GASTRO - DIARREA Y ESTREÑIMIENTO

8/19/2019 GASTRO - DIARREA Y ESTREÑIMIENTO

1/99

!"#$$%# ' %()$%*"+"%,)-

Dr. Gonzalo Torres Villalobos

Profesor Titular de Cirugía y adjunto de FP en gastroenterologíaUniversidad Panamericana.

Departamento de Cirugía. Instituto Nacional de Ciencias Médicas yNutrición.

Clínica de Enfermedades Digestivas y Obesidad. Médica Sur.


2/99

!"#$$%#!%.,"/"-,%(

• 0- 1#' 2,# 3%.,"/"4, 2,"5-$+%+%,)%#/%6)#3#

• 7-( 6#/"%,)%( ",)%$6$%)#, %8 )%$+",- 3"#$$%#%, 5-$+# 3"5%$%,)%

• 7# 3"#$$%# %( 2, ("9,- ' 2, (:,)-+#


3/99

!"#$$%#!%.,"/"-,%(

• !"#$$%# /-+- (:,)-+# – !"(+",2/"4, %, 8# /-,("()%,/"# 3% 8#(

%;#/2#/"-,%( ' #2+%,)- 3% (2 ;-82+%,

• !"#$$%# /-+- ("9,- – > 9$(? 3% %;#/2#/"4, %, =@ 1$(


4/99

!"#$$%#!%.,"/"-,%(

• !"#$$%# #923# – !2$# +%,-( 3% = (%+#,#( – A%,%$#8+%,)% ",5%//"-(# – A%,%$#8+%,)% #2)-8"+")#3#

• !"#$$%# /$4,"/#

– !2$# +#( 3% = (%+#,#( –


5/99

!"#$$%#!%.,"/"-,%(

• 7# 3"#$$%# 3%D% 3"(C,92"$(% 3% – E(%23- 3"#$$%#

• F2+%,)- %, 8# 5$%/2%,/"# 3% 8#( %;#/2#/"-,%( (",/#+D"- %, 8# /-,("()%,/"#

• G% -D(%$;# %, )$#()-$,-( 3% 8# +-C8"3#3 /-+- %8(:,3$-+% 3% ",)%(C,- "$$")#D8% - %, %8 1"6%$C$-"3"(+-

– H,/-,C,%,/"#• I29# ",;-82,)#$"# 3%8 /-,)%,"3- $%/)#8• G% -D(%$;# %, )$#()-$,-( 6J8;"/-(K ,%2$-+2(/28#$%( '

,%2$-849"/-(


6/99

Los padecimientos del intestinodelgado que interfiera con laabsorción produce diarrea acuosa de

gran volumen

Los padecimientos en elcolon producenevacuaciones convolumen pequeño.

frecuentemente contienenmoco y sangre

“Watery Diarrhea” “Dysentery”

Jejunuo Íleon Ciego ColonProximal

colondistal

!"#$$%#E#)-.("-8-9:#


7/99


8/99

!"#$$%#G:,3$-+%( /8:,"/-(

• !"#$$%# #/2-(# – 0- ",;#(";# – 0- ",L#+#)-$"#

• !"(%,)%$:# – H,;#(";#

– H,L#+#)-$"#


9/99

!"#$$%# ",5%//"-(##9%,)%(

• M"$2(

• N#/)%$"#(

• E$-)-O-#$"-(


10/99

I#/)-$%( 3% 3%5%,(# 3%8 12J(6%3

• F/"3%( 9P()$"/#•


11/99

I#/)-$%( 3% ;"$28%,/"# D#/)%$"#,#

• F31%$%,/"#• E$-32//"4, 3% %,)%$-)-T",#(• E$-32//"4, 3% /")-)-T",#(• H,;#("4, 3% 8# +2/-(#


12/99

!"#$$%# ",5%//"-(#Epidemiologia de enteropatogenos aislados en diferentes esenarios clinicos

