Articles in Gastroenterology & Hepatology (34)

I criteri di Ranson costituiscono un sistema di punteggio prognostico basato su 11 parametri clinici e di laboratorio valutati al ricovero e a 48 ore per stimare mortalità e gravità nella pancreatite acuta. L'approccio diagnostico di riferimento si fonda sul dosaggio della lipasi sierica associato alla tomografia computerizzata con mezzo di contrasto (CECT), mentre la gestione terapeutica di prima linea prevede un'aggressiva reidratazione endovenosa mirata e la nutrizione enterale precoce.

La triade di Charcot e la pentade di Reynolds rappresentano le manifestazioni cliniche classiche della colangite acuta, un'infezione potenzialmente fatale delle vie biliari causata da ostruzione e stasi biliare. La gestione richiede rianimazione idrica, terapia antibiotica empirica a largo spettro e decompressione biliare urgente tramite colangiopancreatografia retrograda endoscopica (ERCP).

L'appendicite acuta (Acute appendicitis) rappresenta la più comune urgenza chirurgica addominale a livello globale, caratterizzata da un'infiammazione transmurale dell'appendice vermiforme causata prevalentemente da un'ostruzione luminale. La gestione clinica tempestiva si basa sulla stratificazione del rischio tramite il punteggio di Alvarado o AIR (Appendicitis Inflammatory Response) associata a diagnostica per immagini mirata, ponendo l'appendicectomia laparoscopica come trattamento chirurgico di riferimento.

La pancreatite acuta è un processo infiammatorio acuto del pancreas con coinvolgimento variabile dei tessuti peripancreatici e degli organi sistemici. La diagnosi richiede la presenza di almeno due dei tre criteri della Classificazione di Atlanta Rivista.

The King's College criteria are a validated prognostic scoring system used to determine the necessity of emergency orthotopic liver transplantation in patients with paracetamol (acetaminophen)-induced acute liver failure. The gold-standard diagnostic assessment involves serial evaluation of arterial blood gas, prothrombin time/INR, serum creatinine, and neurological grading; first-line medical therapy centers on immediate administration of intravenous N-acetylcysteine combined with intensive supportive critical care.

The Model for End-Stage Liver Disease (MELD) and MELD-Na scores are validated prognostic frameworks used to predict short-term mortality in chronic liver disease and prioritize organ allocation for liver transplantation. The gold-standard diagnostic approach combines serial laboratory panels (serum creatinine, total bilirubin, international normalized ratio, and serum sodium) with clinical staging, while definitive management centres on orthotopic liver transplantation when the score exceeds institutional thresholds.

Toxic megacolon is a life-threatening, acute non-obstructive colonic dilatation accompanied by systemic signs of toxicity, typically managed with urgent medical stabilization and prompt surgical evaluation. The gold-standard diagnostic modality is an abdominal X-ray demonstrating colonic diameter exceeding 6 cm, and first-line treatment involves intensive conservative resuscitation alongside intravenous corticosteroids and broad-spectrum antibiotics.

Hepatic encephalopathy is a reversible neuropsychiatric syndrome resulting from acute or chronic liver failure, diagnosed primarily through clinical scoring systems and serum ammonia context, and managed first-line with enteral lactulose titration and rifaximin.

Autoimmune hepatitis is a chronic, progressive inflammatory liver disease characterized by loss of immune tolerance to hepatocytes, elevated serum IgG, circulating autoantibodies, and interface hepatitis on histology. Diagnosis is confirmed via autoantibody panels, hypergammaglobulinemia, and liver biopsy, while first-line therapy involves combination or monotherapy with corticosteroids and azathioprine.

Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by progressive inflammation, fibrosis, and multifocal stricturing of the intrahepatic and extrahepatic bile ducts. The gold-standard diagnostic test is magnetic resonance cholangiopancreatography (MRCP), and first-line therapy involves symptom management, endoscopic dilation of dominant strictures, and evaluation for liver transplantation.

Hereditary haemochromatosis is an autosomal recessive disorder of systemic iron metabolism characterized by inappropriately increased intestinal iron absorption and progressive parenchymal iron deposition; the gold-standard diagnostic test is genetic testing confirming HFE mutations (homozygosity for C282Y) in the setting of elevated transferrin saturation, and first-line management consists of regular therapeutic phlebotomy (venesection).

