2016 - I
DOSAJE DE AMILASA SÉRICA Y URINARIA
UNIVERSIDAD PRIVADA SAN JUAN BAUTISTA FACULT FACULTAD DE CIENCIAS CIENCI AS DE LA SALUD ESCUELA PROFESIONAL DE MEDICINA HUMANA
INFORME DE INVESTIGACIÓN
DOSAJE DE AMILASA SÉRICA Y URINARIA
ELABORADO POR:
DONAYRE DONAYRE ARAUJO CLAUDIA CLAU DIA SUSANA
UNIVERSIDAD PRIVADA SAN JUAN BAUTISTA FACULT FACULTAD DE CIENCIAS CIENCI AS DE LA SALUD ESCUELA PROFESIONAL DE MEDICINA HUMANA
INFORME DE INVESTIGACIÓN
DOSAJE DE AMILASA SÉRICA Y URINARIA
ELABORADO POR:
DONAYRE DONAYRE ARAUJO CLAUDIA CLAU DIA SUSANA
ICA – PERÚ 2016
INTRODUCCIÓN La a!"a#a$ %&'(!'a%a )a*!+' ,)!a"!'a$ -'a &'.!a /!%("a#a -& )!&'& "a -'3!4' %& 3a)a"!.a "a &a33!4' %& /!%4"!#!# %& "(# &'"a3 15 %&" 3(,('&')& 75a!"a#a a" %!8& %! 8&! ! &" 8" 8"-3 -348 48&' &'( ( 9 &" a" a"! !%4 %4' ' ,a ,aa a ( ( a a a. a.3 3a a #! #!, ,"& " #; S& , ,(% (%-3 -3& & ,!'3!,a"&')& &' "a# 8"<'%-"a# #a"!=a" >#(*& )(%( &' "a# 8"<'%-"a# ,a4)!%a#? 9 &' &" ,<'3&a#; T!&'& a3)!=!%a% &'.!<)!3a a -' ,H %& @; C-a'%( -'a %& )a# 8"<'%-"a# #& !'"aa$ 3(( &' "a ,a'3&a)!)!#$ a-&')a "a ,(%-33!4' %& a!"a#a 9 a,a&3& &"&=a%( #- '!=&" &' #a'8& >a!"a#&!a?; F-& "a ,!&a &'.!a &' #& !%&')!!3a%a 9 a!#"a%a ,( A'#&"& Pa9&' &' 1$ -!&' &' -' ,!'3!,!( "a *a-)!.4 3(' &" '(*& %& %!a#)a#a; A!"a#a ,a'3&<)!3a: N(a"&')&$ '( a')!&' 3(!%a &' "a *(3a %-a')& -' "a8( ,&!(%( %& )!&,( a') %& )a8a; P( "( )a')($ "a a9( ,a)& %& "a %!8)!4' %&" a"!%4' %&*& #& 3(,"&)a%a &' &" !'))!'( %&"8a%(; La ,&'3!a %& a"!&')(# ,a3!a"&')& %!8&!%(# &' "a ,a ,a) )& & ##-,& ,&! !( ( %& %&"" !' !')& )) #)!' !'( ( %& %&"8 "8a% a%( ( %& %& #&'3 '3a% a%&' &'a a "a #& #&3 3&3 &3!4 !4' ' %& -8( 8(## ,a'3&<)!3(# &' &" !'))!'(; La# #&3&3!(' ,a'3&<)!3a# 3(')!&'&' ()( )!,( %& a!"a#a ""aa%a a"a5a!"a#a ,a'3&<)!3a$ -& -9 #!!"a$ ,&( '( !%+')!3a a "a a!"a#a #a"!=a"; A 3(')!'-a3!4'$ "a a!"a#a ,a'3&<)!3a 3(,"&)a "a %(,(#!3!4' %& "(# a"!%(' a"!%(' &' a")(#a; P( ")!( ")!($$ -'a &'.!a ""aa%a a")a#a a")a#a -& #& &'3&'3-&')a &')a &' "a# 3+"-"a# -& &3-*&' &" !'))!'( %&"8a%( %(,('& "a a")(#a &' 8"-3(#a$ "a 3-a" a*#(*!%a ,( "a #a'8&;
I.
OBJETIVOS
-& &" a"-'( a"-'( %&)& %&)&!' !'& & "a# 3('3& 3('3&') ')a3 a3!(' !(' %& a!"a# a!"a#a a &' #-&( #-&( &' 3('%!3!(' %& a9-'(;
E,"!3a "(# -")a%(# (*)&'!%(# 3(' "(# =a"( '(a" %& &&&'3!a %& "a )+3'!3a ,aa ,(%& #-8&! -'a ,(#!*!"!%a% %!a8'(#)!3a;
II.
MARCO TEORICO
Pancreatitis aguda La ,a'3&a)!)!# a8-%a$ ( !'"aa3!4' a8-%a %&" ,<'3&a# #&3-'%a!( a "a a3)!=a3!4' !')a58"a'%-"a %& "a# &'.!a# ,a'3&<)!3a#$ -'a &'&&%a% %& =a!a%a ,&')a3!4' 3"'!3a$ %%& 3a#(# -9 "&= 9 a-)("!!)a%(# /a#)a ()(# %& a""( -")!(8<'!3( 9 -&)&; E# -' ,(3( !'"aa)(!( "(3a" -& ""&=a a -'a ,-)a !'"aa)(!a #!#)+!3a &' "a a9(a %& "(# 3a#(#; La !'3!%&'3!a %& "a ,a'3&a)!)!# =aa #&8' "(# ,a# 9 %&,&'%& %& "a 3a-#a ,( &&,"($ &" 3('#-( %& a"3(/("$ 3<"3-"(# *!"!a$ a3)( &)a*4"!3(# 9 <a3(#; CLINICA
•
D!r a"d#ina!: E# &" #')(a ,!'3!,a" %& "a ,a'3&a)!)!# a8-%a; E" %("( ,-&%& =a!a %%& -'a "&=& (")!a )("&a*"& /a#)a -' #-!!&')( !')&'#($ 3('#)a')& & !'3a,a3!)a')&; E' (3a#!(' #- 3(!&'.( *-#3( ,&( &' ()a# (,()-'!%a% )< ,&3&%!%( ,( 3!#!# %("((#a# &!)&a)!=a# %& !')&'#!%a% (%&a%a >?;D& (a 3aa3)&#)!3a &" %("($ -& 3('#)a')& 9 #(%($ #& "(3a"!.a &' &" &,!8<#)!3( 9 "a &8!4' ,&!-*!"!3a"$ 9 a &'-%( #& !a%!a /a3!a "a ,a"%a$ &" )4a$ "(# "a'3(# 9 "a &8!4' !'&!( %& a*%(&';
•
Nauseas$ %its: S(' &3-&') 9 #& %&*&' a "a /!,(()!"!%a% 8<#)!3a 9 a "a ,&!)('!)!# -!3a; S! *!&' ,( "( 8&'&a" #(' *!"!(#(#$ &" =4!)( a*-'%a')& %& )!,( 8<#)!3( %&'()a (*#)-33!4' "!)!<#!3a 3(,"&)a %& "a ,a,!"a;
•
Distensi&n a"d#ina!;
•
Ta'uicardia;
•
(i)tensi&n;
•
*ie"re: E' "a a#& !'!3!a" %& "a &'&&%a% #-&"& #& %& (!8&' )4!3(5 !'"aa)(!($ '( !'&33!(#($ #a"=( &' "(# 3a#(# %& 3("a'8!)!# a#(3!a%a; >?
•
(i)ersensi"i!idad + rigide, #uscu!ar en e! a"d#en$ ruids -idrares dis#inuids ausentes;
•
Signs )u!#nares: )&)( *a#a"$ a)&"&3)a#!a 9 %&a& ,"&-a" )& ")!( <# &3-&')& &' &" "a%( !.-!&%(;
•
S-c/: P-&%& (*&%&3& a "a# #!8-!&') 3a-#a#: H!,(=("&!a
#&3-'%a!a a "a &-%a3!4' %& ,()&'a# ,"a#<)!3a# /a3!a &"
,a3!( &)(,&!)('&a" >-&a%-a &)(,&!)('&a"?; Ma9(
(a3!4' 9 "!*&a3!4' %& ,+,)!%(# %& 3!'!'a# -& ,(%-3&'
=a#(%!"a)a3!4' 9 a-&')( %& "a ,&&a*!"!%a% =a#3-"a; E&3)(#
#!#)+!3(# %& "a# &'.!a# ,()&(")!3a# 9 "!,(")!3a# "!*&a%a# "a
3!3-"a3!4'; •
Sign de Cu!!en + Turner : E# "a a,a!3!4' %& -'a 3("(a3!4' a.-"a%a ,&!-*!"!3a" ( &' "(# "a'3(# ,&3)!=a&')&$ -9 !'&3-&')& >&'( a" ? ,&( -' !'%!3a%( %& 8a=&%a% #- (!8&' "a !'!")a3!4' /&(<8!3a %&" &,!,"4' &'($ "!8a&')( &%('%( ( &)(,&!)('&( &' "a# ,a'3&a)!)!# a8-%a# '&3()!.a')
•
Ictericia: #& %a &' &" 20 a" 0 %& "(# 3a#(#; E' "(# 3a#(# "&=$ #- 3a-#a <# &3-&')& "a (*#)-33!4' "!)!<#!3a %& "a ,a,!"a; E' "(# a)a- 8a= "( <# /a*!)-a" -& "a !3)&!3!a #&a &" -")a%( %& -'a a""a /&,<)!3a )&,a'a$ #(*& )(%( 3-a'%( "a &)!("(8a %&" a)a-& &" a"3(/(";
•
*a!!a #u!tirg0nica: "-&8( %& "a# @2/# %& &=("-3!4'$ &" %("( 9 "(# =4!)(# %!#!'-9&'$ ,&( &' "(# a)a- 8a= "(# #!8'(# %& a""a -")!(8<'!3a %(!'a' &" 3-a%(;
•
*!e#&n )ancre0tic: #!8'( )a%( %&" &a&' #!3($ a,a&3& &' &" 0 a" 0 %& "(# a)a- 8a= 9 ,( "( 8&'&a" 3(,('%& a" ,<'3&a# 9 )&!%( ,&!,a'3&<)!3( !'"aa%(; S& "( &3('(3& 3(( -'a a#a #-,a-*!"!3a" %-a$ &)&'%!%a )a'#=&#a"&')& 9 %& )aaK( =a!a*"&; E' (3a#!('$ -'a
3("&33!4' "-!%a %& 8a' )aaK( ,-&%& &)&!(!.a#& )&,a'a&')& ,( -'a a#a ,a",a*"&;
