Profil symptomatique et modalités de prise en charge des gastro-entérites aiguës de l’adulte en médecine générale (original) (raw)
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Pratiques de prise en charge des gastro-entérites aiguës : enquête auprès de 641 pédiatres libéraux
Archives de Pédiatrie, 2013
Acute gastroenteritis (AGE) is a very common reason for pediatric consultations. Various expert committees have issued guidelines for its management, based on systematic use of an oral rehydration solution (ORS), early appropriate nutrition (most recent previous diet), and avoiding routine treatment with medication. The aim of the study was to assess the application of these guidelines by pediatricians in outpatient practice for mild to moderate AGE. A secondary objective was to question pediatricians about their practices for vaccination against rotavirus. Methods. In June 2012, e-mail requests were sent to 1187 pediatricians in private practice, asking them to complete an anonymous questionnaire online at the website of the French Association of Pediatricians in Outpatient Practice. Results. A total of 641 (54%) responses could be analyzed. Nearly all the pediatricians recommended early resumption of nutrition after administration of ORS. Depending on the child's age, 16 to 23% reported they would recommend resuming feeding with lactose-free milk, and 80% would advise an antidiarrhea diet for children older than 6 months. The drugs prescribed most often were, in decreasing order, racecadotril (acetorphan), diosmectite, and probiotics. Although 90% of the pediatricians prescribed vaccination against rotavirus, 65% estimated that it was performed in more than half of all children.
2001
○ En vue de recenser les principales bacteries responsables de diarrhees a Libreville, nous avons analyse retrospectivement 371 dossiers, avec coproculture positive, de malades hospitalises âges en moyenne de 33 ans, pendant la periode de 1992 a 1996. Sur le plan epidemiologique la population cible est representee par des adultes jeunes. Les deux sexes sont touches indifferemment. Ces affections, favorisees par les conditions climatiques, evoluent sur un mode endemo-epidemique avec recrudescence des cas a la saison des pluies. Les etiologies entero-invasives dominent largement. Les salmonelles (46,6 %)et les shigelles(44,2 %) sont les principaux germes isoles. L'accent doit etre mis sur la rehydratation. En cas d'antibiotherapie les fluoro-quinolones sont les mieux indiquees, mais le cotrimoxazole conserve une place non negligeable. Les diarrhees bacteriennes sont generalement de bon pronostic si la prise en charge est precoce et les pathologies associees prises en compte.
Imagerie des affections intestinales aiguës non traumatiques de l'adulte
EMC - Gastro-entérologie, 2007
La douleur abdominale est une cause fréquente d'admission en urgence. La radiologie moderne est devenue incontournable dans ces types de situations. Dans ce chapitre, nous abordons quelques notions de radiologie conventionnelle et nous développons la contribution de l'imagerie en coupes dans la mise au point diagnostique des affections intestinales aiguës de l'adulte. Un diagnostic adapté est basé sur un usage rationnel de l'échographie et de la tomodensitométrie, permettant de réduire le nombre de laparotomies inutiles. Le diagnostic d'affections fréquentes ou inhabituelles est posé plus précocement, souvent avant la survenue de complications dramatiques comme la perforation.
International Journal of Scientific Research and Management, 2021
The anesthesiological management of acute surgical abdomens remains a delicate exercise for anesthesiologists and resuscitators, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the dysfunction of the emergency departments with which they are confronted. The objectives of this work were to study clinical and anesthesiological aspects, as well as intraoperative morbidity and mortality related to acute surgical abdomens. We conducted a prospective 12-month study. In this study was included Any patient received in the emergency room of the C.H.U Gabriel Touré in whom the diagnosis of acute surgical abdomen had been retained on the basis of clinical and paraclinical signs who agreed to participate. Results: During our study period, acute surgical abdomens represented 631/1335 cases of all emergency surgeries. Fifty-six of them were referred to intensive care immediately after surgery. Peritonitis represented 376 cases (61%) followed by ...