Lynch syndrome is an autosomal dominant hereditary cancer predisposition syndrome caused by germline mutations in DNA mismatch repair genes, characterized by markedly elevated lifetime risks of colorectal and endometrial malignancies. The gold-standard diagnostic approach combines universal tumor testing via immunohistochemistry (IHC) for mismatch repair proteins and microsatellite instability (MSI) analysis, confirmed by germline genetic sequencing. First-line clinical management involves high-frequency surveillance colonoscopy every 1-2 years starting between ages 20-25, alongside chemoprevention using low-dose aspirin and risk-reducing surgical options.

Peutz-Jeghers syndrome is an autosomal dominant hereditary polyposis syndrome caused by germline STK11/LKB1 mutations, characterized by mucocutaneous melanin pigmentation and gastrointestinal hamartomatous polyps; diagnosed via genetic testing and small-bowel enterography/endoscopy, with management focused on device-assisted endoscopic polypectomy and structured cancer surveillance.

Plummer-Vinson syndrome is a rare condition defined by the classical triad of dysphagia, iron-deficiency anemia, and post-cricoid esophageal webs, diagnosed definitively via barium swallow or upper gastrointestinal endoscopy, and managed with iron replacement and endoscopic web dilation.

Mallory-Weiss syndrome is characterized by non-transmural longitudinal mucosal lacerations at the gastroesophageal junction resulting from sudden increases in transabdominal pressure, diagnosed definitively via urgent upper endoscopy and managed primarily with supportive care and endoscopic hemostasis for active bleeding.

Budd-Chiari syndrome is hepatic venous outflow obstruction from small hepatic veins to the inferior vena cava, diagnosed definitively via Doppler ultrasonography and venography, and treated primarily with therapeutic anticoagulation and early recanalization.

Sister Mary Joseph nodule is a palpable cutaneous metastasis to the umbilicus indicating advanced intra-abdominal or pelvic malignancy, diagnosed definitively via core needle or excisional biopsy, and managed through systemic palliative chemotherapy or radical surgical resection depending on the primary tumor stage.

Murphy sign is a physical examination maneuver indicating acute inflammation of the gallbladder, most commonly secondary to calculous cholecystitis. The gold-standard diagnostic modality is hepatobiliary iminodiacetic acid (HIDA) scintigraphy or right upper quadrant ultrasonography demonstrating sonographic Murphy sign and gallbladder wall thickening, while first-line treatment involves prompt laparoscopic cholecystectomy combined with broad-spectrum intravenous antibiotic therapy.

Kayser-Fleischer rings represent golden-brown or greenish copper deposits in Descemet's membrane of the cornea, serving as a hallmark ocular sign of Wilson disease, diagnosed via slit-lamp examination and treated with copper chelators like D-penicillamine or trientine.

Asterixis is a form of negative myoclonus marked by brief, arrhythmic lapses of sustained posture caused by temporary motor inhibition. The gold-standard diagnostic test is physical examination demonstrating postural lapses during wrist dorsiflexion, while first-line management addresses underlying metabolic, toxic, or organ failure precipitants.

The Prague C and M criteria represent an international consensus classification system utilized during upper gastrointestinal endoscopy to standardize the endoscopic assessment, measurement, and documentation of the extent of Barrett oesophagus. The gold-standard diagnostic modality combines high-resolution white-light and chromoendoscopy (or virtual chromoendoscopy such as NBI) with targeted and Seattle-protocol random four-quadrant biopsies every 1 to 2 cm, while first-line management involves lifelong acid suppression with once-daily or twice-daily proton pump inhibitors combined with endoscopic eradication therapy (such as radiofrequency ablation) for dysplastic lesions.

The Los Angeles classification is the gold-standard endoscopic grading system for reflux oesophagitis based on the extent and severity of mucosal breaks, diagnosed via upper gastrointestinal endoscopy and managed first-line with proton pump inhibitors (e.g., omeprazole 20-40 mg daily).

The Truelove and Witts severity index is a validated clinical classification tool used to categorize acute flares of ulcerative colitis into mild, moderate, or severe disease based on stool frequency, systemic symptoms, and inflammatory markers. Diagnosis is confirmed via ileocolonoscopy with mucosal biopsy, and first-line treatment for acute severe ulcerative colitis involves intravenous corticosteroids (e.g., methylprednisolone 60 mg/day or hydrocortisone 100 mg IV every 8 hours).