LABORATORIO EN1IMAS PANCREATICAS2 La #&'#!*!"!%a% %& "a# &'.!a# ,a'3&<)!3a# #+!3a# &' &" %!a8'4#)!3( %& ,a'3&a)!)!# a8-%a %!&&')& 9 %&,&'%& *<#!3a&')& %& "a =&"(3!%a% 3(' -& 3a%a -'a %& &""a# #& a3"aa %& "a 3!3-"a3!4'; S(*& "a *a#& %& )& a3"aa3!4' %& &'.!a# 3!3-"a')$ &" ,-')( %& 3()& %& #-# '!=&" #+!3(# ,aa &" %!a8'4#)!3( %& "a ,a'3&a)!)!# a8-%a '( ,-&%& #& !( >/a*!)-a"&')& 25 =&3 ,( &'3!a %&" "!)& #-,&!( %& "a '(a"!%a%?$ #!'( =a!a*"&$ %&,&'%!&'%( %&" )!&,( )a'#3-!%( %%& &" !'!3!( %& "a &'&&%a%;
A#i!asa tta! •
La 3('3&')a3!4' #+!3a %& a!"a#a #& -#a %& (a 8&'&a"!.a%a 3(( ,-&*a %& %&)&33!4' #!#)&<)!3a ,aa "a ,a'3&a)!)!# a8-%a &' &" ,a3!&')& 3(' %("( a*%(!'a" a8-%( ( &" %("( %& ,a"%a;
•
A,(!a%a&')&$ &" %& "(# ,a3!&') 3(' ,a'3&a)!)!# a8-%a ,&')a' -' a-&')( %& "a a!"a#a #+!3a; La a!"a#a #+!3a #-&"& a-&')a &' "a ,!&a# 2/# %&" ,(3( 9 ,&a'&3& &"&=a%a %-a')& 1 a %a#; La# 3!a# &)('a' a "a '(a"!%a% &' a %a#$ #a"=( &' &" 3a#( -& &!#)a '&3(#!# ,a'3&<)!3a &)&'#a$ (*#)-33!4' !'3(,"&)a %& "(# 3('%-3)(# ( (a3!4' %& ,#&-%(-!#) P( )& ()!=( #- #&'#!*!"!%a% 3a& a =a"( %&" 0 a ,a)! %& "a# /# %& !'!3!( %&" %("( a*%(!'a";
•
U' =a"( a9( a 6UIL /a< 3-)!('a*"& -'a ,a'3&a)!)!# a8-%a -'a 3('3&')a3!4' a9( a 10UIL /a3& <# ,(*a*"& &" %!a8'4#)!3( 9 =a"( =&3 a9( %& "( '(a" "( )a*"&3&'$ #!&,& -& #& /a9a &3"-!%( ()(# ,(3(# -& &"&=a' "a a!"a#a; A%&<# %&" ,<'3&a# #(' =a!(# "(# 48a'(# 3a,a3 %& ,(%-3! a!"a#a: "a# 8"<'%-"a# #a"!=a"$ "a# )(,a# %& Fa"(,!($ "(# (=a!(#$ &" !'))!'( %&"8a%($ &" ,-"4'$ "a ,4#)a)a 9 &" /8a%(; S!' &*a8( &' "a ,<3)!3a$ 9 &' 3('%!3!(' '(a"$ #("( &" ,<'3&a# 9 "a#
8"<'%-"a# #a"!=a" 3(')!*-9&' &' (a #!8'!!3a)!=a a" a')&'!!&')( %& "(# '!=&" #+!3(# %& )a &'.!a; L(# =a"( %& "a a!"a#a &' #-&( #(' %& -)!"!%a% #("( ,aa &" %!a8'4#)!3($ '( 8-a%a' 3(&"a3!4' 3(' "a #&=&!%a% %&" 3-a%($ ,( "( )a')( '( )!&'&' =a"( ,('4#)!3(; •
S- #&'#!*!"!%a% %&" $ #- ,&3!!3!%a% %&" 9 #- =a"( ,&%!3)!=( ,(#!)!=( %&" 6;
•
La #!8-!&')& )a*"a -)a "(# )a#)('(# -& ,-&%&' 8&'&a a"#(# ,(#!)!=(# &' )a ,-&*a;
EN*ERMEDADE
TRANSTORNOS
OTROS
S
NO
TRANSTORNOS
PANCREATICAS
PANCREATICOS
ABDOMINALES
Pa'3&a)!)!#
I'#-!3!&'3!a &'a"
C("&3!#)!)!#
34'!3a
L!4'
L!)!a#!#
Ta-a)!#( C<'3&
"a#
8"<'%-"a# #a"!=a"
,a'3&<)!3(
%&
%&
,<'3&a#
Ca;
%&"
3("+%(3(
%&
,-"4'$
Ú"3&a ,&(a%a
a8($
aa$
I'a)( !'))!'a"
P&!)('!)!#
A'&-!#a
(=a!(
Ma3(a!"a#+!a
-&a%-a#
E*aa.(
Ta-a)!#( 3&&*a"
a4)!3(
H&,a)(,a)a 34'!3a
A,&'%!3!)!# a8-%a
O*#)-33!4' !'))!'a"
•
La# #!8-!&') #(' #!)-a3!(' -& ,-&%&' 8&'&a a"#(# '&8a)!=(#:
a? S! #& &)a#a >%& 2 a %a#? "a (*)&'3!4' %& "a -)a %& #a'8&; *? S! &" )a#)('( #-*9a3&')& -'a ,a'3&a)!)!# 34'!3a &' =&. %& -'a ,a'3&a)!)!# a8-%a; 3? P&'3!a %& /!,&)!8"!3&!%&!a;
Li)asa •
E# "a #&8-'%a %&)&!'a3!4' a# &3-&')&&')& -)!"!.a%a &' &" %!a8'4#)!3( %& "a ,a'3&a)!)!# a8-%a; La "!,a#&!a )!&'& "a =&')aa %& -& '( #& &"&=a &' a"8-'a# #!)-a3!(' -& #(' 3a-#a %& a"#(# ,(#!)!=(# %& "a a!"a#a$ #!'
&*a8( a3(,aKa a "a a!"a#a &' "(# a"#(# ,(#!)!=(# #&3-'%a!(# a ,a)("(8a *!"!a a8-%a$ "3&a ,&(a%a$ (*#)-33!4' !'))!'a"$ )(*(#!# &')+!3a 9 a,&'%!3!)!# a8-%a; La a3)!=!%a% %& "a "!,a#a #+!3a a-&')a %& (a ,aa"&"a a "a %& "a a!"a#a$ 9 "a %&)&!'a3!4' %& a*a# &'.!a# a-&')a &" &'%!!&')( %!a8'4#)!3(; •
L(# '!=&" %& "!,a#a ,-&%&' ,&a'&3& &"&=a%(# %& @ a 1 %a#; La "!,a#a ,-&%& #& a/(a "a &'.!a a# !'%!3a%a ,aa )a*"&3& -' %!a8'4#)!3( %& ,a'3&a)!)!# a8-%a; L(# a=a'3 &' "(# #-#)a)(# 9 "a )&3'("(8a (&3&' a" &%!3( &( (,3!('$ ,&3!a"&')& 3-a'%( #& &3-& a -' a'<"!#!# )-*!%(+)!3(; L(# '-&=(# a'<"!#!# %& "!,a#a -)!"!.a' 3("!,a#a 3(( 3(a3)( 9 )<' )()a"&')& a-)(a)!.a%(#;
•
S- #&'#!*!"!%a% %& $ #- ,&3!!3!%a% %&" 6 9 #- =a"( ,&%!3)!=( ,(#!)!=( %&" 6;L(# =a"( &"&=a%(# %& "!,a#a 9 %& )!,#!'a #+!3a #-&"&' #& %!a8'4#)!3(# %& ,a'3&a)!)!# a8-%a )a# ,-&*a# #(' ,&3!a"&')& )!" &' "(# ,a3!&') 3(' /!,&a!"a#&!a %& (!8&' '( ,a'3&<)!3(;
Isa#i!asas •
O)a ,(#!*!"!%a% a33!('a "a a!"a#a &' #-# !#(&'.!a# #a"!=a>#? 9 ,a'3&<)!3a>,?; La !'/!*!3!4' %& "a !.(&'.!a )!,( S$ ,( -' %(*"& a')!3-&,( ('(3"('a"$ -' +)(%( #&'3!""( 9 <,!%( -& ,&!)& -.8a "a &"&=a3!4' a!#"a%a %& "a &'.!a %& (!8&' ,a'3&<)!3($ &=!)a'%( a# "a 3('-#!4' 3(' /!,&a!"a#&!a# &)a,a'3&<)!3a#;
•
Ha9 -& )&'& &' 3-&')a -& "a %&)&!'a3!4' %& "a !#(a!"a#a '( ,&!)& %!&&'3!a "a# 3a-#a# !'))!'a" %& /!,&a!"a#&!a; E#)( #& %&*& a "a a-#&'3!a %& "a !#(a!"a#a S ,( %&*a( %&" A'8-"( %& )&!).$ %& a'&a -& 3-a"-!& /!,&a!"a#&!a %& (!8&' !'))!'a" #& %&*& (.(#a&')& a -'a &"&=a3!4' a!#"a%a %& "a !#(a!"a#a P;
•
E' &" #-&( '(a" &" a" %& "a a!"a#a %& (!8&' ,a'3&<)!3(; E' "(# 3a#(# %& ,a'3&a)!)!# a8-%a$ "a a!"a#a #+!3a )()a" =-&"=& a "a '(a"!%a% a# <,!%a&')& -& "a !#(a!"a#a ,a'3&<)!3a$ )a ")!a ,-&%& ,&a'&3&
&"&=a%a %& @ a 1 %a#; C(' ,&3)( a )a ,-&*a a"8-'(# a-)( a%=!&)&' -& '( #-&"&' #& !a*" 3-a'%( /a9 -' a-&')( '!( ( (%&a%( %& "a a!"a#a )()a" &' )(# 3a#(# -")a )!" &3-! a -' a'<"!#!# %&" )!,#!'48&'( #+!3(; •
Fa33!('a!&')(# a# !'(# %& "a# !#(&'.!a# ,a'3&<)!3a#$ 3(( ,-&%& #& "a %&)&!'a3!4' %& "a #-*a33!4' P$ 3aa3)&#)!3a %& "a ,a'3&a)!)!# a8-%a$ #(' %& a#a -)!"!%a% &' "a -)!'a ,( #- 3(,"&!%a%;
A#i!asuria + tasa de ac!araci&n de A#i!asa3Creatinina E# ,(#!*"& %&)&!'a &'.!a# &' (!'a$ #(*& )(%( a!"a#a$ )a')( &' -)a# %& 2/# 3(( &' "a# &3(8!%a# %& (a a!#"a%a$ !'3"-9&'%( #&'3!""a# ,-&*a# <,!%a# 3-a"!)a)!=a#; E#)a# %&)&!'a3!(' '( #-&"&' #& %& &"&33!4'$ 9a -& &" ,&!" #!')(<)!3( %&" ,a3!&')& 3(' ,a'3&a)!)!# -#)!!3a "a (*)&'3!4' %& -)a# #+!3a#; P( ()( "a%( )a')( "a a!"a#a -!'a!a 3(( "a )a#a %& a3"aa3!4' %& a!"a#a3&a)!'!'a$ '( #-,&a' &' #&'#!*!"!%a% '! &' ,&3!!3!%a% "a %&)&!'a3!4' %& "(# '!=&" #a'8-'&(# %& a!"a#a; S!' &*a8($ &' (3a#!(' ,(#!*"& %&)&3)a '!=&" -!'a!(# %& a!"a#a &"&=a%a# %-a')& a"8( a# %& -' )!&,( -& &' #a'8&$ 9a -& &' a"8-'(# 3a#(# "a &"&=a3!4' %& a!"a#a #+!3a ,-&%& #& -8a.;