Bacteria Diarrea del viajero Guarderias SIDA

E. coli Enterotoxigenica (ETEC) 28% - 76%E. coli Enteroinvasiva (EIEC)Campylobacter sp 2.0% 10.6%Shigella sp 0% - 30% 0.2% 4.9%Salmonella sp 0% - 16% 0.2%

C. difficile sp 7.1%C. trachomatis 11.4%

Viral

Rotavirus 0% - 36% 6.0%Herpes simplex 18.4%

Protozoarios

G. lamblia 0% - 6% 13% 4.4%E. histolytica 0% - 6% 0.0%Cryptosporidium 15.6%Isospora belli 2.2%


13/99

!"#$$%# ",5%//"-(#U6-/#( 3%8 #*-

Enfermedad Estación

Cólera Invierno

Rotavirus Invierno

Shigellosis Veranos (secos)


14/99

!"#$$%# ",5%//"-(#M"$#8

• F5%/)#, 6$",/"6#8+%,)% %8 ",)%(C,- 3%89#3-

• 0- ",;#3%, 8# +2/-(#

• 7#( /J828#( ;%88-(#( (% $%+68#O#, 6-$ /J828#(/2D-"3#8%(

• M"$2(V – W-)#;"$2( RA$26-( FXYS – Z#8"/";"$2( RF9%,)% 0-$[#8\ ' ;"$2( $%8#/"-,#3-(S – F3%,-;"$2( %,)J$"/- RC6-( @> ] @^S – F()$-;"$2( – Q)$-(


15/99

!"#$$%# ",5%//"-(#M"$#8

• W-)#;"$2( – Z#2(# 6$",/"6#8 3% 3"#$$%# %, ,"*-( – Y, #328)-( 6$-32/% %,5%$+%3#3 (2D/8:,"/#

• F9%,)% 0-$[#8\ ' ;"$2( $%8#/"-,#3-( – Z#2(#, 3"#$$%# %, )-3-( 8-( 9$26-( 3% %3#3

• G% )$#,(+")%, 6-$ ;:# 5%/#8 -$#8• F+D-( ;"$2( /#2(#, 3"#$$%# ,- ",;#(";# %, /8"+#(

)%+68#3-( 32$#,)% 8-( +%(%( 3% ",;"%$,-


16/99

W-)#;"$2(


17/99

W-)#;"$2(


18/99

F9%,)% 0-$[#8\


19/99

!"#$$%# ",5%//"-(#M"$#8

Norwalk y virus relacionados RotavirusEdad Niños mayores y adultos Infantes, niños pequeños

Transmisión Fecal-oral, agua contaminada Fecal-oraly crustáceos

Incubación 1 - 2 días 1 - 3 días

Síntomas Vomito & diarrea diarrea severa

Duración 1 - 2 días 5 - 8 días

Prevalencia 1/3 de las epidemias en US 1/2 de los casos dediarrea infantil

Epidemiologia Epidemias en familias o Usualmentecomunidad, invierno esporádica

Diagnostico Inmunoensayo Inmunoensayo ypruebas genéticas


20/99

!"#$$%# ",5%//"-(#M"$#8

• _$#)#+"%,)- – `"3$#)#/"4,

• G"%+6$% a2% (%# 6-("D8% 6-$ ;:# -$#8• Y, /#(-( 3% ;-+")- "+6-$)#,)% HM


21/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• N#/)%$"#( ,- ",;#(-$#(

• N#/)%$"#( ",;#(-$#(


22/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• N#/)%$"#( ,- ",;#(-$#( – !"#$$%# +%3"#3# 6-$ )-T",#( – 0- 1#' ",;#("4, #8 %6")%8"-

– N#/)%$"#(V• G)#161'8-/-//2( #2$%2(• N#/"882( /%$%2(• M"D$"- 6#$#1%+-8'C/2(• Z8-()$"3"2+ 6%$5$",9%,(• M"D$"- /1-8%$#• Y? /-8" Y,)%$-)-T"9%,"/# RY_YZS• Y? /-8" Y,)%$-6#)-9%,# RYEYZS


