Esophageal tumors are relatively rare. They present with typical symptoms in patients that consume spicy food, alcohol, enjoy cigarette smoking, and after alkaline solution ingestion. Considering their accessibility, they can be diagnosed in early stages. In recent years, the incidence of adenocarcinoma has increased in comparison to squamous cell carcinoma. This surge in the incidence is associated with gastroesophageal reflux disease and Barrett’s esophagus. Using better algorithms in the diagnosis and follow up of patients at risk, in the years to come we should diagnose patients at earlier stages of the disease.
{"title":"[ESOPHAGEAL TUMORS IN FAMILY PHYSICIAN PRACT].","authors":"A Amerl Šakić, I Balint","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Esophageal tumors are relatively rare. They present with typical symptoms in patients that consume spicy food, alcohol, enjoy\u0000cigarette smoking, and after alkaline solution ingestion. Considering their accessibility, they can be diagnosed in early stages.\u0000In recent years, the incidence of adenocarcinoma has increased in comparison to squamous cell carcinoma. This surge in the\u0000incidence is associated with gastroesophageal reflux disease and Barrett’s esophagus. Using better algorithms in the diagnosis\u0000and follow up of patients at risk, in the years to come we should diagnose patients at earlier stages of the disease.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35555220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatocellular carcinoma (HCC) is the most common malignancy of the liver, the sixth most common cause of cancer and the third leading cause of cancer-related deaths worldwide. Its incidence has increased dramatically throughout the world mainly driven by the increasing numbers of persons with long-standing chronic hepatitis C virus (HCV) infection who develop cirrhosis. Although 90% of HCV-associated HCC cases occur concurrently with cirrhosis, 30% to 50% of liver cancers associated with chronic HBV occur in the absence of cirrhosis. Since most people with chronic hepatitis are asymptomatic until cirrhosis or HCC is established, initial diagnosis and management of chronic hepatitis rely on primary care physicians to identify and screen high-risk individuals. Studies show that family physicians have inadequate knowledge about screening and counseling for chronic hepatitis and HCC. There is evidence of advances in surgical and nonsurgical therapies in the treatment of HCC, thus different associations have updated their recommendations following these clinical and scientific advances. The aim of this review is to make family physicians familiar with novelties in identifying high-risk patients, implementing an appropriate screening strategy, diagnosis and treatment, and to assist them in the decision-making process according to evidence based data.
{"title":"[HEPATOCELLULAR CARCINOMA – NEWS IN DIAGNOSIS, FOLLOW UP AND TREATMENT AND ROLE OF FAMILY PHYSICIAN].","authors":"V Bralić Lang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is the most common malignancy of the liver, the sixth most common cause of cancer and the\u0000third leading cause of cancer-related deaths worldwide. Its incidence has increased dramatically throughout the world mainly\u0000driven by the increasing numbers of persons with long-standing chronic hepatitis C virus (HCV) infection who develop cirrhosis.\u0000Although 90% of HCV-associated HCC cases occur concurrently with cirrhosis, 30% to 50% of liver cancers associated with\u0000chronic HBV occur in the absence of cirrhosis. Since most people with chronic hepatitis are asymptomatic until cirrhosis or HCC\u0000is established, initial diagnosis and management of chronic hepatitis rely on primary care physicians to identify and screen high-risk\u0000individuals. Studies show that family physicians have inadequate knowledge about screening and counseling for chronic\u0000hepatitis and HCC. There is evidence of advances in surgical and nonsurgical therapies in the treatment of HCC, thus different\u0000associations have updated their recommendations following these clinical and scientific advances. The aim of this review is to\u0000make family physicians familiar with novelties in identifying high-risk patients, implementing an appropriate screening strategy,\u0000diagnosis and treatment, and to assist them in the decision-making process according to evidence based data.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35650207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastric cancer is the second most common cause of cancer-related death in the world. Gastric cancer mostly affects older people. The incidence increases with age and more than 75% of people are older than 50 years. Due to the relatively late detection, long-term survival is poor, except for patients with localized disease and it remains difficult to cure. There are many known risk factors for stomach cancer, but it is not known exactly how these factors cause cells of the stomach lining to become cancerous. But it is known that a certain kind of diet can contribute to its development such as a diet high in salty and smoked foods and low in fruits and vegetables. Long-term infection with H. pylori increases the risk of gastric cancer and the World Health Organization declared H. pylori as carcinogenic for some types of the gastric cancers. About 90% to 95% of cancers of the stomach are adenocarcinomas, the others are Lymphomas, Gastrointestinal stromal tumor (GIST) and MALT lymphoma. Early gastric cancer has no associated symptoms; however, some patients complain of indigestion, nausea or vomiting, dysphagia or postprandial fullness. When there is a suspicion of the gastric it is necessary to do an endoscopy with multiple biopsies. Many treatments may be used such as surgery, radiation therapy, chemotherapy, targeted drugs or a combination of these methods, and the choice depends on the stage of the disease and the condition of the patient. Family physician should determine all patients who are at increased risk and regularly control them.