Otrs Ta')( "a (#("!,a#a A2$ 3(( "a )!,#!'a !'-'(&a3)!=a 9 "a &"a#)a#a515 ,a'3&<)!3a &-!&&' 3(,"&a# %&)&!'a3!('$ 9 ,( &'%& #- -)!"!%a% ,<3)!3a &' "a ,a)("(8a %& -8&'3!a# "!!)a%a;
LABORATORIO 4ENERAL2 •
Leucsitsis2 C(' %=!a3!4' a "a !.-!&%a #&3-'%a!a a" ,(3( )(!3( !'"aa)(!( ,a'3&<)!3( -& ,( "( )a')( '( !'%!3a !'&33!4';
•
(e#atcrit2 E' "(# 3a#(# <# 8a= ,-&%& /a*& /&(3('3&')a3!4' 3(' =a"( %& /&a)(3!)( -& &3&%a' &" 0$ %&*!%( a "a ,+%!%a %& ,"a#a /a3!a &" ,a3!( &)(,a'3&<)!3( 9 "a 3a=!%a% ,&!)('&a";
•
(i)erg!uce#ia2 S&3-'%a!a a ")!," a3)($ &')& &""(# "a &'( ,(%-33!4' %& !'#-"!'a$ &" a-&')( &' "a "!*&a3!4' %& 8"-3a84' 9 "a a9( ,(%-33!4' %& 8"-3(3()!3(!% 9 %& 3a)&3("a!'a# #-,a&'a"
•
Par0#etrs
de
C!estasis
5BILIRRIBINA$
*AL$
4AMA4LUTAMILTRANSPEPTIDASA 6 TRANSAMINASAS72 La &"&=a3!4' %& )(# ,a<&)(# !'%!3a)!=a %&" 3(,(!#( %&" %&'a& *!"!a 9 a,(9a &" (!8&' *!"!a %& )a &'&&%a%; La /!,&*!"!-*!'&!a >a9( a 8%"? a,a&3& a,(!a%a&')& &' &" 10 %& "(# ,a3!&') 9 "(# '!=&" &)('a' a "a '(a"!%a% &' a @ %a#; •
(i)ca!ce#ia2 S& ,&')a &' -' 2 %& "(# 3a#(#; E# !'%!3a)!=( %& '&3(#!# 8a#a ,&!,a'3&<)!3a$ 9a -& #& /a (*#&=a%( -& &!#)& #a,('!!3a3!4' !')a,&!)('&a" %&" 3a"3!( ,( "(# <3!%(# 8a#(# &' .('a# %& '&3(#!# 8a#a$ 3(' 8a'% 3a')!%a% >/a#)a 6 8;? %!#-&")a# ( #-#,&'%!%a# &' &" "-!%( a#3)!3(;
DIA4NOSTICO POR IMA4ENES Estudis Radi!&gics. A-'-& /a9 -'a ( <# a'(a"a# a%!("48!3a# &' <# %&" 0 %& "(# ,a3!&')$ "(# /a""a.8(# #(' !'3('#)a') & !',&3!3(#; E')& &""(# #& %)a3a' &' "a R %!&3)a %& a*%(&': • • •
"&( "(3a"!.a%( -& #-&"& a&3)a &" 9&9-'( >a#a 3&')!'&"a?; "&( 8&'&a"!.a%( 3(' '!=&" /!%(a&&(#; S!8'( %&" 3("(' !')&-,!%($ -& #& %&*& a "a %!"a)a3!4' a!#"a%a %&"
•
3("(' )a'#=&#(; D!#)&'#!4' %-(%&'a" 3(' '!=&" /!%(a&&(# La ,&'3!a %& 3a"3!!3a3!(' &' &" <&a ,a'3&<)!3a &' (3a#!('
•
,-&%& #-8&! -'a ,a'3&a)!)!# 34'!3a %& *a#&; Ma#a -& 3(' &3-&'3!a -' ,#&-%(-!#)&;
•
E" ,!'3!,a" =a"( %& "a# a%!(8aa# 3('=&'3!('a" &' "a ,a'3&a)!)!# a8-%a 3('#!#)& &' a9-%a a &3"-! ()(# %!a8'4#)!3(#$ #(*& )(%( -'a =#3&a ,&(a%a;
Ecgra89a. S-&"& #& &" ,(3&%!!&')( !'!3!a" &' "a a9(a %& "(# ,a3!&') &' "(# -& #& #(#,&3/a &'&&%a% ,a'3&<)!3a; S- ,!'3!,a" -)!"!%a% &' "a
,a'3&a)!)!# a8-%a$ &' &" %!a8'(#)!3( &)!("48!3( &%!a')& "a &=a"-a3!4' %& "a =3-"a 9 "a =a *!"!a; E' 3-a')( a" %!a8'4#)!3( &3(8<!3( %& ,a'3&a)!)!# a8-%a$ #& *a#a &' "a ,&'3!a %& #!8'(# ,a'3&<)!3(# 9 ,&!,a'3&<)!3(#; E" a8a'%a!&')( %& "a 8"<'%-"a 9 "(# 3a*!(# &' #- (a 9 &3(8&'!3!%a% #(' #!8'(# &3-&') ,&( %& =a"( &"a)!=( ,( #- 8a' =a!a*!"!%a% &' #-&)(# '(a" S!' &*a8( &' "a #!)-a3!4' 3"'!3a a,(,!a%a -' ,<'3&a# a-&')a%( %& )aaK( 9 %&(a%( #-!3!&')& ,aa 3('!a &" %!a8'4#)!3(; U' #!8'( -9 ,&3!3( "a #&,aa3!4' '&)a %&" ,<'3&a# 3(' ,&3)( a "(# )&!%(# 3!3-'%a') E' "(# a)a- 8a= 3(' "a ,&'3!a %& 3("&33!(' "!-!%a# *!&' %&!'!%a# -& a#!&')a' &' "(# ,a3!(# &)(8<#)!3(# 9 ,aa&'a" a')&!( !.-!&%( -& )!&'&' 8a' =a"( %!a8'4#)!3(; Ha9 -& )&'& &' 3-&')a -& #- 9a %& ,( #! *aa #&'#!*!"!%a% ,aa &" %!a8'4#)!3( %& ,a'3&a)!)!# a8-%a #& =& &' "a ,<3)!3a &%-3!%a ,( &" /&3/( %& "a &3-&')& !')&,(#!3!4' %& 8a#$ -& !,!%& "a =!#-a"!.a3!4' %& "a 8"<'%-"a &' <# %& "a !)a% %& "(# 3a#(# &' "a a#& !'!3!a" %& "a &'&&%a%$ #!' &*a8($ &" (,&a%( &')&'a%( ,-&%& a,&3!a -' a8a'%a!&')( 3aa3)&#)!3( %& "a 8"<'%-"a;
T#gra89a C#)utada. E" ,a,&" -'%a&')a" %& "a TC "a 3"a#!!3a3!4' "(3a" %& 8a=&%a% <# -& &" %!a8'4#)!3( ,!a!( %& ,a'3&a)!)!# a8-%a; N( (*#)a')&$ &' 3a#(# %& %!a8'4#)!3( %-%(#($ ,( "!8&a ( '-"a &"&=a3!4' &'.!<)!3a &' #-&($ ( &' "(# 3a#(# %& 8a=&%a% 3"'!3a &' a-#&'3!a %& %("( a*%(!'a"$ &" ,a,&" %& "a TC &" -'%a&')a" &' &" %!a8'4#)!3( %& "a &'&&%a%; E' )(# 3a#(# #& (*#&=a -'a 8"<'%-"a a-&')a%a %& )aaK($ %& *(% a" %&!'!%(#$ /&)&(8&'&!%a% %&" ,a+'-!a$ ,&'3!a %& 3("&33!(' "-!%a#; E# <# #&'#!*"& -& "a &3(8aa$ a ,a %& )( ,( a.(' %& 3(#)($ &,"&( %& a%!a3!(' !('!.a') 9 &%-3!%a 3a,a3!%a% ,aa &=a"-a &" #!#)&a *!"!a$ "a )((8aa 3(' ,(,4#!)( %!a8'4#)!3($ #("( )< !'%!3a%a a')& &" a3a#( %& "a &3(8aa ,aa &3('(3& &" ,<'3&a#;
La &a"!.a3!4' %& -'a TC a') %& "a# /#; %& &=("-3!4' %%& &" !'!3!( %& "a &'&&%a%$ )!&'%& a !'a=a"(a "a 8a=&%a% %&" 3-a%( "(3a" %& ,a'3&a)!)!# 9 ,( )a')($ &" (&')( !%4'&( %& #- &a"!.a3!4' &')& "a# 9 @2 /#; D!a8'4#)!3( E' &" 3-#( %& "a ,a'3&a)!)!# a8-%a #& )!&'&' -& ,"a')&a %(# )!,(# %& %!a8'4#)!3(#: 1; D& E'&&%a% 2; D& S&=&!%a% ( Ga=&%a% E" %!a8'4#)!3( %& &'&&%a% #& ,"a')&a &' *a#& a "a# #!8-!&') ,-&*a#$ ,( ,(#&& "(# <# a")(# '%!3 %& #&'#!*!"!%a% 9 ,&3!!3!%a% %!a8'4#)!3a$ "a# 3-a" !'3"-9&':
:. Ac!ara#ient de A#i!asa. S- 3a,a3!%a% #& *a#a &' &" /&3/( %& -& &' &" 3-#( %& ,a'3&a)!)!# a8-%a$ "a &a*#(3!4' )-*-"a %& "a a!"a#a ,a'3&<)!3a #& /a""a %!#!'-!%a 9 &' 3('#&3-&'3!a #- %&,-a3!4' ( a3"aa!&')( &'a" #& /a""a' !'3&&')a%(#; La 4-"a -)!"!.a%a :
AA ; A#i!asa urinaria < V!. Orina #!3tie#) en #in A#i!asa srica =
La# a!"a#a# #+!3a# 9 -!'a!a# #& &,a' &' -'!%a% S((89"; AA '(a": 2; "!' 0;2 "!'; E' "(# 3a#(# ,(#!)!=(#$ )(# =a"( #& /a""a' ,( &'3!a %&" a'8( '(a";