23/99


24/99


25/99

E$-32//"4, 3% )-T",#(

• _-T",#( 6$%5-$+#3#(VN#/"82( /%$%2(K /8-()$"3"2+6%$5$",9%,(K ()#61'8-/-//2( #2$%2(

• Y,)%$-)-T",#VF%$-+-,#( G6?K Y? Z-8" Y,)%$-)9-T"9%,"/#KM"D$"- Z1-8%$#%

• Z")-)-T",#VZ8-()$"3"2+ 3"b/"8%


26/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• N#/)%$"#( ,- ",;#(-$#(

– M"D$"- /1-8%$#

• 7# )-T",# 3%8 /48%$# %( %8 6$-)-C6- 3% %,)%$-)-T",#

• Z#2(# ",1"D"/"4, 3% 8# #D(-$/"4, 3% 0#c ' Z8X

• Y()% /#+D"- %8%/)$-8:C/- %( (%92"3- 3% (%/$%/"4,;-82+",-(# 3% L2"3-( /#2(#,3- 3"#$$%#


27/99

M"D$"- Z1-8%$#

• Z-,)#9"- %, #92# ' #8"+%,)-( +#$",-( +#8/-/"3-(

• G%/$%/"4, 3% L2"3- %, %8 ",)%(C,- 3%89#3-• !"#$$%# #D2,3#,)% %, d#92# 3% #$$-Oe• E$-32/% 3%(1"3$#)#/"4, (%;%$#• E2%3% 3#$ ;-+")- %, 6$-'%/C8• 0- 1#' .%D$% - 3-8-$ #D3-+",#8• Z#8#+D$%( +2(/28#$%(


28/99

_"6-( 3% M"D$"- Z1-8%$#

• !-( D"-C6-( 6$",/"6#8%( a2% /#2(#, 3"#$$%# V! Z8P("/-! Y8_-$

• !-( (%$-C6-( /-+2,%(V! H,#D#! Q9#[#


29/99

N#/)%$"#( ,- ",;#(";#(

M"D$"- /1-8%$#

!"#$$%# ",5%//"-(#N#/)%$"#,#


30/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• N#/)%$"#( ,- ",;#(-$#( – Y? /-8" Y,)%$-)-T"9%,"/# RY_YZS

• Z#2(#,)% 6$",/"6#8 3% 3"#$$%# 3%8 ;"#f%$-

• E$-32/% 3-( )-T",#(

– _-T",# )%$+-%()#D8%K /#2(# (%/$%/"4, 3% L2"3- %, %8 ",)%(C,-

– _-T",# )%$+-8PD"8K #/)B# "92#8 a2% 8# )-T",# 3%8 /48%$#

• E$-32/% 3"#$$%# #/2-(#K ,#2(%# 3-8-$ /48"/- ' .%D$% D#f#


31/99

E. coli Enterotoxigenica (ETEC)

!"#$$%# ",5%//"-(#N#/)%$"#,#


32/99

N#/"882( /%$%2(

• F%$4D"/- 5-$+#3-$ 3% %(6-$#(

• G% %,/2%,)$# %, 9$#,-(K /-+"3#%(6%/"#8+%,)%!""#$ ' #92# /-,)#+",#3#K(-D$%;";% 8# %D288"/"4,

• E$-32/% ;-+")- 6-$ ^Xg 1-$#( ' #/-,C,2#/"4, 3"#$$%#


33/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

Diarrea con bacterias no invasoras

V. cholera E. coli C. perfringens B. cereus S. aureus

Incubación 12 -72 24 -72 6 - 12 3 - 8 1 - 6(horas)

Duración 48 - 120 24 - 48 12 - 48 12 -48 6 - 12(horas)

Cólico abdominal 0 + ++++ ++ ++

Vomito + +/- + ++ ++++


34/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• !"#$$%# /-, D#/)%$"#( ",;#(-$#( R!"(%,)%$:#S – `#' ",;#("4, ' 3#*- 3%8 %6")%8"- /-84,"/- – `#' ",L#+#/"4, ",)%,(# a2% $%(28)# %, 6$%(%,/"# 3%

