J Gastroenterol Hepatol 27(Suppl 2):65–68, 2012 McGuire RF, Bissell DM, Boyles J, Roll FJ. Role of extracelular matrix in regulating fenestrations of sinusoidal endotelial cells isolated from normal rat liver. Hepatology 1992 Elsharkawy AM, Oakley F, Mann DA. The role and regulation of hepatic stellate cell apoptosis in reversal of liver fibrosis. Apoptosis 2005; 10: 927-939 March S, Hui EE, Underhill GH, Khetani S, Bhatia SN. Mi croenvironmental regulation of the sinusoidal endothelial cell phenotype in vitro. Hepatology 2009; 50: 920-928 Lakner AM, Steuerwald NM, Walling TL, Ghosh S, Li T, McKillop IH, Russo MW, Bonkovsky HL, Schrum LW. Inhibitory effects of microRNA 19b in hepatic stellate cellmediated fibrogenesis. Hepatology 2012; 56: 300-310 Tacke F, Weiskirchen R: Update on hepatic stellate cells: pathogenic role in liver fibrosis and novel isolation techniques. Expert Rev Gastroenterol Hepatol 6(1):67–80, 2012 Kolios G, Valatas V, Kouroumalis E. Role of Kupffer cells in the pathogenesis of liver disease. World J Gastroenterol 2006; 12: 7413-7420 Pellicoro A, et al: Liver fibrosis and repair: immune regulation of wound healing in a solid organ. Nat Rev Immunol 14(3):181–194, 2014. Pradere JP, et al: Hepatic macrophages but not dendritic cells contribute to liver fibrosis by promoting the survival of activated hepatic stellate cells in mice. Hepatology 58(4):1461–1473, 2013. Tacke F, Zimmermann HW: Macrophage heterogeneity in liver injury and fibrosis. J Hepatol 60(5):1090–1096, 2014. Deaciuc IV, Spitzer JJ. Hepatic sinusoidal endothelial cell in alcoholemia and endotoxemia. Alcohol Clin Exp Res 1996; 20: 607-614 ål P, Broomé U, Scheynius A, Befrits R, Hultcrantz R. Kupffer cell iron overload induces intercellular adhesión molecule-1 expression on hepatocytes in genetic hemochromatosis. Hepatology 1995; 21: 1308-1316 Mehal W, Imaeda A. Cell death and fibrogenesis. Semin Liver Dis 2010; 30: 226-231 Guicciardi ME, Gores GJ. Apoptosis as a mechanism for liver disease progression. Semin Liver Dis 2010; 30: 402-410 Ribeiro PS, Cortez-Pinto H, Solá S, Castro RE, Ramalho RM, Baptista A, Moura MC, Camilo ME, Rodrigues CM. Hepatocyte apoptosis, expression of death receptors, and activation of NF-kappaB in the liver of nonalcoholic and alcoholic steatohepatitis patients. Am J Gastroenterol 2004; 99: 1708-1717 Marshall A, Rushbrook S, Davies SE, Morris LS, Scott IS, Vowler SL, Coleman N, Alexander G. Relation between hepatocyte G1 arrest, impaired hepatic regeneration, and fibrosis in chronic hepatitis C virus infection. 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Cell Tissue Res. 2012; 347:245–256. Fernández M, Semela D, Bruix J, Colle I, Pinzani M, Bosch J. Angiogenesis in liver disease. J Hepatol 2009; 50: 604–20. García-Pagán JC, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol 2012; 57: 458–61. Arvaniti V, D’Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010; 139: 1246–56.e5. Parkes J, Roderick P, Harris S, et al. Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease. Gut 2010; 59: 1245–51. Taura K, De Minicis S, Seki E, Hatano E, Iwaisako K, Osterreicher CH, et al. Hepatic stellate cells secrete angiopoietin 1 that induces angiogenesis in liver fibrosis. Gastroenterology. 2008; 135:1729–1738. D’Amico G, García-Tsao G, Pagliaro L. 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Comparison with liver biopsy and fibrotest. Hepatology 2007;46(1):32–6. Rossi E, Adams L, Prins A, et al. Validation of the FibroTest biochemical markers score in assessing liver fibrosis in hepatitis C patients. Clin Chem 2003;49(3): 450 Gupta A, Kim D, Krinsky G, et al. CT and MRI of cirrhosis and its mimics. AJR Am J Roentgenol 2004;183:1595–601. Ginès P, Cabrera J, Guevara M, Morillas R, Ruiz del Árbol L, Solà R y Soriano G. Modelos pronósticos en la cirrosis hepática. El modelo MELD Documento de consenso sobre el tratamiento de la ascitis, la hiponatremia dilucional y el síndrome hepatorrenal en la cirrosis hepática. Gastroenterol Hepatol 2004; 27(9):535-44 Groszmann RJ, Garcia-Tsao G, Bosch J, et al: Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: pp. 2254-2261 Ripoll C, Groszmann R, Garcia-Tsao G, et al: Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007; 133: pp. 481-488 Gluud LL, Klingenberg S, Nikolova D, and Gluud C: Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. Am J Gastroenterol 2007; 102: pp. 2842-2848 Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodés J, and Bosch J: Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 2003; 37: pp. 902-908 Garcia-Tsao G, and Bosch J: Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010; 362: pp. 823-832 Bañares R, Albillos A, Rincón D, et al: Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a metaanalysis. Hepatology 2002; 35: pp. 609-615 Goulis J, Patch D, and Burroughs AK: Bacterial infection in the pathogenesis of variceal bleeding. Lancet 1999; 353: pp. 139-142 D'Amico G, Garcia-Tsao G, and Pagliaro L: Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: pp. 217-231 Fede G, D'Amico G, Arvaniti V, et al: Renal failure and cirrhosis: a systematic review of mortality and prognosis. J Hepatol 2012; 56: pp. 810-818 Runyon BA: Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: pp. 2087-2107 Angeli P, Fasolato