{"title":"[GASTRIC CANCER IN THE PRACTICE OF FAMILY PHYSICIAN].","authors":"K Kranjčević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastric cancer is the second most common cause of cancer-related death in the world. Gastric cancer mostly affects older people.\u0000The incidence increases with age and more than 75% of people are older than 50 years. Due to the relatively late detection,\u0000long-term survival is poor, except for patients with localized disease and it remains difficult to cure. There are many known risk\u0000factors for stomach cancer, but it is not known exactly how these factors cause cells of the stomach lining to become cancerous.\u0000But it is known that a certain kind of diet can contribute to its development such as a diet high in salty and smoked foods and\u0000low in fruits and vegetables. Long-term infection with H. pylori increases the risk of gastric cancer and the World Health Organization\u0000declared H. pylori as carcinogenic for some types of the gastric cancers. About 90% to 95% of cancers of the stomach are\u0000adenocarcinomas, the others are Lymphomas, Gastrointestinal stromal tumor (GIST) and MALT lymphoma. Early gastric cancer\u0000has no associated symptoms; however, some patients complain of indigestion, nausea or vomiting, dysphagia or postprandial\u0000fullness. When there is a suspicion of the gastric it is necessary to do an endoscopy with multiple biopsies. Many treatments may\u0000be used such as surgery, radiation therapy, chemotherapy, targeted drugs or a combination of these methods, and the choice\u0000depends on the stage of the disease and the condition of the patient. Family physician should determine all patients who are at\u0000increased risk and regularly control them.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35650208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specific for nutritional status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications. The electronic databases were searched using defined key words adapted to each database and using MESH terms. Manual revision of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community: Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk. MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and continuous validation in the study with a higher level of evidence need to be conducted in family medicine.
{"title":"[SCREENING OF NUTRITIONAL STATUS AMONG ELDERLY PEOPLE AT FAMILY MEDICINE].","authors":"M Račić, N Ivković, S Kusmuk","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening\u0000or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specific for nutritional\u0000status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting\u0000Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed\u0000and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications.\u0000The electronic databases were searched using defined key words adapted to each database and using MESH terms. Manual revision\u0000of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and\u0000validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing\u0000for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short\u0000Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community:\u0000Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk\u0000Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening\u0000of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several\u0000tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk.\u0000MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and\u0000the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and\u0000are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and\u0000continuous validation in the study with a higher level of evidence need to be conducted in family medicine.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35650210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person and his decision.
{"title":"[PALLIATIVE CARE OF PATIENT WITH GASTROINTESTINAL CANCER IN FAMILY MEDICINE].","authors":"M Katić, Kašuba Lazić, D Soldo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative\u0000care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most\u0000patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician\u0000and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months\u0000of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the\u0000therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer\u0000of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most\u0000common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness\u0000of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival\u0000and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively\u0000treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of\u0000care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner\u0000with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to\u0000the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a\u0000fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients\u0000and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients\u0000with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person\u0000and his decision.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35504740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I Diminić-Lisica, B Bergman Marković, L Bukmir, N Bašić Marković, N Radošević Quadranti, I Lisica
Dyspepsia is a common symptom among patients in family medicine practice. The prevalence in adult population is about 40%. Two-thirds of patients have functional dyspepsia. Clinical assessment, diagnostic procedures and treatment of patients depend on the age, symptoms and Helicobacter pylori infection. In patients with dyspepsia, it is necessary to assess the potential impact of other concurrent diseases and medications that the patient regularly uses. Prompt or early endoscopy is recommended in patients with newly detected dyspepsia older than 50 and presenting with alarming symptoms. In persons younger than 50, the recommended strategy is ‘test and treat’. In some patients, treatment is carried out by acid suppression. In patients failing to achieve success in treatment, further endoscopic diagnosis is indicated. Ultrasound diagnostics in primary care can significantly contribute to diagnostic evaluation and early treatment in patients with hepatobiliary and pancreas diseases presenting with symptoms of dyspepsia. Treatment of concurrent mental disorders can improve the symptoms of dyspepsia. Treatment of patients who do not respond to the recommended treatment strategies is a challenge for family physicians. Regular visits and psychotherapeutic support in these patients can reduce the level of anxiety and encourage the patient for treatment of psychological morbidity, as well as his efforts in healthy behavior.
