Hlavní téma: gastroenterologie

Petr Dítě

Vnitr Lek 2021, 67(2):71  

Immunoglobulin G4-related disease in gastroenterology

Peter Mačinga, Jana Jarošová, Julius Špičák, Tomáš Hucl

Vnitr Lek 2021, 67(2):76-83 | DOI: 10.36290/vnl.2021.018  

IgG4-related disease is a recently defined clinical entity that can manifest itself in any organ. The most common gastrointestinal manifestations are diseases of the pancreas (autoimmune pancreatitis type 1) and biliary tree (IgG4-associated cholangitis); involvement of liver parenchyma is uncommon and the affection of tubular organs is very rare. IgG4-related pancreatitis and cholangitis can mimic malignancies in their clinical presentation. Diagnosis is often difficult and requires careful evaluation of the combination of symptoms, serology and imaging findings, while adhering to the established diagnostic criteria. The first line of treatment is...

Diagnostics and therapy of chronic pancreatitis according to UEG guidelines

Lumír Kunovský, Petr Dítě, Martina Bojková, Jiří Dolina, Jitka Vaculová, Hana Kolovratníková, Magdalena Uvírová, Pavel Janeček, Zdeněk Kala, Petr Jabandžiev

Vnitr Lek 2021, 67(2):85-91 | DOI: 10.36290/vnl.2021.019  

Chronic pancreatitis is one of the diseases whose incidence is slightly increasing long-term. Apparently this is related to our current dietary habits and to the way of life in industrialized societies in general. In recent years, chronic pancreatitis has experienced greater diagnostic accuracy and reliability, although we are still unable to diagnose the early stages of the disease. In diagnostics, sophisticated imaging methods are in the forefront, and less frequent is the use of tests that assess the exocrine function of the gland. Non-invasive therapeutic approaches include dietary measures, including an absolute ban on alcohol. Drug therapy consists...

Extraintestinal complications of inflammatory bowel diseases

Vít Navrátil, Silvia Cveková, Peter Slodička, Květoslava Aiglová, Barbora Pipek, Přemysl Falt

Vnitr Lek 2021, 67(2):92-96 | DOI: 10.36290/vnl.2021.020  

Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). Those are chronic gastrointestinal disorders of inflammatory nature and not fully known etiology. As a result of their immune-mediated mechanism and complex impact on the whole organism other organs than gastrointestinal system may be affected in many ways. These extraintestinal manifestations (EIM) and complications may severely deteriorate prognosis of the patient, cause his morbidity and worsen the quality of life. While classical extraintestinal manifestations, such as enteropathic arthropathy, skin or eye involvement or primary sclerosing cholangitis, share...

Current view of diagnosis and treatment of latent autoimmune diabetes in adults

Jana Urbanová, Ludmila Brunerová, Jana Malinovská, Barbora Pelechová, Ludmila Koberová, Jan Brož

Vnitr Lek 2021, 67(2):97-102 | DOI: 10.36290/vnl.2021.021  

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune disease arising at adulthood. LADA is characterized by a less intensive autoimmune process, slower progression and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus. The onset of LADA is usually in non-obese patients over 30, without prominent features of metabolic syndrome and insulin resistance. Nevertheless it may be falsely classified as type 2 diabetes, especially, when diagnosed in older age and for the possibility of non-insulin treatment for at least 6 months after diagnosis. LADA is treated early with insulin and combined with metformin in...

Glucagon in treatment of hypoglycemia - novelties

Jan Brož, Jana Malinovská, Ludmila Brunerová, Jana Urbanová

Vnitr Lek 2021, 67(2):103-108 | DOI: 10.36290/vnl.2021.022  

Glucagon is actually used in the treatment of severe hypoglycemia. Due to technological difficulties with stability in solution, glucagon in currently available preparations was contained in a form of powder, which needs to be first dissolved in the water before application. This particular administration of glucagon was associated with a certain delay and several mistakes that decreased real amount of glucagon injected in the body. Currently two new formulas of glucagon appeared on the market - first as a stable liquid solution, second as a powder for nasal administration. This article summarizes currently available information about these preparations.