(#,9$% ' 62( %, 8# %;#/2#/"4,

– `#' 3-8-$ #D3-+",#8 ' )-T"/"3#3 ("()J+"/# – 7#( D#/)%$"#( /#2(#,)%( ",/82'%,V• G#8+-,%88#• G1"9%88#• h%$(","#

• Z#+6'8-D#/)%$• Y? /-8" Y,)%$-";#(";# RYHYZS• Y? /-8" Y,)%$-1%+-$$1#9"/# RY`YZS• Z8-()$"3"2+ 3"b/"8%


35/99

!"#$$%# 6-$ D#/)%$"#( ",;#(-$#(Shigella E.coli Salmonella Yesinia

Incubación 24 - 72 24 - 72 8 - 48 1 - 6(horas)

Duración 48 - 120 24 - 48 12 - 24 6 - 12(horas)

Dolor Abdominal ++++ ++++ + ++

Vomito ++ + + ++

Fiebre ++ ++ ++++ ++


36/99

!"#$$%# ",5%//"-(#N#/)%$"#,#

• !"#$$%# /-, D#/)%$"#( ",;#(-$#( R!"(%,)%$:#S – 7# G1"9%88# %( 8# D#/)%$"# %,)%$-",;#(-$# /8P("/# – H,32/% #2)-5#9-/")-("( 6#$# %,)$#$ %, 8-( /-8-,-(")-( ' (%

$%68"/# %, %88-( – Y()# ",;#("4, 6$-32/% $%#//"4, ",L#+#)-$"# (%92"3# 3% +2%$)%

/%828#$? F /-,C,2#/"4, 8# (1"9%88# (% %(6#$/% # -)$#( /J828#( – 7# G1"9%88# 6$-32/% )#+D"J, 2,# /")-)-T",# 88#+#3# (1"9#

)-T",# a2% 6$-32/% 3%()$2//"4, /%828#$ – Q)$-( %,)%$-6#)49%,-( a2% 6$-32/%, ",;#("4, 3% 8# +2/-(#

",/82'%,V• Y? Z-8" Y,)%$-",;#(";#• G#8+-,%88#• Y,)#+-%D# 1"()-8'C/#


37/99

G1"9%88#

• Z-,)#9"- 6-$ /-+"3# ' #92# /-,)#+",#3#(• Z#$#/)%$:(C/#+%,)% 6$-32/% 3"#$$%#

(#,92",-8%,)#• I"%D$%• F892,-( (-, 6-$)#3-$%( #(",)-+PC/-( /-,

(:,)-+#( ","/"#,3- %, = - i 3:#(• E2%3% 6$-32/"$ (:,3$-+% 2$J+"/- 1%+-8:C/-


38/99

_"6-( 3% (1"9%88#

• 7-( 6$",/"6#8%( C6-( /#2(#,)%( 3% 3"#$$%# (-,V! !"(%,)%$"#% C6- ^ -!"#$%&&' )"#$'!