>. Re!aci&n Ac!ara#ient A#i!asa3Creatinina. E#)a -'a ,-&*a a #& &,"&a%a 3-a'%( &!#)& %/!%a)a3!4' #!8'!!3a)!=a 3(' &" (*&)( %& &=!)a &" a3)( %& &( &,&')a'%( ,( -'a
%!#!'-3!4' %& a3"aa!&')( %& "a a!"a#a ,( "a !'#-!3!&'3!a &'(-'3!('a" ,&')&; La 4-"a :
AA ; A#i!asa urinaria < %!. Orina #!3tie#) en #in A#i!asa srica = A Cr ; Creatinina urinaria < %!. Orina #!3tie#) en #in Creatinina srica en #ag = Va"( '(a": 2;2; La %&)&!'a3!4' %& a!"a#a 9 3&a)!'!'a -!'a!a #& &a"!.a &' "a !#a -)a$ "( -& /a3& -& &" a3)( =("-&')!&,( #& a'-"& &' "(# %(# '!=&" %& "a a33!4'; E' "a ,a'3&a)!5a8-%a "a &"a3!4' #& /a""a !'3&&')a%a;
?. Li)asa Srica. S-# '!=&" #& &"&=a' a "a# /(a# %& !'!3!a%( &" ,(3($ a')&'!+'%(#& &' a# 3('%!3!(' ,( -' ,(&%!( %& @ %a#; P(#&& -'a a")a #&'#!*!"!%a% 9 ,&3!!3!%a% %!a8'4#)!3a; Va"( '(a": D&*a( %& 2$ - C/&95Ca'%a"";
@. Radigra89a si#)!e de a"d#en. S- =a"( !%& &' )a*"&3& -' %!a8'4#)!3( %!&&'3!a" 3(' ()a# 3('%!3!(' 3(,a)!*" 3(' a*%(&' a8-%(; Ha""a.8(# 3(,a)!*" 3(' &" %!a8'4#)!3( %& ,a'3&a)!)!# a8-%a !'3"-9&' "( #!8-!&')&: a? A#a 3&')!'&"a; *? S!8'( %&" 3()& >3-) ( #!8'?; A-#&'3!a %& =!#-a"!.a3!4' %&" 3("(' )a'#=&#(; a? I"&( ,aa")!3(; D!a8'4#)!3( %& S&=&!%a% E" #!8'!!3a%( ,('4#)!3( %& a3)( ,&3(3 %& !( )a')( 3"'!3( 3(( a-!"!a$ /a ,&!)!%( "a !%&')!!3a3!4' (*&)!=a )&,a'a %&" !( %&
3(,"!3a3!(' 9 ()a"!%a% &' &" ,a3!&')& 3(' ,a'3&a)!)!# a8-%a; E" %a(""( %& )& 3('3&,)( '( #4"( /a %&(#)a%( #- !,()a'3!a &' &" a'&( a3!('a" %&" ,a3!&')& ,&3!3($ #!'( )a*!+' &' "a &=a"-a3!4' %& '-&=a# (%a"!%a% )&a,+-)!3a#; A "( "a8( %& "a# ")!a# %(# %+3a%a# #& /a' ,"a')&a%( %!&&') (%&"(# ,aa )a*"&3& ,('4#)!3($ /a*!&'%( #!%( Ra'#(' 9 &" 8-,( %& Ba' 9 Q!#& "(# ,!&(# &' %a(""a )a (%a"!%a% %!a8'4#)!3a;
:. Mde! de Ransn. S& *a#a &' %&)&!'a 11 ,a<&)(#$ %& &""(# a" !'8($ -& &"&a' "a #&=&!%a% %&" ,(3( !'"aa)(!( 9 "(# )a') 6 )a*"&3!%(# %&')( %& "a# ,!&a# /(a# #-*#!8-!&') -& %&)&!'a' "a &=&')-a" ,&'3!a %& 3(,"!3a3!(' )a')( #!#)+!3a# 3(( "(3a" S! &'(# %& ) ,a<&)(# 3-,"&' 3(' "(# 3!)&!(# %& ,(#!*!"!%a%$ ,<3)!3a&')& &" ,a3!&')& #(*&=!=&; S! ,a<&)(# ( <# #(' ,(#!)!=(#$ "a ()a"!%a% a-&')a ,( &'3!a %&" 1 %& "(# 3a#(#; La a9(a %& "(# %&3(# (3-&' 3-a'%( 6 4 <# ,a<&)(# #(' ,(#!)!=(#;
>. Mde! de Ban/ + ise. E#)& #!#)&a !'3"-9& ,a<&)(# 3"'!3(# 9 a-!"!a -& #& 3(&"a3!('a' 3(' "(# 3!)&!(# %& Ra'#('; La ,&'3!a %& -'( ( <# %& )(# ,a<&)(# 3(' 3!)&!(# ,(#!)!=(# !,"!3a' "a ,&'3!a %& (a #&=&a ( 8a=& %& "a &'&&%a%$ 3(' -'a a")a ,(*a*!"!%a% %& ()a"!%a%; R-!. 9 3("; &' -' )a*a( & !'=)!8a3!4' 3"'!3a &a"!.a%( &' &" P&$ &' -'a ,(*"a3!4' %& 1 3a#(# %& ,a'3&a)!)!# a8-%a$ &=a"-a(' "a =a"!%&. %& "(# 3!)&!(# %& Ra'#(' 9 Ba'5Q!#& a,"!3a%(# a '-)a ,(*"a3!4'; S& 3('3"-94 -& "a &%a%$ a# 3(( "a# %&)&!'a3!(' %& 3a"3!($ &a$ 9 &3-&')( "&-3(3!)a!( 3('#)!)-9&(' "(# a3)( 3(' "a <# a")a #&'#!*!"!%a% ,('4#)!3a; S(*& )a *a#& #& &3(&'%4 "a a,"!3a3!4' %& %!3/a# 3('#)a') &' '-)( &%!( ,aa %&)&!'a &" ,('4#)!3( &' ,a'3&a)!)!#
a8-%a$ 9a -& #- ,(#!)!=!%a% &-!=a"!4 a "a 3(,('%!&')& a <# %& 6 3-a'%( #& &=a"a' "a# 11 (!8!'a"
?. Mde! de Ba!t-a,ar. E#)& #!#)&a #& -'%a&')a &' /a""a.8(# (*)&'!%(# &%!a')& "a a,"!3a3!4' %& TAC; La ,&'3!a %& "(# 8a%(# D ( E %&')( %& "a# ,!&a# /(a# )!&'& =a"( ,&%!3)!=( %a=(a*"&$ &' 3(')a,(#!3!4' %& "a ,&'3!a %& ()(# 8a%(#; La &)a,("a3!4' %&" #!#)&a Ba")a/a.a 3(' &" %& Ra'#(' (&3& ,<3)!3a&')& -' 100 %& #&'#!*!"!%a% 9 ,&3!!3!%a% %!a8'4#)!3a;
@. Siste#a APAC(EII. A3-)& ,/9#!("(89 a'% 3/('!3 /&a")/ &=a"-a)!(' 3('!&& ,-')(# %& #&=&!%a% #(*& "a *a#& %& "a &)&'#!4' %& a'(a"!%a% &' -' 8-,( %& =a!a*" !#!("48!3a#$ a "( 3-a" a8&8a ,-')a& ,( &%a% 9 ,(3(# 34'!3(# &=&')-a"&')& ,&') &' &" ,a3!&')& 3(' ,a'3&a)!)!# a8-%a;
. Misce!0nea. S& /a' ,(#)-"a%( -'a #&!& %& ()(# #!#)&a# -& ,&)&'%&' &=a"-a "a #&=&!%a% %& "a 3('%!3!4' -& '(# (3-,a; E')& "(# '%!3 !'%!=!%-a" a,"!3a%(#$ "a %&)&!'a3!4' 3-a')!)a)!=a %& ,()&'a C &a3)!=a$ /a %&(#)a%( )&'& &" <# a")( '%!3& %& #&'#!*!"!%a% 9 ,&3!!3!%a% %!a8'4#)!3a;
Pancreatitis cr&nica E# -'a &'&&%a% -& #& 3aa3)&!.a ,( "a !'"aa3!4' %&" )&!%( ,a'3&<)!3( 3(' ,+%!%a %& #-# -'3!('$ %&*!%( a "a %)-33!4' ,(8!=a & !&=&#!*"& %& "a# 3+"-"a# 9 #- #-#)!)-3!4' ,( )&!%( !*(#(; E" ,<'3&a# #& a)(!a$ %&3!$ %!#!'-9& %& )aaK(; E' 3('%!3!(' '(a" &" ,<'3&a# )!&'& %(# -'3!(' -'%a&')a" La -'3!4' &(3!'a "a %a(""a' "a# 3+"-"a# a3!'a 9 %-3)a" A )a=+# %& #-# ,(%-3)(# >&'.!a# 9 &"&3)4"!)(#? 3('#!8-&' -& a*#(*a(# )(%( "( -& 3(&(# 9 -& ,a#&' "(# '-)!&') a "a #a'8&; Sa*&(# -& "a &'.!a a!"a#a a9-%a &' "a a*#(3!4' %& "(# /!%a)(# %& 3a*('($ "a )!,#!'a a "a %& "a#
,()&'a# 9 ,( ")!( "a "!,a#a a "a %& "a# 8a#a#; La -'3!4' &'%(3!'a %&" ,<'3&a# )< a 3a8( %& -'a# 3+"-"a# ,&3!3a# >!#"() %& La'8&/a'#? 9 )a# #& &'3a8a' %& ,(%-3! !'#-"!'a ,aa &)a*("!.a "a 8"-3(#a; P(%&(# =!=! #!' ,<'3&a# ,&( /a9 -& #-#)!)-! #-# -'3!(' La !'3!%&'3!a %& "a ,a'3&a)!)!# 34'!3a &' E#,aKa #&8' -' )a*a( &a"!.a%( &' "a .('a %& Ca')a*!a %& 1 3a#(# ,( 100;000 /a*!)a') 9 aK(;
UF CAUSA LA PANCREATITIS CRÓNICAG H(9 &' %a #& 3('#!%&a -& "a 3a-#a <# &3-&')& %& "a ,a'3&a)!)!# 34'!3a &" a"3(/(" >3a#! &" 0 %& "(# ,a3!&')? 9 #& 3&& -& "a !'8)a 3(')!'-a%a %& 0 8 %& a"3(/(" %!a!(# &' &" /(*& 9 60 8 &' "a -&$ #&a' %(#!# #-!3!&') ,aa %a(""a"a; N( )(%a# "a# ,&#('a# 3(' )a !'8)a %& a"3(/(" %a(""a' -'a ,a'3&a)!)!# 34'!3a; P&'#a(# -& ,(*a*"&&')& )!&'&' -& &!#)! ()(# a3)( a3!"!)a%($ 3(( ,( &&,"( ,a&3& #& /(9 &' %a &" 3a#( %&" )a*a3(; E' a,(!a%a&')& -' 20 %& "(# 3a#(# '( &'3(')a(# -'a 3a-#a -&%a'%( 3a)a"(8a%a "a ,a'3&a)!)!# 3(( !%!(,<)!3a$ #!&'%( "a #&8-'%a 3a-#a &' (%&' %& &3-&'3!a; E' -' "a ,a'3&a)!)!# 34'!3a %&*!%a a a")&a3!(' 8&'+)!3a# >,a'3&a)!)!# /&&%!)a!a$ !*(#!# -#)!3a?$ a a")&a3!(' a-)(!'-' >,a'3&a)!)!# a-)(!'-'&?$ a 3!&)(# a3)( a*!&')a" %&" 3"!a ( "a %!&)a$ 3(( "a ,a'3&a)!)!# -& #& (*#&=a &' I'%!a ( !3a >,a'3&a)!)!# )(,!3a"?;