Rheumatoid arthritis and metabolic disorders

Stela Kašperová, Lenka Tarabčáková, Barbora Kašperová, Emőke Šteňová

Vnitr Lek 2021, 67(2):e18-e24 | DOI: 10.36290/vnl.2021.029  

Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with multiple metabolic alterations and increased cardiovascular risk. It is supposed that visceral obesity seems to be a connection between rheumatoid arthritis and cardiovascular diseases. Obesity is not only associated with increased disease activity and worsened quality of life in this group of patients, but also determines the effectiveness of treatment. Biological therapy interferes with metabolic changes, too. Therefore, there is a tendency to select the right anticytokine preparation in the first line of treatment to reduce not only disease activity but also affect...

Non-pharmacological treatment of gout

Dávid Líška

Vnitr Lek 2021, 67(2):e25-e28 | DOI: 10.36290/vnl.2021.030  

Gout is a metabolically-related joint disease, characterized by recurrent episodic arthritis. The recent epidemiological study suggests that the incidence of hyperuricemia and gout in many countries has risen especially in recent decades. A possible explanation may be a decreased physical activity level and changes in eating habits. The patient's lifestyle is one of the key factors contributing to the development of hyperuricemia. For patients, an important part of therapy is non-pharmacological treatment through changes in lifestyle factors such as dietary measures, weight control, and adequate hydration and exercise. Lifestyle changes can lead to...

Serum butyrylcholinesterase/HDL-cholesterol ratio and atherogenic index of plasma in patients with fatty liver disease

Ladislav Turecký, Viera Kupčová, Monika Ďurfinová, Marcel Repiský, Eva Uhlíková

Vnitr Lek 2021, 67(2):e04-e08 | DOI: 10.36290/vnl.2021.027  

Cardiovascular diseases on an atherosclerotic basis are a serious health problem. Atherosclerosis is a multifactorial pathological process with complex pathogenesis. Its origin and development is conditioned by a set of several risk factors. Changes in the spectrum of lipoproteins are one of the well-known, serious risk factors for cardiovascular disease. The results of several authors showed, that the examination of the ratio of some lipoproteins can provide more accurate information about the cardiovascular risk in a given individual than the individual lipid parameters alone. Non-alcoholic fatty liver disease (NAFLD) is currently the most common...

Comparison of LDL-C calculation by Martin, Sampson and old Friedewald methods in real data and synthetic data set

Rudolf Gaško

Vnitr Lek 2021, 67(2):e09-e17 | DOI: 10.36290/vnl.2021.028  

Objective: LDL-cholesterol (LDL-C) is determined by methods whose accuracy is significantly affected in various clinical or analytical situations. Two computational methods have recently been described, the Martin equation and the Sampson equation, validity of which we compare with the Friedewald equation. Methods: LDL-C comparisons determined by the 3 equations were performed on 4 real sets of lipid data, generated in various previous studies, ranging from n = 140 to n = 7 393. We have created an artificial set of data on the extent of 900 members with equally distributed values of TC, HDL-C and TG troughout the commonly found range. Such a data set...

Hemodynamic significant pericardial effusion as a possible rare extraintestinal manifestation of Crohn's disease

Barbora Pipek, Martin Pleva, Petr Fojtík, Přemysl Falt

Vnitr Lek 2021, 67(2):109-113 | DOI: 10.36290/vnl.2021.023  

Crohn's disease (CN) and ulcerative colitis (UC) belong to a group of diseases called inflammatory bowel diseases (IBD). The etiology of these illnesses is still not known, however, they are diagnosed mainly at a young age and 1/3 of these patients develop extraintestinal manifestation of the disease. These include arthropathy, ocular and cutaneous manifestations of this inflammation, metabolic bone disease, and hepatobiliary or urological disease. The treatment of extraintestinal manifestations is similar to the treatment for the main disease and frequently consists of immunosuppression. Pericardial effusion or pericarditis is a rare extraintestinal...

Massive pulmonary embolism with a large thrombus stuck in patent foramen ovale - an impending paradoxical embolism

Josef Hornof, Ondřej Čermák

Vnitr Lek 2021, 67(2):114-118 | DOI: 10.36290/vnl.2021.024  

Patent foramen ovale is a persisting communication between the left and right atrium, present in approximately 25% of population, usually asymptomatic. Under normal conditions there is either no blood flow or a hemodynamically nonsignificant left-to-right shunt between the atria. However, increased right atrium pressure, as it is in pulmonary embolism, can make PFO a right-to-left shunt and poses a risk of paradoxical systemic embolism, including the risk of ischemic stroke. Here we report a case of a patient presenting with venous thromboembolism provoked by a recent polytrauma. We identified a large thrombus stuck in patent foramen ovale - an impending...