!"#$%&&' *%+,%-#! !"#$%&&' ).,,%#! !"#$%&&' /.01##


39/99

• G#8+-,%88#

!"#$$%# 6-$ D#/)%$"#( ",;#(-$#(


40/99

G#8+-,%88#• Z-,)#+",# 12%;-( /$23-(K 8P/)%-(K 6$-32/)-(

3% 62%$/- ' -)$#( /#$,%(

• I"%D$% 3"#$$%# ' D#/)%$%+"#(

•


41/99

!"#$$%# 6-$ D#/)%$"#( ",;#(-$#(G#8+-,%88#


42/99

!"#$$%# 6-$ D#/)%$"#( ",;#(-$#(G#8+-,%88#


43/99

h%$(","#• Z-,)#9"- 6-$ 8P/)%-(K /#$,% 3% 62%$/- ' -)$#(

/#$,%(• E$-32/% +B8C68%( (:,3$-+%( ",/82'%,3-V

(%6("( %, 6#/"%,)%( ",+2,-(26$"+"3-(K ' 2,/2#3$- ("+"8#$ # #6%,3"/"C(

• E2%3% 6$-32/"$ GT? !% W%")%$ R#$)$"C(K 2' /-,f2,C;"C(S


44/99

Z#+6'8-D#/)%$• Z-,)#9"- 6-$ #92# - 8%/1% D$-,/#

• Z#2(# 3%()$2//"4, %, 6#$/1%( 3%8 ",)%(C,-3%89#3- ' /-8-,

• E$%(%,)# .%D$%K ;-+")- ' 3-8-$ #D3-+",#8


45/99

Y? /-8" Y,)%$-",;#(";#• 7-( (:,)-+#( ("+28#, (1"9%88#V 3"#$$%# /-,

(#,9$%K .%D$% ' /48"/-• Z-,)#9"- 6-$ /-+"3# /-,)#+",#3#• _$#)#+"%,)- /-, )%$#6"# 3% (-6-$)% (",

#,CD"4C/-(


46/99

Y? /-8" Y,)%$-1%+-$$P9"/#• Z-,)#9"- 3% )-T",# /-, /-+"3# +#8 /-/"3#

%(6%/"#8+%,)% /#$,% $-f#• `#' .%D$%K /48"/-( "+6-$)#,)%( ' 3"#$$%# /-,

(#,9$%• Z#2(# (:,3$-+% 2$J+"/- 1%+-8:C/- R/#2(#3#

6-$ ;%$-)-T",# )#+D"J, 88#+#3# )-T",# ("+"8#$# G1"9# )-T",#S


47/99

Z8-()$"3"2+ 3"b/"8%• E$-8"5%$# /2#,3- (-, 2C8"O#3-( #,CD"4C/-( 3%

#+68"- %(6%/)$-• Z-8"C( 6(%23-+%+D$#,-(#• !"#$$%# ;%$3-(# a2% 62%3% )%,%$ (#,9$%• _$#)#+"%,)-V ;#,/-+"/",# - +%)$-,"3#O-8 -$#8


48/99

!"#$$%# 6-$ 6$-)-O-#$"-(• _$%( 6$-)-O-#$"-( (-, $%(6-,(#D8%( 3% 8# +#'-$:# 3%

8-( /#(-(V

– Y,)#+-%D# 1"()-8'C/#

– A"#$3"# 8#+D"# – Z$'6)-(6-$"3"2+

• 7# Y,)#+-%D# 1"()-8"C/# ' 8# A"#$3"# 8#+D"# 62%3%,

",5%/)#$ ",3";"32-( (#,-(• Y8 Z$'6)-(6-$"3"2+ 9%,%$#8+%,)% ",5%/)# 6#/"%,)%(",+2,-/-+6$-+%C3-(


49/99

!"#$$%# 6-$ 6$-)-O-#$"-(

• 7# Y,)#+-%D# 1"()-8"C/# ",;#3% %8 %6")%8"- 3%'#( ' /#2(# ",L#+#/"4, ' (#,9$#3-/#2(#,3- 3"(%,)%$:#

• 7# A"#$3"# 8#+D"# ' %8 Z$'6)-(6-$"3"2+2(2#8+%,)% ",5%/)#, %8)(*+,-(# .+'/!.# ' (%#8-f#, %, %8 D-$3% %, /%6"88-? Z#2(#,

(:,3$-+%( 6#$%/"3-( # 8-( 3% +#8#D(-$/"4, (",",;#("4, 3%8 %6")%8"-


50/99

" 0(*!1#+2! 3),*#'4-&!

!"#$$%# 6-$ 6$-)-O-#$"-(


51/99

Entamoeba histolytica

!"#$$%# 6-$ 6$-)-O-#$"-(


52/99

Y,)#+-%D# 1"()-8'C/#• !"#$$%#K /-, (#,9$%K .%D$%K /48"/-(• !2$# 3% = # @ (%+#,#( 6%$- 62%3% 32$#$

+%(%(• !"#9,-(C/-V


53/99

" 5)!".)! '!12)!

