ENHA
-
Upload
luis-alberto-macias-garcia -
Category
Documents
-
view
27 -
download
0
description
Transcript of ENHA
![Page 1: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/1.jpg)
MANEJO DE HIGADO GRASO
LUIS ALBERTO MACIAS GARCIAMEDICINA INTERNA
HOSPITAL GENERAL DE ZONA #47IMSS
![Page 2: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/2.jpg)
ENSEÑANZA
APRENDER A ENSEÑAR.ENSEÑAR A APRENDER.
![Page 3: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/3.jpg)
LA RUTA DEL CONOCIMIENTO
El conocimiento:No se escatima ni se raciona.No se atesora ni se oculta
Se cuestiona, se valida y se comparte.
Se transforma y regresa.
Cuando regresa; se empodera y se convierte en mas conocimiento
Luis A. Macías García.
![Page 4: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/4.jpg)
HIGADO GRASO
Se aplica a un espectro amplio de condiciones clínicas que resulta en la acumulación hepatocelular.
Triglicéridos (Esteatosis)Enfermedad hepática necro inflamatorio progresivo (Esteatohepatitis)
Descartar el consumo de alcohol para integrarse la definición diagnostica.
Verdelho Machado; Mariana. “Non-alcoholic fatty liver disease: What the clinician need to know”. World j Gastroenterol 2014 September 28; 20 (36): 12956-12980
![Page 5: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/5.jpg)
HIGADO GRASO
ENFERMEDAD HEPATICA GRASA NO ALCHOLICA
Espectro de enfermedades Esteatosis hepáticaInflamación inespecífica leve sin fibrosisNASH (Esteatohepatitis no alcohólica)Insuficiencia hepática y hepatocarcinoma
Verdelho Machado; Mariana. “Non-alcoholic fatty liver disease: What the clinician need to know”. World j Gastroenterol 2014 September 28; 20 (36): 12956-12980
![Page 6: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/6.jpg)
DEFINICION
Hígado Graso no alcohólicoForma simpleInfiltración macrovesicular del hígado (5% hepatocitos)
Esteatohepatitis no alcohólica.Necroinflamacion con daño hepatocelularGrados variables de fibrosis.
Gill, Ryan. “Nonalcoholic Steatohepatitis. Diagnostic Challenges”. Surgical Pathology 6 (2013) 227-257.
![Page 7: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/7.jpg)
DEFINICIONES INTEGRADAS
Chalasani, Naga. Et al. “ The diagnosis and Management of Non-alcoholic Fatty Liver Disease:Practice Gudideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American”. Gastroenterology 2012; 142: 1592-1609.. June 2012.
![Page 8: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/8.jpg)
EPIDEMIOLOGIA
Aproximadamente 20% (2.8-46%) de la población tiene EHGNA.
Prevalencia en obesos 75-92%
Población Pediátrica13-14%
600 000 han progresado a cirrosis.
Paredes, Angelo. Et al. “Nonalcoholic Fatty Liver Disease” Clin Liver Dis 16 82012) 397-419.
![Page 9: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/9.jpg)
EPIDEMIOLOGIA
Noureddin, Mazen. “Nonalcoholic Fatty Liver Disease, Diabetes, Obesity, and Hepatocellular Carcinoma”. Clin Liver Dis 19 (2015) 361-379
![Page 10: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/10.jpg)
EPIDEMIOLOGIA
Hombres (68%)Hispanos (36.7 años)Blancos (43.1 años)Afroamericanos (39.5 años)
ProgresiónCirrosis 3-5% en un periodo de 10 años20 años 38-45% de progresión.
Bertolotti, Marco. . Et al. “Nonalcoholic Fatty Liver Disease and Aging: Epidemiology to Management”. Worl J Gastroenterol 2014 october 21; (20) 39.
![Page 11: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/11.jpg)
EPIDEMIOLOGIA
Larrain, Soledad. “ A Myriad of Pathways to NASH”. Clin Liver Dis 16(2012) 525-548
![Page 12: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/12.jpg)
FISIOPATOLOGIA. NASH
TEORIA “Two Hits”1er Golpe
Resistencia insulinica (Genética y ambiental)Aumento de lipolisis Esteatosis
2do GolpeAumento de estrés oxidativo
Aumento de hierro almacenado.