{"title":"[APPROACH TO A PATIENT WITH DYSPEPSIA IN FAMILY MEDICINE PRACTICE].","authors":"I Diminić-Lisica, B Bergman Marković, L Bukmir, N Bašić Marković, N Radošević Quadranti, I Lisica","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dyspepsia is a common symptom among patients in family medicine practice. The prevalence in adult population is about 40%.\u0000Two-thirds of patients have functional dyspepsia. Clinical assessment, diagnostic procedures and treatment of patients depend\u0000on the age, symptoms and Helicobacter pylori infection. In patients with dyspepsia, it is necessary to assess the potential impact\u0000of other concurrent diseases and medications that the patient regularly uses. Prompt or early endoscopy is recommended\u0000in patients with newly detected dyspepsia older than 50 and presenting with alarming symptoms. In persons younger than 50,\u0000the recommended strategy is ‘test and treat’. In some patients, treatment is carried out by acid suppression. In patients failing\u0000to achieve success in treatment, further endoscopic diagnosis is indicated. Ultrasound diagnostics in primary care can significantly\u0000contribute to diagnostic evaluation and early treatment in patients with hepatobiliary and pancreas diseases presenting\u0000with symptoms of dyspepsia. Treatment of concurrent mental disorders can improve the symptoms of dyspepsia. Treatment of\u0000patients who do not respond to the recommended treatment strategies is a challenge for family physicians. Regular visits and\u0000psychotherapeutic support in these patients can reduce the level of anxiety and encourage the patient for treatment of psychological\u0000morbidity, as well as his efforts in healthy behavior.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B Popović, I Sutić, N Skočibušić, A Ljubotina, I Diminić-Lisica, L Bukmir
Cholestasis indicates stagnation of bile, a disorder in the synthesis, secretion and/or outflow of bile. Cholestasis is classified as intrahepatic or extrahepatic. Intrahepatic cholestasis may occur as a result of hepatocellular disorders or due to obstruction of the intrahepatic bile ducts. Extrahepatic cholestasis is caused by obstruction of the bile ducts outside the liver. Cholestasis manifests as acute or chronic (>6 months). Early biochemical markers of cholestasis include increased alkaline phosphatase, γ-glutamyltransferase, and conjugated hyperbilirubinemia. Clinically, the most common presenting symptoms are jaundice, itchy skin and fatigue. A key element in diagnosis is visual presentation of the biliary system. New insights into the pathophysiological mechanisms of cholestasis at the molecular level will contribute to the development of new treatments. Pancreatitis is an inflammatory process in the tissue of the pancreas caused by prematurely activated pancreatic enzymes. The course of acute pancreatitis is in most cases mild, with minimal organ dysfunction and full recovery, while the severe form of the disease is characterized by complications and high mortality. Chronic pancreatitis is characterized by persistent inflammation of the pancreas with permanent damage to glandular tissue in the presence of fibrosis and narrowed pancreatic ducts. Treatment of pancreatitis is supportive and directed to maintaining the basic physiological functions. The role of family physicians is very important in early detection of liver diseases, which can significantly affect the success of treatment and improve the quality of life in these patients.