The Revised Atlanta Classification of acute pancreatitis is the international consensus standard for defining, categorizing, and grading the severity of acute pancreatitis episodes using morphological criteria and the modified Marshall scoring system for organ failure. The gold-standard diagnostic workup relies on serum lipase or amylase elevation combined with cross-sectional contrast-enhanced computed tomography, while first-line therapy mandates aggressive goal-directed fluid resuscitation with balanced crystalloids.

The Maddrey discriminant function (DF) is a validated prognostic scoring system utilized to assess disease severity and guide corticosteroid therapy in acute alcoholic hepatitis. The gold-standard evaluation combines clinical assessment, laboratory testing for coagulopathy and hyperbilirubinemia, and transjugular liver biopsy when diagnosis remains uncertain. First-line therapy for severe cases (DF ≥ 32) consists of prednisolone at an adult dosage of 40 mg daily for 28 days.

The Child-Pugh score is a widely utilized clinical classification system used to assess the severity and prognosis of chronic liver disease, primarily cirrhosis, by combining laboratory parameters and clinical manifestations. The gold-standard diagnostic approach combines quantitative elastography or liver biopsy with biochemical assessment, while first-line therapy focuses on treating underlying etiologies, managing complications like ascites and encephalopathy, and adjusting drug pharmacokinetics.

The Forrest classification is an endoscopic staging system that categorizes peptic ulcer bleeding based on stigmata of recent hemorrhage to guide endoscopic therapy and predict rebleeding risk. Urgent upper gastrointestinal endoscopy serves as the gold-standard diagnostic tool, while first-line management combines high-dose intravenous proton pump inhibitors with endoscopic hemostasis.

The AIMS65 score is a validated 5-point clinical risk stratification tool used to predict in-hospital mortality, length of stay, and resource utilization in patients presenting with acute upper gastrointestinal bleeding. Gold-standard diagnostic evaluation involves urgent upper endoscopy (esophagogastroduodenoscopy, EGD), while first-line management centers on immediate hemodynamic resuscitation, aggressive intravenous proton pump inhibitor therapy, and correction of coagulopathy.

The Rockall score is a validated clinical risk-stratification tool used to predict mortality and rebleeding risk in patients presenting with acute upper gastrointestinal bleeding, combining pre-endoscopic clinical variables and post-endoscopic findings. The gold-standard diagnostic and therapeutic modality is urgent upper gastrointestinal endoscopy (esophagogastroduodenoscopy, EGD), and first-line therapy involves immediate hemodynamic resuscitation, intravenous proton pump inhibitor infusion, and endoscopic hemostasis for high-risk stigmata.

Cullen sign and Grey Turner sign are rare cutaneous manifestations of severe acute necrotizing pancreatitis, retroperitoneal hemorrhage, or intra-abdominal bleeding characterized by periumbilical and flank ecchymosis resulting from the retroperitoneal tracking of blood and exudative enzymes. The gold-standard diagnostic investigation is contrast-enhanced computed tomography (CECT) of the abdomen, and first-line therapy involves aggressive fluid resuscitation, enteral nutrition, and ICU monitoring.

The Glasgow-Blatchford bleeding score is a validated pre-endoscopy risk stratification tool used to identify low-risk patients with acute upper gastrointestinal bleeding who may be safely managed as outpatients. The gold-standard diagnostic and therapeutic procedure is urgent upper endoscopy (esophagogastroduodenoscopy), while first-line management involves prompt hemodynamic stabilization, intravenous proton pump inhibitors, and risk scoring.

Upper gastrointestinal bleeding is defined as hemorrhage originating proximal to the ligament of Treitz, most commonly caused by peptic ulcer disease or esophageal varices. Prompt endoscopic evaluation combined with restrictive blood transfusion thresholds and targeted pharmacological therapy forms the cornerstone of acute management.

Acute cholangitis is a potentially life-threatening bacterial infection of the biliary tree caused by biliary obstruction and stasis, presenting classically with Charcot's triad. Diagnosis is established via Tokyo Guidelines criteria using systemic inflammation, cholestasis, and biliary imaging, while management mandates urgent biliary decompression via ERCP alongside broad-spectrum intravenous antimicrobial therapy.

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid in the absence of an intra-abdominal, surgically treatable source, diagnosed via diagnostic paracentesis revealing an absolute PMN count ≥250 cells/mm³, and treated empirically with intravenous third-generation cephalosporins and intravenous albumin.