Aumento de Cyt P450
Disminución de actividad antioxidante
Actividad de células estrelladas hepáticas
Citosinas proinflamatorias
![Page 13: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/13.jpg)
FISIOPATOLOGIA NASH
![Page 14: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/14.jpg)
FISIOPATOLOGIA
![Page 15: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/15.jpg)
METODOLOGIA DIAGNOSTICA
Browning; Jeffrey. “New Iimagingfor Non-Alcoholic Steatohepatits”. Clin Liver Dis 13 (2009) 607-619
![Page 16: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/16.jpg)
BIOMARCADORES DIAGNOSTICOS
Browning; Jeffrey. “New Iimagingfor Non-Alcoholic Steatohepatits”. Clin Liver Dis 13 (2009) 607-619
![Page 17: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/17.jpg)
BIOMARCADORES SEROLOGICOS/PATOLOGIA
Browning; Jeffrey. “New Iimagingfor Non-Alcoholic Steatohepatits”. Clin Liver Dis 13 (2009) 607-619
![Page 18: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/18.jpg)
ESTANDAR DE ORO
Browning; Jeffrey. “New Iimagingfor Non-Alcoholic Steatohepatits”. Clin Liver Dis 13 (2009) 607-619
![Page 19: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/19.jpg)
RM HEPATICA
Browning; Jeffrey. “New Iimagingfor Non-Alcoholic Steatohepatits”. Clin Liver Dis 13 (2009) 607-619
![Page 20: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/20.jpg)
LA IMPORTANCIA DEL MANEJO DE ESTA
ENFERMEDAD
![Page 21: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/21.jpg)
TRATAMIENTO DE NAFLD
Por qué..?
• La causa más común de enfermedad hepática crónica
• Potencial progresión a fibrosis, cirrosis y cáncer hepático
– 673 biopsias hígado :• 66% algún grado de fibrosis• 25% fibrosis septal• 14% cirrosis
– 70% casos de cirrosis criptogénica tienen NASH
– Estadio cirrótico de NAFLD puede ser una condición
pre-maligna
Targher, giovanni. Et al. “ Risk of Cardiovascular Disease in patients with nonalcoholic Fatty Liver Disease” . N Engl J Med 2010; 363: 1341-50.
![Page 22: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/22.jpg)
TRATAMIENTO
Proteger elHígado
Factores de riesgo deltratamiento
Resistenciaa insulina
Vitamina EAUDCDeplesión de hierro
Diabetes
Obesidad
Drogas
DietaEjercicioMeds ?Cirugía
Metformin ?? Tiazolidinedionas Troglitazone Darglotazone Rosiglitazone
Tratamientos
![Page 23: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/23.jpg)
MODIFICACIONES AL ESTILO DE VIDA
Neuschwander, Brent. “ Lifestyle Modification as the Primary Treatment of NASH”. Clin Liver Dis 13 (2009) 649-665.
![Page 24: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/24.jpg)
METAS TERAPEUTICAS
Corrado, Richele. Et al. “ Review of Treatment Options for Nonalcoholic Fatty Liver Disease”. Med Clin N am 98 (2014) 55-72.
![Page 25: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/25.jpg)
TERAPEUTICA BASADA EN EVIDENCIA
Paredes, Angelo. Et al. “Nonalcoholic Fatty Liver Disease” Clin Liver Dis 16 82012) 397-419.
![Page 26: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/26.jpg)
TRATAMIENTO FARMACOLOGICO
Abdurrahman, Kadayifci. Et al. “Medical Treatment of Nonalcoholic Steatohepatitis”. Clin Liver Dis (2007) 119-140.
![Page 27: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/27.jpg)
MODELO TERAPEUTICO PROPUESTO
Abdurrahman, Kadayifci. Et al. “Medical Treatment of Nonalcoholic Steatohepatitis”. Clin Liver Dis (2007) 119-140.
![Page 28: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/28.jpg)
DECISIÓN TERAPEUTICA
![Page 29: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/29.jpg)
FLUJOGRAMA DIAGNOSTICO-TERAPEUTICO
CENETEC. “ Diagnostico y Tratamiento de la Enfermedad Hepática Grasa no alcohólica del Adulto” Secretaria de Salud 2014.
![Page 30: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/30.jpg)
FLUJOGRAMA DIAGNOSTICO-TERAPEUTICO
CENETEC. “ Diagnostico y Tratamiento de la Enfermedad Hepática Grasa no alcohólica del Adulto” Secretaria de Salud 2014.
![Page 31: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/31.jpg)
OTRO FLUJOGRAMA DIAGNOSTICO
Paredes, Angelo. Et al. “Nonalcoholic Fatty Liver Disease” Clin Liver Dis 16 82012) 397-419.
![Page 32: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/32.jpg)
Cirujano
![Page 33: ENHA](https://reader033.fdocuments.mx/reader033/viewer/2022050908/563dbb81550346aa9aadc2b2/html5/thumbnails/33.jpg)
GRACIASLUIS ALBERTO MACIAS GARCIA
MEDICINA INTERNA IMSS HGZ 47
RESIDENTE DE MEDICINA CRITICAISSSTE HOSPITAL GENERAL FERNANDO QUIROZ
SCRIBD SLIDE SHARE