!"#$$%# 6-$ 6$-)-O-#$"-(


54/99

A"#$3"#

• Y( 2,# j--,-("(K #92# /-,)#+",#3# 6-$ #,"+#8%(• !"#$$%#K 3-8-$ #D3-+",#8K L#)28%,/"# ' 6-("D8%

%()%#)-$$%#• !"#9,-(C/-

–


55/99

" 6"47*#,7#").)81

!"#$$%# 6-$ 6$-)-O-#$"-(


56/99

Z$'6)-(6-$"3"2+• _$#,(+"("4, 6-$ ;:# 5%/#8 -$#8

• F5%/)# 6#/"%,)%( /-, GH!F

• !"#$$%# #/2-(#K ;4+")-K /48"/-(K .%D$%

• _$#)#+"%,)-V #O")$-+"/",#


57/99

!"#$$%# 6-$ 6$-)-O-#$"-(E.histolytica G. lambia Cyptosporidium

Distribución Todo el mundo Todo el mundo Todo el mundo

Padecimiento Disentería Diarrea crónica Diarrea leve cortaamibiana leve a moderada Diarrea severa en

SIDA

Complicaciones Abscesos Malabsorción Malabsorción

Transmisión Persona a persona Persona a persona Ingestión deRuta fecal oral Ruta fecal oral productos animales

contaminados

Diagnostico Huevos y parásitos Huevos y parásitos Huevos y parásitosen heces en heces en heces

Tratamiento Metronidazol Metronidazol No efectivo


58/99

Y;#82#/"4, 3% 3"#$$%# ",5%//"-(#

• Y()23"-( %, 1%/%( – 7%2/-/")-(K %$")$-/")-( ' (#,9$% – Z28C;-

–


59/99

E-8"+-$5-,2/8%#$%( %, 1%/%(

• Z-+2,%( %, !"#$%&&'72'890&./'5:%- K Y`YZKYHYZK23 1#;

• W#$-( %,!'&8.,%&&'7


60/99

!"#$$%# ",5%//"-(#


61/99

!"#$$%# ",5%//"-(#


62/99

!"#$$%# ",5%//"-(#


63/99

!"#$$%# ",5%//"-(#


64/99

!"#$$%# ",5%//"-(#


65/99

! #$$%# ,5%// -(#


66/99

!"#$$%# ",5%//"-(#


67/99

Z-+68"/#/"-,%( 3% 8# 3"#$$%# #/2-(#

• !%(1"3$#)#/"4,• _$#()-$,-( %8%/)$-8:C/-(• _%)#,"# +2(/28#$• Z-,;28("-,%(• `"6-982/%+"#

• H,(2./"%,/"# $%,#8 #923#


68/99

M#/2,#(

• `#' 2,# ;#/2,# /-,)$# %8 /48%$# a2% 3#",+2,"3#3 3%8 n>Xg>o

• 0- 1#' -)$#(

!"#$$%# Z$4 "/#


69/99

! #$$%# Z$4, /#_"6-(

• H,L#+#)-$"#• Q(+4C/#•


70/99

H,L#+#)-$"#

• Z#2(#(V Z-8"C( 28/%$-(#K %,5%$+%3#3 3% Z$-1,K%,)%$"C( 6-$ $#3"#/"4,K 9#()$-%,)%$"C( %-(",-.8"/#K",5%//"-,%( #(-/"#3#( # GH!F