{"title":"[CHOLESTASIS AND INFLAMMATION OF THE PANCREAS IN FAMILY MEDICINE].","authors":"B Popović, I Sutić, N Skočibušić, A Ljubotina, I Diminić-Lisica, L Bukmir","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cholestasis indicates stagnation of bile, a disorder in the synthesis, secretion and/or outflow of bile. Cholestasis is classified\u0000as intrahepatic or extrahepatic. Intrahepatic cholestasis may occur as a result of hepatocellular disorders or due to obstruction\u0000of the intrahepatic bile ducts. Extrahepatic cholestasis is caused by obstruction of the bile ducts outside the liver. Cholestasis\u0000manifests as acute or chronic (>6 months). Early biochemical markers of cholestasis include increased alkaline phosphatase,\u0000γ-glutamyltransferase, and conjugated hyperbilirubinemia. Clinically, the most common presenting symptoms are jaundice, itchy\u0000skin and fatigue. A key element in diagnosis is visual presentation of the biliary system. New insights into the pathophysiological\u0000mechanisms of cholestasis at the molecular level will contribute to the development of new treatments. Pancreatitis is an\u0000inflammatory process in the tissue of the pancreas caused by prematurely activated pancreatic enzymes. The course of acute\u0000pancreatitis is in most cases mild, with minimal organ dysfunction and full recovery, while the severe form of the disease is characterized\u0000by complications and high mortality. Chronic pancreatitis is characterized by persistent inflammation of the pancreas\u0000with permanent damage to glandular tissue in the presence of fibrosis and narrowed pancreatic ducts. Treatment of pancreatitis\u0000is supportive and directed to maintaining the basic physiological functions. The role of family physicians is very important in early\u0000detection of liver diseases, which can significantly affect the success of treatment and improve the quality of life in these patients.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L Bukmir, H Smokrović, I Diminić-Lisica, A Ljubotina, B Popović
With the increasing prevalence of obesity and metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in adults and children. Despite the increasing prevalence, NAFLD remains largely undiagnosed and untreated in routine medical practice. Most patients with NAFLD have no symptoms, while only a few feel discomfort in the upper right quadrant of the abdomen or increased fatigue. The diagnosis is usually set during abdominal ultrasound examination, which is done for some other reason, or by elevated liver biochemical test findings. Early recognition is very important for correct and successful treatment. In primary health care, little is known about the processes related to the identification, diagnosis and referral of patients to specialists. Differentiation between steatosis and steatohepatitis by assessing the severity of fibrosis within steatohepatitis is extremely important. Histopathologic analysis of tissue obtained by biopsy remains the gold standard in this field. For family physician, guidelines that should be combined can be of great help in treating patients with suspected NAFLD. The serious consequences of late recognition of NAFLD could be reduced by such guidelines. Recent studies have shown that NAFLD is associated with an increased prevalence and incidence of cardiovascular complications. Because of their complexity, hepatic and extrahepatic complications, heterogeneity in clinical presentation, histologic severity, prognosis and therapeutic outcome, NAFLD requires a multidisciplinary approach with the active role of family physicians in preventive care, diagnosis and treatment, especially in individuals and groups at risk. Greater attention should be focused on lifestyle modifications (reduction in body weight and physical activity) and their practical implementation. Key words: non-alcoholic fatty liver disease, liver biopsy
{"title":"[NON-ALCOHOLIC FATTY LIVER DISEASE].","authors":"L Bukmir, H Smokrović, I Diminić-Lisica, A Ljubotina, B Popović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With the increasing prevalence of obesity and metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) has become the\u0000most common liver disease in adults and children. Despite the increasing prevalence, NAFLD remains largely undiagnosed and\u0000untreated in routine medical practice. Most patients with NAFLD have no symptoms, while only a few feel discomfort in the upper\u0000right quadrant of the abdomen or increased fatigue. The diagnosis is usually set during abdominal ultrasound examination,\u0000which is done for some other reason, or by elevated liver biochemical test findings. Early recognition is very important for correct\u0000and successful treatment. In primary health care, little is known about the processes related to the identification, diagnosis and\u0000referral of patients to specialists. Differentiation between steatosis and steatohepatitis by assessing the severity of fibrosis within\u0000steatohepatitis is extremely important. Histopathologic analysis of tissue obtained by biopsy remains the gold standard in this\u0000field. For family physician, guidelines that should be combined can be of great help in treating patients with suspected NAFLD.\u0000The serious consequences of late recognition of NAFLD could be reduced by such guidelines. Recent studies have shown that\u0000NAFLD is associated with an increased prevalence and incidence of cardiovascular complications. Because of their complexity,\u0000hepatic and extrahepatic complications, heterogeneity in clinical presentation, histologic severity, prognosis and therapeutic\u0000outcome, NAFLD requires a multidisciplinary approach with the active role of family physicians in preventive care, diagnosis and\u0000treatment, especially in individuals and groups at risk. Greater attention should be focused on lifestyle modifications (reduction in\u0000body weight and physical activity) and their practical implementation.