S, Mazza E, et al: Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial. Gut 2010; 59: pp. 98-104 Ginès P, Titó L, Arroyo V, et al: Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94: pp. 1493-1502 Bureau C, Métivier S, D'Amico M, et al: Serum bilirubin and platelet count: a simple predictive model for survival in patients with refractory ascites treated by TIPS. J Hepatol 2011; 54: pp. 901-907 Arvaniti V, D'Amico G, Fede G, et al: Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010; 139: pp. 1246 Fernández J, Navasa M, Planas R, et al: Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133: pp. 818-824 Sort P, Navasa M, Arroyo V, et al: Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999; 341: pp. 403-409 Jepsen P, Ott P, Andersen PK, Sørensen HT, and Vilstrup H: Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology 2010; 51: pp. 1675-1682 Jepsen P, Ott P, Andersen PK, Sørensen HT, and Vilstrup H: Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology 2010; 51: pp. 1675-1682 Bai M, Yang Z, Qi X, Fan D, and Han G: l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2013; 28: pp. 783-792 Bass NM, Mullen KD, Sanyal A, et al: Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010; 362: pp. 1071-1081
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spelling	Ortega, RolandoIglesias Acosta, Jesús E.Escorcia Charris, Edgardo JoséMarrugo Balceiro, Wilson RafaelBarranquilla2017-10-25T20:23:07Z2017-10-25T20:23:07Z2017https://hdl.handle.net/10901/10705instname:Universidad Librereponame:Repositorio Institucional Universidad LibreCaracterizar epidemiológicamente y clínicamente a los pacientes con diagnóstico de cirrosis hepática en región Caribe Colombiana, que reciben atención en la Unidad de Gastroenterología y Hepatología de la Clínica General del Norte, durante el periodo enero de 2012 a marzo de 2017. Materiales y Métodos: Estudio descriptivo transversal y retrospectivo; muestra por conveniencia de 284 pacientes con diagnóstico de cirrosis hepática, ya sea clínico, de laboratorio, imagenológico o histopatológico. La tabulación de la información se realizó en programa Epi-Info 7.0; se valoraron parámetros estadísticos descriptivos. Resultados: El 70.4% de los pacientes procedían del departamento del Atlántico, el principal motivo de consulta fue la imagen hepática alterada en estudios de imagen 36,2%; la etiología de mayor frecuencia fue por virus C con el 28,5%, el 66.2% presentó enfermedad bien compensada (CHILD-A). Conclusiones: La etiología por virus de hepatitis C es la de mayor prevalencia en el medio local, le siguen en frecuencia el hígado graso no alcohólico, la hepatitis autoinmune, la cirrosis biliar primaria, el alcohol, viral hepatitis B y otras etiologías.To characterize epidemiologically and clinically patients diagnosed with liver cirrhosis in the Colombian Caribbean region, receiving care in the Gastroenterology and Hepatology Unit of the Clínica General del Norte, from January 2012 to March 2017. Materials and methods: Descriptive cross-sectional and retrospective study; sample for the convenience of 284 patients with diagnosis of hepatic cirrhosis, whether clinical, laboratory, imaging or histopathological. The information was tabulated in Epi-Info 7.0 program, descriptive statistical parameters were evaluated. Results: 70.4% of the patients came from the Atlantico department, main reason for consultation was altered liver imaging in imaging studies 36.2%; the most frequent etiology was C virus with 28.5%, 66.2% had well-compensated disease (CHILD-A). Conclusions: The etiology of hepatitis C virus is the most prevalent in the local environment, followed by non-alcoholic fatty liver, autoimmune hepatitis, primary biliary cirrhosis, alcohol, viral hepatitis B and other etiologies.PDFapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadas 2.5 Colombiainfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Cirrosis hepáticaEpidemiologiaMedicinaLiver cirrhosis.EpidemiologyEpidemiologíaCirrosis HepáticaCirrosis HepáticaEpidemiologíaCaracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.Tesis de Especializacióninfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesisSamada M, Hernández J, Barroso L, Chao L, González M, Fernández I. 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N Engl J Med 2010; 362: pp. 1071-1081ORIGINAL1.047.371.408.pdf1.047.371.408.pdfTrabajo de Gradoapplication/pdf484102http://repository.unilibre.edu.co/bitstream/10901/10705/1/1.047.371.408.pdf2dbf43d4d46d5d330f617c920c914befMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repository.unilibre.edu.co/bitstream/10901/10705/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52THUMBNAIL1.047.371.408.pdf.jpg1.047.371.408.pdf.jpgIM Thumbnailimage/jpeg6101http://repository.unilibre.edu.co/bitstream/10901/10705/3/1.047.371.408.pdf.jpg5ccdce3a14961d0bfd5f15ae5d597039MD5310901/10705oai:repository.unilibre.edu.co:10901/107052022-10-11 12:08:26.752Repositorio Institucional Unilibrerepositorio@unilibrebog.edu.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

Caracterización epidemiológica y clínica de la cirrosis hepática en un centro regional del caribe colombiano: clínica general del norte. Enero 2012 a marzo 2017.

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