Application of surgical mask with high-flow nasal cannula (HFNC) leads to improved oxygenation in patients with COVID-19: a set of case reports

Juraj Smaha, Martin Kužma, Kristína Brázdilová, Peter Jackuliak, Juraj Payer

Vnitr Lek 2021, 67(2):e29-e33 | DOI: 10.36290/vnl.2021.031  

The new coronavirus SARS-CoV-2 is responsible for the development of acute infectious illness named COVID-19. While most people have a mild course of the disease, a significant minority of patients will develop some degree of respiratory insufficiency requiring hospitalization. In case of failure of conventional oxygen therapy, the method of choice in patients with respiratory insufficiency is ventilation with high-flow nasal cannula (HFNC). In order to reduce the dispersion of infectious aerosol during HFNC treatment, nasal cannula is often covered with a surgical mask in many hospitals. According to recent observations, the application of a surgical...

Primary pneumococcal peritonitis with a fulminant course

Benjamín Tolmáči, Jiří Klein, Peter Žuffa, Alona Řehulková

Vnitr Lek 2021, 67(2):e34-e37 | DOI: 10.36290/vnl.2021.032  

Introduction: Primary peritonitis is an inflammation of the peritoneal cavity in the absence of a localized intra-abdominal source. It is included in the differential diagnosis of acute abdomen and can be potentially life-threatening. Pneumococci were a frequent pathogen causing primary peritonitis especially in the preantibiotic era. Nowadays, they act as an uncommon primary pathogen. Pneumococcal peritonitis in adults is more frequently seen in cases of liver cirrhosis with ascites and other pre-existing conditions. Primary pneumococcal peritonitis is uncommon in healthy individuals and therefore its diagnosis is difficult. Secondary peritonitis...

How to prolong the lives of our patients in health? And is it possible?

Aleš Linhart

Vnitr Lek 2021, 67(2):125-129 | DOI: 10.36290/vnl.2021.026  

Recent data suggest that cardiovascular diseases are treatable but not curable. We are prolonging our patients lives, unfortunately not their life years spent in health. As shown by the British BioBank trial a longstandingexposition to genetically determined low LDL substantially lower cardiovascular risk. This is particularly relevant considering that modern medicinemakes possible to detect and safely intervene these risk factors in a timely fashion. This approach should be able to prevent early vascular aging. These methods should be applies in patients early after detection of high blood pressure and hypercholesterolemia and treat them to target...

Screening for risk alcohol use in clinical settings

Jana Malinovská, Lucie Kršková, Barbora Švarcová, Veronika Vejtasová, Jana Urbanová, Jan Brož

Vnitr Lek 2021, 67(2):e38-e43 | DOI: 10.36290/vnl.2021.033  

Alcohol is an important risk factor for development of numerous chronic diseases and it is a cause of 3 million deaths worldwide every year. The Czech Republic is one of the countries with highest alcohol consumption per capita in the world. AUDIT and CAGE are examples of fast and easy screening tools for early diagnostics of patients at risk that help in estimating a level of risk related to patient's drinking. The screening is followed by simple advice for risk drinking and brief intervention for harmful drinking, based on the estimated level of risk. This approach is an easy and effective prevention measure to reduce risk and harmful alcohol drinking...

Perindopril: a long-term certainty in treating hypertension

Miroslav Souček

Vnitr Lek 2021, 67(2):119-124 | DOI: 10.36290/vnl.2021.025  

Blockade of the renin angiotensin aldosterone system (RAAS) is currently considered to be the gold standard of antihypertensive therapy. ACE inhibitors and AT1-blockers are clinically the most relevant groups of RAAS blockers. Even though both drug groups block angiotensin II, ACE inhibitors typically reduce the degradation of bradykinin, which leads to the release of nitric oxide and prostaglandins with subsequent vasodilation. These differences in the mechanism of action can be of clinical relevance for hypertensive patients. Morbidity mortality studies of RAAS blockers have been reported in which ACE inhibitors, particularly perindopril, improved...