SINTOMAS E" %("( &" #')(a ,!'3!,a" 9 "( ,&')a' &' a"8' (&')( %& "a &'&&%a% <# %&" 0 %& "(# ,a3!&') E# -' %("( -& #& "(3a"!.a &' "a ,a)& 3&')a" 9 a")a %&" a*%(&' 9 -& #& !a%!a /a3!a a*(# "a%(# 9 &' (3a#!(' a "a ,a"%a; E#)& %("( ,-&%& #& 3(')!'-a%( ( 3-#a a *() #!-"a'%( &,!#(%!(# %& ,a'3&a)!)!# a8-%a -& &' -3/a# (3a#!(' ,&3!#a' !'8( /(#,!)a"a!(; E" %("( 3(')!'-a%( -' %("( -& #& %&'3a%&'a 3(' "a 3(!%a 9 &' (3a#!(' )a' !')&'#( -& &" ,a3!&')& a%&"8a.a ,( &" !&%( -& )!&'& a 3(&; E' "a /!#)(!a 'a)-a" %& "a &'&&%a% &" %("( a,a&3&
&')& "a )&3&a 9 3-a)a %+3a%a %& "a =!%a &' "(# ,a3!&') a"3(/4"!3(# 9 ,-&%& %a,a&3& ,(')<'&a&')& 3-a'%( "a &'&&%a% )< 9a -9 a=a'.a%a; E' "(# ,a3!&') 3(' ,a'3&a)!)!# !%!(,<)!3a #& %!&&'3!a' %(# (a# 9a *!&' 3a)a"(8a%a#: "a -=&'!" -& #& !'!3!a ,( 3!#!# %& %("( !')&'#( &' "a #&8-'%a %+3a%a %& "a =!%a$ 9 "a #&'!"$ -& 8&'&a"&')& !'%("(a; La )&a)(&a "a #&8-'%a a'!)a3!4' &' &3-&'3!a %,-+# %&" %("(; E#)&a)(&a &" &3( %& 8a#a &' "a# /&3 %&*!%( a "a !'#-!3!&'3!a ,a'3&<)!3a &(3!'a >&"a a")a %& &'.!a# !,!%& -& "a 8a#a %& "a %!&)a #& a*#(*a?; E#)( (3-& /a*!)-a"&')& %& (a )a%a &' "a &=("-3!4' %& "a &'&&%a%$ a-'-& ,-&%& (3-! -& #&a &" ,!& #')(a 3(( (3-& &3-&')&&')& &' "a ,a'3&a)!)!# !%!(,<)!3a #&'!"; S& 3aa3)&!.a ,( %&,(#!3!(' %!a&!3a#$ *!""a')$ ,a#)(#a# 9 -9 =("-!'(#a# ,( "( -& '( ,a#a' %a,&3!*!%a# a" ,a3!&')& 9 /a*!)-a"&')& =a' a#(3!a%a# a "a ,+%!%a %& ,(; La %!a*&) &""!)-# &" )&3& #')(a &' &3-&'3!a 9 #& %&*& a "a !'#-!3!&'3!a ,a'3&<)!3a &'%(3!'a; Ha*!)-a"&')& -' #')(a %& "a ,a'3&a)!)!# 34'!3a -9 a=a'.a%a 9 8&'&a"&')& a,a&3& &' ,a3!&') -& 9a )!&'&' )&a)(&a; O)(# #')(a# 9a -3/( &'(# &3-&') #(' "a !3)&!3!a >,!8&')a3!4' aa!""a %& ,!&" 9 -3(#a#? ,( 3(,!4' %&" 3('%-3)( *!"!a$ "a a#3!)!# ,a'3&<)!3a >(a3!4' %& "-!%( &' "a *a!8a? 9 "a /&(a8!a %!8)!=a ,( =a!3 8<#)!3a#;
MFTODOS DE DIA4NÓSTICO A')& "a #(#,&3/a 3"'!3a "a ,!&a &,"(a3!4' -'a a%!(8aa %!&3)a %& a*%(&' -& &' -3/(# 3a#(# (#)a< 3a"3!!3a3!(' &' &" <&a ,a'3&<)!3a$ "( -& %!a8'(#)!3a "a &'&&%a%; H(9 &' %a )&'&(# a '-)a %!#,(#!3!4' %!=&#a# ,-&*a# %& !a8&' -& '(# !'(a<' %& "a# a")&a3!(' &' )aaK($ (a 9 )-3)-a %&" ,<'3&a#; S(' "a &3(8aa a*%(!'a"$ "a )((8aa 3(,-)a!.a%a a*%(!'a" 9 "a 3("a'8!(,a'3&a)(8aa ,( ('a'3!a )(%a# &""a# ,-&*a# '( !'=a#!=a# >'(
&-!&&' &'%(#3(,!a?; S! #& )a)a %& =!#-a"!.a &( &" )&!%( ,a'3&<)!3( ,( &!#)! %-%a %!a8'4#)!3a 3(' -' ,(3( 3a'3&(#( "a &,"(a3!4' %& &"&33!4' #&< "a -")a#('(8aa &'%(#34,!3a >&3(5&'%(#3(,!a? 3(' )(a %& -)a ,aa )-%!( %&" )&!%(; E#)a &,"(a3!4' '!a&')& !'=a#!=a 9 ,&3!#a %& "a !')(%-33!4' %& -' &'%(#3(,!( /a#)a &" %-(%&'(; La 3("a'8!(,a'3&a)(8aa &)48a%a &'%(#34,!3a >CPRE? #& &=a< ,aa "(# ,a3!&') &' "(# -& #& )&'8a -& &a"!.a -'a a'!(*a )&a,+-)!3a; E" %!a8'4#)!3( %a "a !'#-!3!&'3!a ,a'3&<)!3a &(3!'a #& ,-&%& &a"!.a &%!a')& &" )-%!( %& &"a#)a#a &' -'a -)a %& /&3$ &')& ()(# +)(%(#;
TRATAMIENTO La a9(a %& "(# ,a3!&') a3-%&' a" +%!3( ,( &" %("( 3(')!'-a%( ( a *() La ,!&a &%!%a "a &3(&'%a3!4' %& "a #-,!4' %&" a"3(/(" 9 &" )a*a3(; E" )a)a!&')( #&< ,!&( 3(' a'a"8+#!3(# &'( 3(( ,aa3&)a(" ( &)a!.(" ,aa ,a#a ,(#)&!(&')& a a')!!'"aa)(!(# '( )&(!%&(#; Ha9 -& !')&')a '( -)!"!.a %&!=a%(# 4!3(# 9 #! &" %("( '( #& ,-&%& 3(')("a #& ,a#a< a ()a# (,3!(' %& )a)a!&')(; La ,!&a %& &""a# 9 #! #& 3(,-&*a -& &!#)& -'a )&'(#!# %&" 3('%-3)( ,a'3&<)!3( ,!'3!,a" #&< "a 3("(3a3!4' )&,(a" %& -'a ,4)!# >)-*(? %&')( %&" 3('%-3)( &%!a')& -'a CPRE; S! '( &!#)!&a )&'(#!# -'a ,(#!*!"!%a% #&a "a '&-("!#!# %&" ,"&( 3&"!a3( &%!a')& "a !'9&33!4' %& -'a #-#)a'3!a &' "(# 8a'8"!(# 3&"!a3(# 8-!a%(# ,( -'a )((8aa 3(,-)&!.a%a ( ,( -'a &3(5 &'%(#3(,!a$ )a*!+' %& (a )&,(a"; S! '( #& ,-&%& 3(')("a &" %("( 3(' )(# &%!(# )< !'%!3a%a "a !')&=&'3!4' -!8!3a; E" )a)a!&')( %& "a !'#-!3!&'3!a ,a'3&<)!3a >)&a)(&a? #& &a"!.a< )(a'%( &' "a# 3(!%a# "a# &'.!a# -& &" ,<'3&a# '( ,(%-3&; E!#)&' ,&,aa%(# %& &)a3)(# %& ,<'3&a# %& 3&%( -9 &&3)!=(# 9 *!&' )("&a%(#; E" )a)a!&')( %& "a !'#-!3!&'3!a ,a'3&<)!3a &'%(3!'a >%!a*&)? #& *a#a &' -'a %!&)a ,&3!a" 9 &' "a a%!'!#)a3!4' %& !'#-"!'a;
An0!isis de a#i!asa en sangre
Amilasa en sangre
-'a &'.!a -& a9-%a a %!8&! "(# 3a*(/!%a)(# 9 #&
,(%-3& &' &" ,<'3&a# 9 &' "a# 8"<'%-"a# #a"!=a" C-a'%( &" ,<'3&a# )< &'&( ( !'"aa%($ #& "!*&a a!"a#a &' "a #a'8&; S& ,-&%& /a3& -' a'<"!#!# %& #a'8& ,aa &%! &" '!=&" %& )a &'.!a &' &" #-&(; La a!"a#a )a*!+' #& ,-&%& &%! 3(' -' a'<"!#!# %& (!'a; V&: a!"a#a &' (!'a; F(a &' -& #& &a"!.a &" a'<"!#!# S& '&3!)a -'a -)a %& #a'8&; Paa (*)&'& !'(a3!4' #(*& "a (a 3(( #& /a3& )($ =& &" a)3-"(: =&'(,-'3!4'; P&,aa3!4' ,aa &" a'<"!#!# N( #& '&3!)a ,&,aa3!4' ,&3!a" #!' &*a8($ #& %&*& &=!)a &" 3('#-( %& a"3(/(" a') %&" &a&'; E" +%!3( ,&3!a"!#)a ,-&%& ,&%!"& -& %&& %& )(a <a3(# -& ,-&%&' a&3)a &" &a&'; NUNCA %&& %& )(a '!'8' &%!3a&')( #!' /a*"a ,!&( 3(' &" +%!3(; L(# &%!3a&')(# -& ,-&%&' a-&')a "a# &%!3!(' %& a!"a#a #('$ &')& ()(#: •
A#,aa8!'a#a
•
3!%( a3&)!"#a"!3"!3( > A#,!!'a?
•
P"%(a# a')!3('3&,)!=a#
•
C("!'+8!3(#
•
3!%( &)a3'!3(
•
M&)!"%(,a
•
O,!<3&(# >3(%&'a$ &,&!%!'a$ (!'a?