• `#' ",L#+#/"4, 3% +2/-(# ' (2D+2/-(#• `#' 3#*- #8 %6")%8"-

– I"%D$%K 3-8-$ #D3-+",#8K (#,9$% ' 8%2/-/")-( %,

%;#/2#/"-,%(


71/99

H,5%//"-,%(

• H,5%//"4, /$4,"/# /-, – A"#$3"# – Y,)#+-%D# 1"()-8'C/# – Z'/8-(6-$#

• F(-/"#3-( # `HM – Z')-+%9#8-;"$2( – Z$'6)-(6-$"3"2+


72/99

Q(+4C/#

• Z#2(#( – 7# +#( /-+B, %( 3%./"%,/"# 3% 8#/)#(#

• `#' 2, (-82)- ",)$#82+",#8 a2% ,- (% 3"9"%$% ',- (% #D(-$D% –


73/99

Y()%#)-$$%#

• H,(2./"%,/"# 6#,/$%PC/# – Y;#/2#/"-,%( /-, +#8 -8-$


74/99

G%/$%)-$#

• Z#2(#(V (:,3$-+% /#$/",-"3% R/#2(#3- 6-$)2+-$%( ,%2$-%,3-/$",-( 6$-32/)-$%( 3%(%$-)-,",#S ' GT? 3% j-88",9%$ Y88"(-, R9#()$",#

• G%/$%/"4, %T/%(";# 3% %8%/)$-8")-( – !"#$$%# #/2-(# – E%$("()% 32$#,)% %8 #'2,-


75/99


76/99

!"#$$%# 5#//"-(#

• F2)-",32/"3# – A%,%$#8+%,)% %, +2f%$%( – !"#$$%# #/2-(# – F(-/"#3# # 1"6-/#8/%+"#K 3%D"8"3#3 ' %3%+# – E-$ #D2(- 3% 8#T#,)%(


77/99

Y;#82#/"4 3% 3"#$$%# /$4 "/#


78/99

Y;#82#/ 4, 3% 3 #$$%# /$4, /#• Z28C;-(• NB(a2%3# 3% 6#$P(")-( ' 12%;-( %, 1%/%(• W%/-8%//"4, 3% 1%/%( @l X p= `$( 6#$# +%3"$

6%(-K /-,)%,"3- 3% 9$#(#K %8%/)$-8")-( '-(+-8#$"3#3

• Z-8-,-(/-6"# 6#$# ;"(2#8"O#/"4, ' )-+# 3%D"-6("#


79/99


80/99

_$#)#+"%,)-

• H3%,C./#$ ' )$#)#$ 8# /#2(# %(6%/:./#

$ $$


81/99

Q)$#( /#2(#( 3% 3"#$$%#

q _$#()-$,-( +%)#D48"/-(q `"6%$C$-"3"(+-q !"#D%)%( +%88")2(

q H,(2./"%,/"# 6#,/$%PC/#q F8%$9"# # #8"+%,)-(q G:,3$-+% 3% 32+6",9


82/99

ZQ0G_HEFZHQ0

!YIH0HZHQ0V^? Y;#/2#/"4, ",5$%/2%,)% - /-, 3"./28)#3=? G:,)-+#( 6%$("()%,)%( 6-$ +#( 3% )$%( +%(%( %, 2,

#*-i? Y;#/2#/"4, +%,-$ # )$%( ;%/%( 6-$ (%+#,#

– Y(52%$O- "+6-$)#,)% – `%/%( 32$#( – Y;#/2#/"4, ",/-+68%)#

ZQ0G HEFZHQ0


83/99

ZQ0G_HEFZHQ0


84/99

ZQ0G HEFZHQ0


85/99

ZQ0G_HEFZHQ0

Y6"3%+"-8-9:#V• F328)-( ^>o• F,/"#,-( => # i> o

– ==o 3% 8-( #,/"#,-( %, 8# /-+2,"3#3 – n>o %, 8-( a2% %()P, %, #/"8-( – gio %, 8-( 1-(6")#8"O#3-(

W-+%$- h? Y)?#8? ^rr>t


86/99

ZQ0G_HEFZHQ0

E#)$-,%( 3% +-C8"3#3V^? Y8 #8"+%,)- 62%3% 6#(#$ ^X= 1$(? %, %8 ",)%(C,- 3%89#3-=? ^Xi 3:#( %, %8 /-8-,

i? G" 1#' ",#/C;"3#3 6#(# +#( C%+6-

HoldstockDJ. Gut 1990; 11: 91-99.