\u0000Key words: non-alcoholic fatty liver disease, liver biopsy</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The paper gives a short presentation of 40 years of experience of Osijek Health Center family physicians in colorectal cancer (CRC) prevention and early detection. Systematic work in the prevention and early detection of cancer includes raising public awareness and knowledge of healthcare issues, educating health professionals, conducting scientific research and contributing to the development and implementation of the National Program for Early Detection of Cancer. Cooperation of the Ministry of Health and Osijek Health Center resulted in issuing brochures entitled Men and Cancer and Women and Cancer in 100,000 copies, and later 20,000 copies of a book entitled Smoking Induced Diseases. Analysis of patients undergoing surgery for CRC at Department of Surgery, Osijek General Hospital during the 1973-1984 period showed a low 5-year and 10-year survival rate. A study of early CRC detection by using fecal occult blood test (FOBT), conducted in Osijek between 1980 and 1984, included 11,431 subjects. Results of the study confirmed FOBT to be an acceptable and reliable method for early CRC detection because of its simple use, general level of acceptance by the population and relatively low cost. Physical examinations aimed at detecting CRC by using FOBT were to be implemented in a planned, systematic manner in high-risk persons (those older than 50). Based on the results of this study, guidelines on cancer control were published in 1993 by teams of primary care physicians, especially family physicians. The Osijek Health Center, specifically its Family Medicine Department, participated in the development and implementation of the National Program for Colorectal Cancer Prevention and Early Detection, which started in 2007. Response to the National Program for Early Detection of Colorectal Cancer in individual counties was under 37%. A project called Early Cancer Detection Model Integrated in Family Medicine Practice, which was implemented in Osijek and included subjects from the 45-49 and 75-84 age groups at risk, revealed that teams of family physicians were motivated to join the national programs for early detection of cancer in Croatia. Experiences of the Osijek Health Center Family Medicine Department in the prevention and early detection of CRC indicated that family physicians were pioneers in activities that had ultimately led to the establishment of a National Program for Colorectal Cancer Prevention and Early Detection in Croatia.
{"title":"[CONTRIBUTION OF FAMILY MEDICINE TO COLORECTAL CANCER PREVENTION\u0000AND EARLY DETECTION; FORTY-YEAR EXPERIENCE OF FAMILY MEDICINE\u0000DEPARTMENT, OSIJEK HEALTH CENTER].","authors":"Z Ebling","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The paper gives a short presentation of 40 years of experience of Osijek Health Center family physicians in colorectal cancer\u0000(CRC) prevention and early detection. Systematic work in the prevention and early detection of cancer includes raising public\u0000awareness and knowledge of healthcare issues, educating health professionals, conducting scientific research and contributing\u0000to the development and implementation of the National Program for Early Detection of Cancer. Cooperation of the Ministry\u0000of Health and Osijek Health Center resulted in issuing brochures entitled Men and Cancer and Women and Cancer in 100,000\u0000copies, and later 20,000 copies of a book entitled Smoking Induced Diseases. Analysis of patients undergoing surgery for CRC\u0000at Department of Surgery, Osijek General Hospital during the 1973-1984 period showed a low 5-year and 10-year survival rate.\u0000A study of early CRC detection by using fecal occult blood test (FOBT), conducted in Osijek between 1980 and 1984, included\u000011,431 subjects. Results of the study confirmed FOBT to be an acceptable and reliable method for early CRC detection because\u0000of its simple use, general level of acceptance by the population and relatively low cost. Physical examinations aimed at detecting\u0000CRC by using FOBT were to be implemented in a planned, systematic manner in high-risk persons (those older than 50). Based\u0000on the results of this study, guidelines on cancer control were published in 1993 by teams of primary care physicians, especially\u0000family physicians. The Osijek Health Center, specifically its Family Medicine Department, participated in the development and\u0000implementation of the National Program for Colorectal Cancer Prevention and Early Detection, which started in 2007. Response\u0000to the National Program for Early Detection of Colorectal Cancer in individual counties was under 37%. A project called Early\u0000Cancer Detection Model Integrated in Family Medicine Practice, which was implemented in Osijek and included subjects from\u0000the 45-49 and 75-84 age groups at risk, revealed that teams of family physicians were motivated to join the national programs for\u0000early detection of cancer in Croatia. Experiences of the Osijek Health Center Family Medicine Department in the prevention and\u0000early detection of CRC indicated that family physicians were pioneers in activities that had ultimately led to the establishment of\u0000a National Program for Colorectal Cancer Prevention and Early Detection in Croatia.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}