•
D!-+)!3(# )!a.%!3(#
L( -& #& #!&')& %-a')& &" a'<"!#!# C-a'%( #& !'#&)a "a a8-a ,aa &)a& "a #a'8&$ a"8-'a# ,&#('a# #!&')&' -' %("( (%&a%($ !&')a# -& ()a# #4"( #!&')&' -' ,!'3/a.( ( #&'#a3!4' %& ,!3a%-a; P(#)&!(&')&$ ,-&%& /a*& a"8( %& #&'#a3!4' ,-"#<)!"; Ra.(' ,( "a# -& #& &a"!.a &" a'<"!#!# E#)& &a&' #& &a"!.a 3a#! #!&,& ,aa %!a8'(#)!3a ( =!8!"a -'a ,a'3&a)!)!# a8-%a; Ta*!+' ,-&%& %&)&3)a a"8-'(# ,(*"&a# %&" )-*( %!8)!=(; E" &a&' )a*!+' #& ,-&%& /a3& ,( "a# #!8-!&') a&33!(': •
Pa'3&a)!)!# 34'!3a
•
S&-%(-!#)& ,a'3&<)!3(
L(# =a"( '(a" %& a'<"!#!# %& a!"a#a &' #a'8& E" a'8( '(a" %& 2 a -'!%a% ,( "!)( >UL?; A"8-'(# "a*(a)(!(# %a' -' a'8( %& 0 a 10 UL; N()a: "(# a'8(# %& "(# =a"( '(a" ,-&%&' =a!a "!8&a&')& &')& %!&&') "a*(a)(!(#; Ha*"& 3(' &" +%!3( a3&3a %&" #!8'!!3a%( %& "(# -")a%(# ,&3!3(# %& #- &a&'; S!8'!!3a%( %& "(# =a"( a'(a" %& a'<"!#!# %& a!"a#a &' #a'8& L(# '!=&" &"&=a%(# %& a!"a#a ,-&%&' (3-! %&*!%( a: •
Pa'3&a)!)!# a8-%a
•
C<'3& %&" ,<'3&a#$ (=a!(# ( ,-"('
•
C("&3!#)!)!#
•
A)a-& %& "a =3-"a *!"!a 3a-#a%( ,( &'&&%a%
•
Ga#)(&')&!)!# >8a=&?
•
I'&33!4' %& "a# 8"<'%-"a# #a"!=a" >3(( ,a,&a#? ( -'a (*#)-33!4'
•
O3"-#!4' !'))!'a"
•
Ma3(a!"a#&!a
•
O*#)-33!4' %& "a# =a# *!"!a ( ,a'3&<)!3a#
•
Ú"3&a ,&(a%a
•
E*aa.( &3)4,!3( >,-&%& (,&#&?
La %!#!'-3!4' %& "(# '!=&" %& a!"a#a ,-&%& (3-! %&*!%( a: •
C<'3& ,a'3&<)!3(
•
DaK( a" ,<'3&a#
•
N&(,a)a
•
T(&!a %&" &*aa.(
C-<" #(' "(# !(# La# =&'a# 9 "a# a)&!a# =aa' &' )aaK( %& -' ,a3!&')& a ()( 9 %& -' "a%( %&" 3-&,( a ()( ,( )a a.4'$ ,-&%& #& <# %!3!" (*)&'& -'a -)a %& #a'8& %& a"8-'a# ,&#('a# -& %& ()a#; O)(# !(# a#(3!a%(# 3(' "a &)a33!4' %& #a'8& #(' "&=$ ,&( ,-&%&' #&: •
Sa'8a%( &3!=(;
•
Da9( ( #&'#a3!4' %& a&(;
•
H&a)(a >a3--"a3!4' %& #a'8& %&*a( %& "a ,!&"?;
•
I'&33!4' >-' !( "&=& 3a%a =&. -& #& ,&')a -,)-a %& "a ,!&"?;
A#i!asa en rina Amilasa en orina -' a'<"!#!# %& (!'a -& !%& "a 3a')!%a% %& a!"a#a$ 9
-'a &'.!a -& a9-%a a %!8&! 3a*(/!%a)(#$ 9 ,(%-3!%a ,!'3!,a"&')& &' &" ,<'3&a# 9 &' "a# 8"<'%-"a# -& ,(%-3&' "a #a"!=a;
La a!"a#a )a*!+' #& ,-&%& &%! 3(' -' a'<"!#!# %& #a'8&; F(a &' -& #& &a"!.a &" a'<"!#!# S& '&3!)a -'a -)a %& (!'a; E" &a&' #& ,-&%& &a"!.a -#a'%( -'a #("a -)a %& (!'a ( -'a &3("&33!4' %& (!'a %-a')& 2 /(a#; Paa (*)&'& a9( !'(a3!4' #(*& "a (a %& &3(8& "a -)a %& (!'a$ =& "(# a)3-"(#: A'<"!#!# %& (!'a >-)a "!,!a? R&3("&33!4' %& (!'a &' 2 /(a# P&,aa3!4' ,aa &" a'<"!#!# E" +%!3( ,&3!a"!#)a ,-&%& #("!3!)a"& -& %&& %& )(a a"8-'(#
• •
&%!3a&')(# -& ,-&%&' a&3)a "(# -")a%(# %&" &a&'; E')& "(# &%!3a&')(# -& ,-&%&' a-&')a "(# '!=&" %& a!"a#a #& &'3-&')a': A#,aa8!'a#a 3!%( a3&)!"#a"!3"!3( > A#,!!'a? P"%(a# a')!3('3&,)!=a# F<a3(# 3("!'+8!3(# C(%&'a C()!3(#)&(!% I'%(&)a3!'a D!-+)!3(# )!a.%!3(# 9 %& a#a M&)!"%(,a M(!'a P&')a.(3!'a L( -& #& #!&')& %-a')& &" a'<"!#!# E" &a&' #4"( &-!&& -'a !33!4' '(a" 9 '( ,(%-3& '!'8-'a (")!a; Ra.(' ,( "a# -& #& &a"!.a &" a'<"!#!# E#)& &a&' #& /a3& ,aa %!a8'(#)!3a ,a'3&a)!)!# 9 ()a# &'&&%a% -&
• • • • • • • • • • •
a&3)a' &" ,<'3&a#; E" +%!3( )a*!+' ,-&%& ,&%!"( ,aa =& 34( )< -'3!('a'%( &" )a)a!&')( ,aa )a# &'&&%a% L(# =a"( '(a" %& a'<"!#!# %& a!"a#a &' (!'a E" a'8( '(a" %& 2;6 a 21;2 -'!%a% !')&'a3!('a" ,( /(a >UI/?; L(# a'8(# %& "(# =a"( '(a" ,-&%&' =a!a "!8&a&')& &')& %!&&') "a*(a)(!(#; Ha*"& 3(' &" +%!3( a3&3a %&" #!8'!!3a%( %& "(# -")a%(# ,&3!3(# %& #- &a&'; S!8'!!3a%( %& "(# =a"( a'(a" %& a'<"!#!# %& a!"a#a &' (!'a U' !'3&&')( &' "a 3a')!%a% %& a!"a#a &' "a (!'a #& %&'(!'a a!"a#-!a 9 ,-&%& #& -' #!8'( %&: Pa'3&a)!)!# a8-%a C('#-( %& a"3(/(" C<'3& %& ,<'3&a#$ (=a!(# ( ,-"(' C("&3!#)!)!#
• • • •
• • •
E*aa.( )-*<!3( &3)4,!3( ( 3(' -,)-a C("&3!#)(,a)a I'&33!4' %& "a# 8"<'%-"a# #a"!=a" >%&'(!'a%a #!a"(a%&'!)!# ,-&%& #&
3a-#a%a ,( ,a,&a# ( -'a (*#)-33!4'? O3"-#!4' !'))!'a" O*#)-33!4' %&" 3('%-3)( ,a'3&<)!3( E'&&%a% !'"aa)(!a ,+"=!3a Ú"3&a ,+,)!3a La %!#!'-3!4' %& "(# '!=&" %& a!"a#a ,-&%& %&*&#& a: DaK( a" ,<'3&a# E'&&%a% &'a" C<'3& ,a'3&<)!3( T(&!a %&" &*aa.( C-<" #(' "(# !(# N( /a9 !(#;
• • • •
• • • •
III.
IV.
MATERIALES 6 REACTIVOS2 -
E#,&3)(()4&)(; M!3(,!,&)a# 9 ,!,&)a# 3a,a3 %& &%! "(# =("&' !'%!3a%(#; T-*(# %& &'#a9( 9 3-*&)a# %& "&3)-a; BaK( aa a @C; R&"( %& !')&=a"(#; S-*#)a)(: #("-3!4' %& a"!%4' 00 8"$ )a,('a%a a ,H @ 3(' *-&
-
(#a)( 0;1 ("" &' NaC" 0;1 (""; R&a3)!=( %& 9(%(: #("-3!4' 0;01 &" %& 9(%( &' HC" 0;02 ("";
PARTE EHPERIMENTAL2 P!&($ #& ,&,aa(' "(# #!8-!&') )-*(#:
S-#)a)(
C(')("
M-)a
1 "
1 "
D,-+#$ %&a(# -'(# !'-)(# &' *aK( %& a8-a a @C 9 a8&8a(#: M-)a
555
20 -L
L-&8($ !'3-*a(# a @C; A "(# 0 &a3)(# 9 a8&8a(#: R&a3)!=( %& 9(%(
1 "
1 "
M&.3"a(# ,( a8!)a3!4' #-a=&; R&)!a(# "(# )-*(# %&" *aK( 9 a8&8a: A8-a %)!"a%a
"
"
M&.3"a(# ,( !'=&#!4'; F!'a"&')&$ "&&(# &' ,&3)(()4&)( a 0 '$ ""&=a'%( a 3&( &" a,aa)( 3(' a8-a %)!"a%a; L&&(# =&3 3(' !')&=a"( %& -' !'-)( A*# 0 A*# 1 A*# 2 A*# A*#
V.
RESULTADOS2 a*#(*a'3!a# 2 V' #-&( ,"a#a W 0 -"
Pr 8r#u!a -a!!are#s !s resu!tads A#i!asa UA3d! ; A"s. Cntr! A"s. Muestra < : A"s. Cntr! A*#;0 0;6
0;0
A*#;1 0;00
0;01 0;12 0;00@ 2 .K
A*#;2 0;1
0;02@
A*#; 0; A*#; 0;
0;00
VI.