ZQ0G HEFZHQ0


87/99

ZQ0G_HEFZHQ0I2,/"4, /-84,"/# ' #,-$%/)#8K %;#/2#/"4,V• 7#( 1%/%( 6#(#, +#( C%+6- %, %8 /-8-, 3%$%/1-• G% +2%;%, %, +#(# #8 /-8-, "Oa2"%$3-• !"()%,/"4, 3%8 $%/)-• W%8#f#/"4, 3%8 %(v,)%$ ",)%$,-• Z-,)$#//"4, 3%8 %(v,)%$ %T)%$,-• W%8#f#/"4, 3%8 62D-$%/)#8"(

ZQ0G HEFZHQ0


88/99

ZQ0G_HEFZHQ0

YC-8-9:#V^? I"D$# %, 8# 3"%)#V• E$-+2%;% %8 )$#,(")- ,-$+#8• A%,%$#8+%,)% 3"(+",2"3# %, 8-( #,/"#,-(

=? 7:a2"3-( %, 8# 3"%)#

7%3%$8% IF?^rrn? !$29( F9",9 gV @gnX@gr`#$#$" !? Y)#8? ^rr@ wFAG @=V r@pXrn=?

ZQ0G HEFZHQ0


89/99

ZQ0G_HEFZHQ0

i? H,+-;"8"O#/"4,V• 7# #/C;"3#3 v("/# 3"(+",2'% 8# /-,(C6#/"4,

@?


90/99

ZQ0G_HEFZHQ0

n? E#3%/"+"%,)-( ("()J+"/-(V• `"6-\#8%+"#• `"6-+#9,%(%+"#• `"6-C$-"3"(+-• !"#D%)%( +%88")2(• E#$\",(-,• !%+%,/"#

• YMZ

ZQ0G HEFZHQ0


91/99

ZQ0G_HEFZHQ0

g? E#3%/"+"%,)-( %()$2/)2$#8%(V•


92/99

ZQ0G_HEFZHQ0

YMF7mFZHQ0V^? `"()-$"#V• 0,&!'! .+ @!'#"!&)9( .+ (,-7!&)9(

=? YT68-$#/"4, v("/#V• E$",/"6#8+%,)% #D3-+",#8 '

$%/)#8?

ZQ0G HEFZHQ0


93/99

ZQ0G_HEFZHQ0

Y()23"-( 3"#9,4(C/-(V• C)+17# .+ *"!(,)*#D ( 1!"&!.#"+,

"!.)#7!, 4 >E +( .8"!(*+ +' .F!

• 0'+&*"#1)#/"!G! .+' "+&*#,)/1#).+,• H!(#1+*"F! !(#"+&*!'• A+?+/"!G!

u%T,%$ G!? Y)#8? Z-8-$%/)#8 61'("-8-9"/#8 )%()(V m(% -$ #D2(% -5 )%/1,-8-9'x Y2$w G2$9 ^g>V gpXp@K ^rr@

`#$$"(-,y( =>>^ n)1 Y3"C-,K F18a2"() ] Z#+"88%$"V !"#$$1%# ] Z-,(C6#C-,V=@lX=@r?

ZQ0G HEFZHQ0


94/99

ZQ0G_HEFZHQ0


95/99

Q _ Q_WF_F


96/99

Q _ Q_WF_F


97/99

Q _ Q_WF_F


98/99

Q Q_WF_F


99/99

ZQ0G_HEFZHQ0 _WF_F HY0_QF9%,)%( $%/)#8%(

NO J),!.4' P.8''!:Q +,-18'! '#&!'1+(*+

RO I87#,)*#")#, .+ /')&+")(!; +(+1!, .+ !&+)*+ .+ #')@!

GASTRO - DIARREA Y ESTREÑIMIENTO

Documents

Transcript of GASTRO - DIARREA Y ESTREÑIMIENTO