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sábado, 3 de octubre de 2015

Otra triada "patognomónica"

En lo personal, no me gusta mucho esa palabreja, que no sólo me recuerda al MIR, sino que con la práctica uno descubre que en medicina absolutamente nada es patognomónico.

No obstante, os hago la siguiente pregunta. Si os encontráis con un paciente con pneumobilia, diarrea crónica y tiempo de protrombina alargado.. ¿En qué pensáis? Y lo más importante ¿por qué?

3, 2, 1...




3 comentarios:

  1. Hay una respuesta acertada, aunque le falta explicar porqué... Si nadie más responde os lo cuento mañana.

    Y por cierto... ¿Se opera?

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  2. Aquí va la explicación (extraida del Blumgart):

    A pathognomonic triad consisting of pneumobilia, chronic diarrhea, and vitamin K malabsorption was recently suggested by Savvidou and colleagues (2009) to aid in the diagnosis of cholecystocolonic fistula. Diversion of bile acids into the colon results in malabsorption of fat and fat-soluble vitamins. In particular, vitamin K deficiency can be clinically significant and is easily detected by a prolonged prothrombin time (PT), and it can be corrected by parenteral supplementation ( Savvidou et al, 2009 ). Although the condition of bile acid malabsorption can be easily diagnosed by the selenium-75-homocholic acid taurine (SeHCAT) test, this study is time consuming and is not widely available ( Pattni & Walters, 2009 ). Plain abdominal radiographs have been reported to reveal air in the biliary tree in only 50% of cases, however, the diagnosis becomes evident only if a barium enema examination is done, preferably with air contrast, because barium ( Fig. 42B.8 (f0045) ) and air fill the gallbladder and extrahepatic bile ducts. In a recent report, a barium enema showing contrast filling of the biliary tract was used to diagnose a patient with a rare choledochocolonic fistula causing severe diarrhea (Anees et al, 2008). Failure of even a barium enema to show a cholecystocolonic fistula has been reported, but this is quite rare. In such cases, the cholecystocolic fistula is diagnosed by ERCP ( Arvanitidis et al, 2004 ; Schoeters et al, 2002 ).

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