CUESTIONARIO2 :. E<)!i'ue c se )rduce !a acti%aci&n de !as en,i#as )rducidas )r e! )0ncreas e<crinG E!#)&' ) )-"(# *<#!3(# ,aa "a #&3&3!4' ,a'3&<)!3a: O)( a,a)a%( a %)a3a "a &8-"a3!4' %& "a# #&3&3!(' ,a'3&<)!3a#$ "a# 3-a" #& &a"!.a' &%!a')& "a #&3&3!4' %& a3&)!"3("!'a$ "a 3-a" "!*&a%a ,( "a# )&!'a3!(' '&=!(#a# ,aa#!,<)!3a# %&" =a8($ La 3("&3!#)(-!'!'a >-' ,("!,+,)!%( %& a!'(<3!%(# 8&'&a%( ,( ()( 8-,( %!#)!')( %& 3+"-"a# %& "a -3(#a %&" %-(%&'( 9 "a ,a)& ,(!a" %&" 9&9-'($ ""aa%( 3&"-"a# I? -& #&3&)a%a ,( "a -3(#a %&" %-(%&'( 9 "a# ,!&a# ,(3!(' %&" 9&9-'( 3-a'%( "(# a"!&')(# ,&'&)a' &' &" !'))!'( %&"8a%($ 9 "a #&3&)!'a >,("!,+,)!%( (a%( ,( 2@ a!'(<3!%(# -& #& &'3-&')a &' "a# ""aa%a# 3+"-"a# S %& "a -3(#a %&" %-(%&'( 9 9&9-'( &' -'a (a !'a3)!=a$ "a ,(#&3&)!'a? #&3&)a%a ,( "a !#a -3(#a %-(%&'a" 9 9&9-'a" 3-a'%( ""&8a' "(# a"!&')(# -9 <3!%(# a" !'))!'( %&"8a%(; La# %(# ,!&a# #-#)a'3!a#$ a3&)!"3("!'a 9 3("&3!#)(3!'!'a$ )!-"a' a "a# 3+"-"a# a3!'a %&" ,<'3&a# 9 a=(&3&' "a ,(%-33!4' %& 8a'% 3a')!%a% %& &'.!a# ,a'3&<)!3a# %!8)!=a# 3(' a%!3!(' &"a)!=a&')& a#a# %& "-!%( a#(3!a%(; S!' a8-a$ "a a9(a %& "a# &'.!a# -&%a )&,(a"&')& a"a3&'a%a &' "(# <3!'(# 9 3('%-3)(# /a#)a -& -'a 3a')!%a% a9( %& #&3&3!4' "-!%a "a# aa#)a /a3!a &" %-(%&'(; La #&3&)!'a )!-"a "a #&3&3!4' %& #("-3!4' a3-(#a %& *!3a*('a)( #4%!3( ,( &" &,!)&"!( ,a'3&<)!3( %-3)a"; La #&3&3!4' ,a'3&<)!3a #-3&%& &' ) a#$ "a# !#a# -& "a# %& "a #&3&3!4' 8<#)!3a$ "a# 3-a" #(' a#& 3&<"!3a$ 8<#)!3a & !'))!'a"; C-a'%( &" -!( <3!%($ 3(' -' ,H !'&!( a $ ( $ ,&'&)a &' &" %-(%&'( ,(3&%&')& %&" )4a8($ ,(=(3a "a "!*&a3!4' &' "a -3(#a %-(%&'a" 9 "a a3)!=a3!4' %& #&3&)!'a$ -& ,a#a a "a #a'8&; La #&3&)!'a$ a #- =&.$ )!-"a a" ,<'3&a# a #&3&)a -'a 8a' 3a')!%a% %& "-!%( 3(' -3/(# !(' *!3a*('a)(; E" &3a'!#( %& "a #&3&)!'a !,()a')& ,( %(# a.(': "a ,!&a -& "a #&3&)!'a 3(!&'.a a
#&3&)a#& &' "a -3(#a %&" !'))!'( %&"8a%( 3-a'%( &" ,H %&" 3(')&'!%( %-(%&'a" %!&'%& ,( %&*a( %& $ ( 9 #- "!*&a3!4' a-&')a -3/( 3-a'%( &" ,H 3a& a ; E""( /a3& -& &" ,<'3&a# #&3&)& %& !'&%!a)( 8a'% 3a')!%a% %& -8( 3(' a*-'%a')& *!3a*('a)( #4%!3(; La #&3&3!4' %& !(' *!3a*('a)( ,( &" ,<'3&a# ,(,(3!('a -' ,H a%&3-a%( ,aa "a a33!4' %& "a# &'.!a# %!8)!=a# ,a'3&<)!3a#$ %('%& #-'3!4' 4,)!a (3-& &' "(# &%!(# '&-)(# ( "&=&&')& a"3a"!'(#$ 3(' ,H %& @ a ; E" ,H %& "a #&3&3!4' %& *!3a*('a)( #4%!3( $ ,( )+!'( &%!($ %& ;
>. En una )ancreatitis 'u i#)rtancia tiene e! dsae de !as en,i#as2 !i)asa$ tri)sina$ e!astasa + 8s8!i)asa A>G A#i!asa tta! La 3('3&')a3!4' #+!3a %& a!"a#a #& -#a %& (a 8&'&a"!.a%a 3((
•
,-&*a %& %&)&33!4' #!#)&<)!3a ,aa "a ,a'3&a)!)!# a8-%a &' &" ,a3!&')& •
3(' %("( a*%(!'a" a8-%( ( &" %("( %& ,a"%a A,(!a%a&')&$ &" %& "(# ,a3!&') 3(' ,a'3&a)!)!# a8-%a ,&')a' -' a-&')( %& "a a!"a#a #+!3a; La a!"a#a #+!3a #-&"& a-&')a &' "a ,!&a# 2/# %&" ,(3( 9 ,&a'&3& &"&=a%a %-a')& 1 a %a#; La# 3!a# &)('a' a "a '(a"!%a% &' a %a#$ #a"=( &' &" 3a#( -& &!#)a '&3(#!# ,a'3&<)!3a &)&'#a$ (*#)-33!4' !'3(,"&)a %& "(# 3('%-3)(# ( (a3!4' %& ,#&-%(-!#) P( )& ()!=( ##&'#!*!"!%a% 3a& a =a"( %&" 0 a ,a)! %& "a# /# %& !'!3!( %&" %("(
•
a*%(!'a" U' =a"( a9( a 6UIL /a< 3-)!('a*"& -'a ,a'3&a)!)!# a8-%a -'a 3('3&')a3!4' a9( a 10UIL /a3& <# ,(*a*"& &" %!a8'4#)!3( 9 =a"( =&3 a9( %& "( '(a" "( )a*"&3&'$ #!&,& -& #& /a9a &3"-!%( ()(# ,(3(# -& &"&=a' "a a!"a#a; A%&<# %&" ,<'3&a# #(' =a!(# "(# 48a'(# 3a,a3 %& ,(%-3! a!"a#a: "a# 8"<'%-"a# #a"!=a"$ "a# )(,a# %& Fa"(,!($ "(# (=a!(#$ &" !'))!'( %&"8a%($ &" ,-"4'$ "a ,4#)a)a 9 &" /8a%(; S!' &*a8( &' "a ,<3)!3a$ 9 &' 3('%!3!(' '(a"$ #("( &" ,<'3&a# 9 "a# 8"<'%-"a# #a"!=a" 3(')!*-9&' &' (a #!8'!!3a)!=a a" a')&'!!&')( %& "(# '!=&" #+!3(#
%& )a &'.!a; L(# =a"( %& "a a!"a#a &' #-&( #(' %& -)!"!%a% #("( ,aa &" %!a8'4#)!3($ '( 8-a%a' 3(&"a3!4' 3(' "a #&=&!%a% %&" 3-a%($ •
,( "( )a')( '( )!&'&' =a"( ,('4#)!3(; >5@? S- #&'#!*!"!%a% %&" $ #- ,&3!!3!%a% %&" 9 #- =a"(
,&%!3)!=( ,(#!)!=( %&" 6; La# #!8-!&') #(' #!)-a3!(' -& ,-&%&' 8&'&a a"#(# '&8a)!=(#: a? S! #& &)a#a >%& 2 a %a#? "a (*)&'3!4' %& "a -)a %& #a'8&; *? S! &" )a#)('( #-*9a3&')& -'a ,a'3&a)!)!# 34'!3a &' =&. %& -'a ,a'3&a)!)!# a8-%a; 3? P&'3!a %& /!,&)!8"!3&!%&!a; Li)asa E# "a #&8-'%a %&)&!'a3!4' <# &3-&')&&')& -)!"!.a%a &' &" %!a8'4#)!3( %& "a ,a'3&a)!)!# a8-%a; La "!,a#&!a )!&'& "a =&')aa %& -& '( #& &"&=a &' a"8-'a# #!)-a3!(' -& #(' 3a-#a %& a"#(# ,(#!)!=(# %& "a a!"a#a$ #!' &*a8( a3(,aKa a "a a!"a#a &' "(# a"#(# ,(#!)!=(# #&3-'%a!(# a ,a)("(8a *!"!a a8-%a$ "3&a ,&(a%a$ (*#)-33!4' !'))!'a"$ )(*(#!# &')+!3a 9 a,&'%!3!)!# a8-%a; La a3)!=!%a% %& "a "!,a#a #+!3a a-&')a %& (a ,aa"&"a a "a %& "a a!"a#a$ 9 "a %&)&!'a3!4' %& a*a# &'.!a# a-&')a &" &'%!!&')( %!a8'4#)!3(; L(# '!=&" %& "!,a#a ,-&%&' ,&a'&3& &"&=a%(# %& @ a 1 %a#; La "!,a#a ,-&%& #& a/(a "a &'.!a <# !'%!3a%a ,aa )a*"&3& -' %!a8'4#)!3( %& ,a'3&a)!)!# a8-%a; L(# a=a'3 &' "(# #-#)a)(# 9 "a )&3'("(8a (&3&' a" +%!3( &( (,3!('$ ,&3!a"&')& 3-a'%( #& &3-& a -' a'<"!#!# )-*!%(+)!3(; L(# '-&=(# a'<"!#!# %& "!,a#a -)!"!.a' 3("!,a#a 3(( 3(a3)( 9 )<' )()a"&')& a-)(a)!.a%(# S- #&'#!*!"!%a% %& $ #- ,&3!!3!%a% %&" 6 9 #- =a"( ,&%!3)!=( ,(#!)!=( %&" 6;L(# =a"( &"&=a%(# %& "!,a#a 9 %& )!,#!'a #+!3a #-&"&' #& %!a8'4#)!3(# %& ,a'3&a)!)!# a8-%a )a# ,-&*a# #(' ,&3!a"&')& )!" &' "(# ,a3!&') 3(' /!,&a!"a#&!a %& (!8&' '( ,a'3&<)!3( Isa#i!asas O)a ,(#!*!"!%a% a33!('a "a a!"a#a &' #-# !#(&'.!a# #a"!=a>#? 9
•
,a'3&<)!3a >,?; La !'/!*!3!4' %& "a !.(&'.!a )!,( S$ ,( -' %(*"& a')!3-&,( ('(3"('a"$ -' +)(%( #&'3!""( 9 <,!%( -& ,&!)& -.8a "a &"&=a3!4' a!#"a%a %& "a &'.!a %& (!8&' ,a'3&<)!3($ &=!)a'%( a# "a 3('-#!4' 3(' /!,&a!"a#&!a# &)a,a'3&<)!3a#;