Les entérocolites aiguės nécrosantes non obstructives de l'adulte
La Revue de médecine …, 1992
R~sum6 --Les ent~rocolites aigui~s n~crosantes non obstructives de I'adulte sont caract~ris~es par leur aspect anatomopathologique : n~crose intestinale h point de d~part muqueux, sans obstruction vasculaire m~sent~rique. Les circonstances de survenue sont nombreuses, et y sont sch~matiquement distingu~es les formes infectieuses et les formes secondaires hun has d~bit m~sent~rique proximal ou distal ; les facteurs infectieux et circulatoires sont en fait souvent intriqu~s. Les tableaux cliniques et paracliniques sont peu ~vocateurs. La prise en charge dolt 8tre m~dico-chirurgicale : mesures symptomatiques de r~animation, tentatives de vasodilatation locale quand les circonstances le permettent et r6section des segments intestinaux I~s~s. Cependant, le diagnostic est souvent port~ Iors de la laparotomie exploratrice, te pronostic reste sombre, en pattie li~ ~_ I'hge des patients, h I'~tendue des I~sions conduisant parfois h de larges r~sections intestinales et au retard diagnostique. Mots-cMs : ENTISROCOLITE AIGUE --N[~CROSE INTESTINALE --INFARCTUS MI~SENTI~RIQUE NON OBSTRUCTIF.
Pancréatites aiguës graves : approches diagnostiques et implications thérapeutiques
Annales Françaises d'Anesthésie et de Réanimation, 1993
ABSTRACT Diagnosis of acute panereatitis (AP) can be obtained with a high level of accuracy by clinical assessment and determination of common laboratory parameters such as serum amylase and lipase concentrations. However, the key of an optimal management of patients with AP is based on an early discrimination between interstitial œdematous and necrotizing forms. The former resolves spontancously whereas parenchymal necrosis acting as a focus for bacteria has a very high severity. In this respect, multifactor prognostic scoring systems and new biological assessments like C reactive protein are valuable methods for forecasting the prognosis of AP. However, these indicators of severity require a full 48 hour period of observation. In order to overcome these drawbacks, other prognostic criteria have been explored based mainly, on laboratory data. The most interesting ones are trypsinogen activation peptides and leucocyte elastase. Finally, the more useful tool is computed tomographie (CT). Combined with high dose intravenous contrast agent, it allows an early identification of necrosis. Other goals of computed tomography are an accurate diagnosis of infection by guided needle aspirations and a preoperative recognition of devitalized and infected tissues, which require a careful surgical necrosectomy. A prolonged drainage is always recommended but relative merits of a conventional closed drainage and an open one are controversial. Another therapeutic challenge is gallstone associated to severe pancreatitis. An early stone removal is advocated by some authors but others prefer delayed surgery because of high mortality rates in case of emergency surgery. Delayed surgery until biological parameters of pancreatitis are normalized seems preferable. An early endoscopic sphincterotomy in an attractive alternative method.
Hémorragies digestives hautes aiguës: Expérience d’un milieu rural
Acta Endoscopica, 2007
Notre travail avait pour but d’étudier les aspects épidémiologiques, étiologiques et évolutifs des hémorragies digestives hautes aiguës (HDHA) dans un contexte rural. Les maladies ayant une hémorragie digestive ont bénéficié d’un examen clinique et d’une endoscopie digestive haute. Au terme de cette étude, 125 malades ont été retenus. Les HDHA ont représenté 5,55 % de l’ensemble des endoscopies digestives hautes. L’âge moyen de nos patients était de 47,45 ans avec un sex ratio de 2,78 en faveur des hommes. Les principales causes de l’hémorragie étaient respectivement une rupture de varices œsophagiennes (55,2 %), des ulcères gastroduodénaux (16 %) et les tumeurs gastriques (12 %). La mortalité a été plus importante en cas de tumeurs gastriques et de rupture de varices œsophagiennes. Les HDHA figurent parmi les urgences digestives les plus fréquentes. L’amélioration de leur pronostic passe par la qualité de la prise en charge. The purpose of our work is to study the epidemiological, etiological and evolution aspects of acute upper digestive bleeding (AUDB) in a farming context. The patients with pathologies inducing digestive hemorrhage benefited from a clinical examination and a high digestive endoscopy. At the end of this survey 125 patients were included in our study. The AUDB represented 5.55% of all high digestive endoscopies. The mean age of our patients was of 47.45 years with a sex ratio of 2.78 in favour of men. The main causes of bleeding were respectively a rupture of oesophageal varices (55.2%), of gastroduodenal ulcers (16%) and gastric tumours (12%). Mortality was increased in case of gastric tumours and rupture of oesophageal varices. AUDB represents one the most frequent digestive emergencies. The improvement of their prognosis is directly related with the quality of management.