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Dr. sc. Željko Krznarić KBC Zagreb Klinika za internu medicinu Zavod za gastroenterologiju

Dr. sc. Željko Krznarić KBC Zagreb Klinika za internu medicinu Zavod za gastroenterologiju . GASTROENTEROLOGIJA. GER B (gastroe z o fagealna refluksna bolest). ?. Žgaravica je tipični simptom GERB-a. Koliki postotak odraslih ima simptom žgaravice barem jednom mjesečno ? > 7% > 20%

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Dr. sc. Željko Krznarić KBC Zagreb Klinika za internu medicinu Zavod za gastroenterologiju

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  1. Dr. sc. Željko KrznarićKBC ZagrebKlinika za internu medicinuZavod za gastroenterologiju GASTROENTEROLOGIJA

  2. GERB(gastroezofagealna refluksna bolest) ? Žgaravica je tipični simptom GERB-a. Koliki postotak odraslih ima simptom žgaravice barem jednom mjesečno ? • > 7% • > 20% • > 40%

  3. u strukturi vodećih uzroka hospitalizacije i mortaliteta u Zagrebu i Hrvatskoj u 2000. godini bolesti probavnog sustava nalaze se na četvrtom, odnosno trećemmjestu Zavod za javno zdravstvo grada Zagreba - Centar za gerontologiju, 2001. ZAGREB, 2000.(uzorak Gradska ljekarna) HRK 1.... 2.... 3.... 4. RANITIDIN 5.... 6.... 7. OMEPRAZOL LIJEKOVI U GASTROENTEROLOGIJI

  4. KBC ZAGREB- 2000/01 - po broju utrošenih DDD

  5. DISPEPSIJA • ¼ opće populacije u razvijenim zemljama • 15% bolesnika sa dispepsijom traži liječnika unutar 3 mjeseca od nastanka tegoba • 7% svih posjeta liječniku i 40-70% svih GIT tegoba u općoj medicini • značajan uticaj na kvalitetu života • godišnja cijena po bolesniku 431 $ Am J Med 1997.

  6. Presumptive Diagnosis of Peptic Ulcer Disease Often Incorrect • May 30, 2003 — Many patients with presumptive diagnoses of peptic ulcer disease (PUD) who are receiving chronic acid suppression have neither PUD nor Helicobacter pylori (HP) infection, according to the results of an open-label, randomized trial published in the May 26 issue of the Archives of Internal Medicine. • Arch Intern Med. 2003;163:1165-1171

  7. JAMA. 2003;289:1107-1116 • “The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years.” • Electrolyte/renal (26.6%), gastrointestinal tract(21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events.

  8. ADVERSE EFFECTS OF NSAID THERAPY ON THE GASTROINTESTINAL SYSTEM • NSAID dyspepsia • Exacerbation or induction of gastroesophageal reflux disease (GERD) • Gastric and duodenal erosions • Gastric and duodenal ulcers • Small bowel erosions and ulcers ! • Exacerbation of colitis • Drug-induced hepatitis !

  9. (Arthritis, Rheumatism and Aging Medical Information System) ARAMIS • 75% liječenih s NSAR nisu “znali” za mogućnost nastanka gastrointestinalnih komplikacija • 2/3 liječenih “očekivalo” je upozoravajuće znakove i simptome prije nastanka komplikacija • < 20% liječenih imalo je gastrointestinalne simptome prije nastanka komplikacija J Rheumatol, 1999

  10. Rizik od razvoja ulkusa kod pojedinih NSAR • niski rizik:ibuprofen(Ibuprofen,Brufen) • srednji rizik:acetilsalicilna kiselina indometacin(Indometacin)piroksikam(Lubor, Erazon, Artrocam) diklofenak (Voltaren, Naklofen) • visoki rizik:ketoprofen(Knavon, Ketonal) UpToDate 2005.

  11. ANTACIDI • H2-antagonisti • IPP

  12. Antibiotics Chemotherapeutic agents Cisapride Laxatives Magnesium (antacids and laxatives) Proton pump inhibitors Azathioprine Thyroxine NSAIDs Prostaglandins (misoprostol) Statins Methyldopa Metformin 5-Aminosalicylates Beta-blockers Colchicine Iron COMMON DRUG CAUSES OF DIARRHEA

  13. Liječenje • Terapijski je u svim vrstama proljeva najvažnija pravovremena i dostatna nadoknada tekućine i korekcija vrijednosti elektrolita (osobito u djece i starijih odraslih osoba) • Primjena klasične medikamentozne terapije u liječenju proljeva je od sporednog značenja

  14. Pseudomembranozni kolitis • Clostridium difficile • Čest problem u hospitaliziranih bolesnika (antibiotici, prolongirane i učestale hospitalizacije) • Liječenje: metronidazol, vankomicin,bacitracin • Probiotici • Kirurška terapija: kolektomija

  15. SIGURNA POVEZANOST azatioprin diuretici- furosemid, klorotiazid estrogeni sulfonamidi tetraciklini citostatici- L-asparginaza, cisplatin, citarabin, merkaptopurin MOGUĆA POVEZANOST > 50 lijekova klorotalidon kortikosteroidi etakrinska kiselina Pankreatitis i lijekovi (1-3%)

  16. Fretland AA. Tidsskr Nor Laegeforen.  2005; 125(10):1323-5  Antibiotic prophylaxis in acute pancreatitis--is the evidence good enough? Zhou YM; Xue ZL; Li YM; Zhu YQ; Cao NHepatobiliary Pancreat Dis Int.  2005; 4(1):23-7 Antibiotic prophylaxia in patients with severe acute pancreatitis.   PROPHYLACTIC ANTIBIOTIC THERAPYYes or No?

  17. Klinička slika • Kolestaza (estrogeni, anabolici, fenotiazini, eritromicin) • Hepatitis (halotan, izoniazid, fenitoin, suflonamidi, alopurinol) • Steatohepatitis • Ciroza (vitamin A, metotreksat) • Tumori (estrogeni, anabolici) • Portalna hipertenzija (oralni kontraceptivi, citostatici)

  18. Paracetamol 4- 15 g • “Paracetamol overdose mortality figures have been falling since 1998. It is possible that this welcome fall is at least in part due to the restrictions on pack sizes set out by the Medicines Control Agency, and in force throughout the UK since September 1998.” Antidot: N- acetilcistein (FLUIMUKAN)140/mg/kg

  19. Probiotics Prebiotics

  20. autonomija dobrobit neškodljivost pravednost “dobre namjere” ? zablude ? inercija ? “utjecaj industrije”? Etičke dileme ili nešto drugo ?

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