•
Ha9 -& )&'& &' 3-&')a -& "a %&)&!'a3!4' %& "a !#(a!"a#a '( ,&!)& %!&&'3!a "a# 3a-#a# !'))!'a" %& /!,&a!"a#&!a; E#)( #& %&*& a "a a-#&'3!a %& "a !#(a!"a#a S ,( %&*a( %&" A'8-"( %& )&!).$ %& a'&a -& 3-a"-!& /!,&a!"a#&!a %& (!8&' !'))!'a" #& %&*&
•
(.(#a&')& a -'a &"&=a3!4' a!#"a%a %& "a !#(a!"a#a P; E' &" #-&( '(a" &" a" %& "a a!"a#a %& (!8&' ,a'3&<)!3(; E' "(# 3a#(# %& ,a'3&a)!)!# a8-%a$ "a a!"a#a #+!3a )()a" =-&"=& a "a '(a"!%a% <# <,!%a&')& -& "a !#(a!"a#a ,a'3&<)!3a$ )a ")!a ,-&%& ,&a'&3& &"&=a%a %& @ a 1 %a#; C(' ,&3)( a )a ,-&*a a"8-'(# a-)( a%=!&)&' -& '( #-&"&' #& !a*" 3-a'%( /a9 -' a-&')( '!( ( (%&a%( %& "a a!"a#a )()a" &' )(# 3a#(# -")a
•
)!" &3-! a -' a'<"!#!# %&" )!,#!'48&'( #+!3(; Fa33!('a!&')(# <# !'(# %& "a# !#(&'.!a# ,a'3&<)!3a#$ 3(( ,-&%& #& "a %&)&!'a3!4' %& "a #-*a33!4' P$ 3aa3)&#)!3a %& "a ,a'3&a)!)!#
a8-%a$ #(' %& a#a -)!"!%a% &' "a -)!'a ,( #- 3(,"&!%a%; A#i!asuria + tasa de ac!araci&n de A#i!asa3Creatinina E# ,(#!*"& %&)&!'a &'.!a# &' (!'a$ #(*& )(%( a!"a#a$ )a')( &' -)a# %& 2/# 3(( &' "a# &3(8!%a# %& (a a!#"a%a$ !'3"-9&'%( #&'3!""a# ,-&*a# <,!%a# 3-a"!)a)!=a#; E#)a# %&)&!'a3!(' '( #-&"&' #& %& &"&33!4'$ 9a -& &" ,&!" #!')(<)!3( %&" ,a3!&')& 3(' ,a'3&a)!)!# -#)!!3a "a (*)&'3!4' %& -)a# #+!3a#; P( ()( "a%( )a')( "a a!"a#a -!'a!a 3(( "a )a#a %& a3"aa3!4' %& a!"a#a3&a)!'!'a$ '( #-,&a' &' #&'#!*!"!%a% '! &' ,&3!!3!%a% "a %&)&!'a3!4' %& "(# '!=&" #a'8-'&(# %& a!"a#a; S!' &*a8($ &' (3a#!(' ,(#!*"& %&)&3)a '!=&" -!'a!(# %& a!"a#a &"&=a%a# %-a')& a"8( <# %& -' )!&,( -& &' #a'8&$ 9a -& &' a"8-'(# 3a#(# "a &"&=a3!4' %& a!"a#a #+!3a ,-&%& #& -8a. Otrs Ta')( "a (#("!,a#a A2$ 3(( "a )!,#!'a !'-'(&a3)!=a 9 "a &"a#)a#a515 ,a'3&<)!3a &-!&&' 3(,"&a# %&)&!'a3!('$ 9 ,( &'%& #- -)!"!%a% ,<3)!3a &' "a ,a)("(8a %& -8&'3!a# "!!)a%a;
?. E<)!i'ue c se )rduce !a digesti&n c#)!eta de! a!#id&n en nuestr tu" digesti%G La DIGESTIÓN UMICA %&" A"!%4' #& ,(%-3& &' 2 Ó8a'(# %&" #!#)&a %!8)!=(:
15 E' "a BOCA &%!a')& "a I'#a"!=a3!4'$ "a #a"!=a 3(')!&'& -'a 1 &'.!a %!8)!=a ""aa%a P)!a"!'a ( A!"a#a #a"!=a" -& 3(!&'.a 3(' "a %&8a%a3!4' ,!a!a %&" A"!%4' &' a")(#a >D!#a3<!%(?; 25 La 2 %!8)!4' -!3a %&" A"!%4' #& &a"!.a &' "a AMPOLLA %& VATER %&" D-(%&'( >1 ,(3!4' %&" !'))!'( %&"8a%(?$ ,aa &""( "a# &'.!a# A!"a#a ,a'3&<)!3a #!')&)!.a%a ,( "a ,(3!4' &43!'a %&" ,<'3&a# 9 "a A!"a#a !'))!'a" #!')&)!.a%a ,( "a# 8"<'%-"a# !'))!'a" )&!'a' ,( %%(*"a -!3a&')& a" A"!%4' &' Ma")(#a >%!#a3<!%(?$ "-&8( "a &'.!a Ma")a#a #!')&)!.a%a &' "a# 8"<'%-"a# !'))!'a" %&" D-(%&'( %%(*"a' a "a a")(#a &' 2 ("+3-"a# %& a"a 8"-3(#a )&!'a'%( "a %!8)!4' -!3a %&" A"!%4' &' M('(#a3<!%(# - O#a# #!,">G"-3(#a?; E" a"!%4' >P("!#a3<!%( &=a')&? )a#'(a%( -!3a&')& &' "a B(3a &%!a')& "a I'#a"!=a3!4' &' Ma")(#a >1 %!8)!4' -!3a?$ ,aa ,(#)&!(&')& )&!'a %& %%(*"a#& -!3a&')& &' &" D-(%&'( >1 ,(3!4' %&" !'))!'( %&"8a%(? &' G"-3(#a 8a3!a# a "a# &'.!a# A!"a#a ,a'3&<)!3a ,(=&'!&')& %&" P<'3&a#$ "a A!"a#a !'))!'a" ,(=&'!&')& %& "a# G"<'%-"a# !'))!'a" 9 "a Ma")a#a ,(=&'!&')& %& "a# 8"<'%-"a# !'))!'a" -& )&!'a' ,( %%(*"a a" A"!%4' &' Ma")(#a 9 )< &' 2 ("+3-"a# %& a"a 8"-3(#a;
@. Cu0! es e! cuadr c!9nic de una )ancreatitis agudaG La ,a'3&a)!)!# a8-%a >PA? -' ,(3( !'"aa)(!( %&" ,<'3&a# 3aa3)&!.a%( 3"'!3a&')& ,( -' %("( a*%(!'a" 9 &"&=a3!4' %& "a# &'.!a# ,a'3&<)!3a# &' "a #a'8&; E" 3-a%( 3"'!3( ,-&%& #& -9 =a!a*"& a*a3a'%( %%& -' 3-a%( "&=& >PAL? %& <,!%a 3-a3!4' 9 &3&"&')& &=("-3!4' /a#)a -'a ,a'3&a)!)!# 8a=& >PAG? 3(' "a ,&'3!a %& '&3(#!# -& ,-%!&a ,&')a#& 3(' #&,#!#$ #'%(& %& %!#) ,!a)(!($ a3a#( &'a"$ a""( -")!(8<'!3( 9 !'a"&')& "a -&)& %&" ,a3!&')&; L(# #')(a# &'3(')a%(# 8&'&a"&')& #(' %("( a*%(!'a" )a'#"!3)!=( a "a ,a"%a$ %!#)&'#!4'$ )a-!3a%!a$ !&*&$ a#a ,a",a*"& &' &,!8a#)!( ( /!,()&'#!4' &)3; A%&<# %&" 3-a%( 3"'!3( "a a!"a#&!a$ #& &"&=a !'&%!a)a&')& ,aa %!#!'-! a" )&3& %a (&')( &' &" 3-a" #& &"&=a &' (!'a
>a!"a#-!a?; E#)a &'.!a -9 #&'#!*"& ,&( -9 !',&3!3a 9a -& /a#)a 1 %& ,a3!&') 3(' a*%(&' a8-%( ,&')a' -'a &"&=a3!4' %& "a !#a &' a-#&'3!a %& -'a ,a'3&a)!)!# a8-%a >a"#(# ,(#!)!=(#?; E#)a '( )!&'& =a"( &' &" ,('4#)!3( %& "a PA 9 '( %&*& #& #("!3!)a%a "-&8( %& )a*"&3!%( &" %!a8'(#)!3($ &3&,)( 3-a'%( #& #(#,&3/& %& -'a &3!%!=a %& "a &'&&%a%; E# !,()a')& #&Ka"a -& &!#)&' ()a# &'&&%a% -& ,(%a' #!-"a -'a PA )&'!&'%( #!&,& -& %a)a -'a 3("&3!#)!)!# a8-%a$ (*#)-33!4' !'))!'a" ( ,&(a3!4' %& =!#&a /-&3a a') %& &)!-&)a a -' ,a3!&')& 3(' PA 9a -& )(# #(' 3-a%( -!8!3(# %& &&8&'3!a a %!&&'3!a %& "a PA; E" ,(*"&a '( %!a8'4#)!3( &' "a ,a'3&a)!)!# a8-%a$ '! #- 3('!a3!4'$ '! #- &)!("(8a$ "( 3(,"!3a%( "a !%&')!!3a3!4' 9 )a)!!3a3!4' <,!%a 9 &&3)!=a %& "a# (a# "&= 9 8a=$ a# 3(( "(# 8-,(# ,('4#)!3(# %%& &" ,!& (&')( %&" !'8( 9a -& &" )a)a!&')( %& -'a (a "&=a =a!a )&&'%a&')& a" %& -'a (a 8a=&$ #!&'%( -'a %& "a# &%!%a# <# !,()a') "-&8( %&" %!a8'4#)!3($ &" )a*"&3& #! -'a (a "&=& ( 8a=& ,aa ,(%& ,(3&%& "( <# <,!%a&')& ,(#!*"& a !'%!3a "a# &%!%a# '&3a!a# a )(a;
. u trs e<0#enes au3(' &3-&')( %& "a# 3+"-"a# %& "a #&!& *"a'3a? E#)-%!( &)a*4"!3( 3(' &%!%a %& *!"!-*!'a 9 ,-&*a# %& -'3!4' • •
/&,<)!3a G"-3(#a Ca"3!( Ma8'!( P()&'a C &a3)!=a >,aa &=a"-a !'"aa3!4'? O)a# ,-&*a# %!a8'4#)!3a# >a&'a# a" "a*(a)(!(? E3(8aa a*%(!'a" CPRE >3("a'8!(,a'3&a)(8aa &)48a%a &'%(#34,!3a? 5 ,-&*a -& • • • •
• •
-)!"!.a -' )-*( "&!*"& !')(%-3!%( ,( "a *(3a /a3!a &" a8( 9 &" )4a8($ a"3a'.a'%( &" ,<'3&a#$ ,aa (*#&=a 9 &' a"8-'a#