Medicina

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Abdomen Agudo Obstructivo Secundario A Tumor de la cola del Páncreas
(2016-09-01) Valle Proaño, Christian Andrés; Yépez Yerovi, Fabián Eduardo Dr. Esp.
The following case is a male patient 67 years old, mestizo, catholic religion, born and living in Ambato (Pishilata), painter occupation, incomplete higher education; Family history Pathological father died with pancreatic cancer; Personal history Pathological Parkinson's disease 11 years ago; Pathological history Surgical Prostatectomy 5 years. Go to present about 72 hours ago epigastric pain, cramping of mild to moderate intensity that radiates to the right flank and left shaped belt accompanied with widespread decay, so go to Mobile Hospital where he administered antibiotic therapy not specified, probable diagnosis of acute diarrheal disease without showing clinical improvement, 24 hours before admission, the patient persists with abdominal pain of great intensity accompanied postprandial vomiting on three occasions in moderate amount of food and bilious content as well alteration of intestinal habit prone to constipation, so go back to Mobile Hospital who you refer to Provincial Teaching Hospital Ambato (HPDA). In the emergency service received HPDA patient with TA 100/60 mmHg FC: 108 lpm FR: 35 rpm, 96% O2 Sat, aware, no fever, dry oral mucosa, preserved cardiopulmonary, tense abdomen distended and painful epigastric mesogastrio, with increased bowel sounds, no signs of peritonitis, no limbs edema, tremor in the upper extremities, distal pulses present at the entrance to the surgery department with presumptive diagnosis of obstructive acute abdomen is decided. Having assessed the patient decides to perform a Laparotomy Exploratory meeting free fluid inflammatory abdominal cavity, erythematous bowel loops and dilated from the first jejunal loops to the angle of Treitz and duodenum, is also a tumor in the tail of the pancreas was found irregular edges, well vascularized, enlarged spleen, performing pancreatectomy Distal and splenectomy hard consistency, remaining hospitalized in the Department of Surgery at later presented a pancreatic fistula low spending the same which was controlled and had an evolution favorably so within 30 days of hospitalization is decided hospital in good general conditions for outpatient control. The histopathologic result was a lymphangioma tail of the pancreas.
Abdomen Agudo Quirúrgico Secundario a Rotura Uterina por Legrado Inducido
(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Chango Silva, Margarita Fernanda; Pancho Zela Dr., Marlon Mauricio
Introduction. Abdominal pain is a complex, sometimes difficult to diagnose and one of the most frequent causes of consultation in emergency services entity, and it is for all medical meet its features to quickly determine the conduct to be followed, since its timely decision may depend on the outcome of the patient. The clinical signs and symptoms are varied and depend on the etiology. In our case report the cause of acute abdomen was the same uterine perforation that may be iatrogenic or spontaneous. Iatrogenic causes include procedures such as dilation and curettage. Spontaneous causes are less commonly responsible for uterine perforation. Given the severity of the disease it is very important to study the female population to prevent irremediable complications in the patient. Objective. Evaluate the clinical management of patients with acute abdomen secondary to surgical uterine perforation. Development. This case is a female patient 26 years of age diagnosed incomplete abortion from 10 weeks pregnancy about concerns that perform curettage twice a week after you have perforativo peritoneal syndrome so go to hospital IESS Riobamba, there perform additional biochemical and imaging test, so is diagnosed with acute abdomen possible uterine rupture, and perform emergency surgery. He later transferred to Hospital IESS Ambato where he is transferred to Ambato IESS Hospital where he is admitted to the intensive therapy during hospitalization is relaparotomy, develop favorably. Conclusions. The acute abdomen secondary to uterine perforation, is a box that requires a proper diagnosis and an immediate resolution because it is at risk the life of the patient. In our case report the clinical management was not entirely appropriate.
Abdomen Obstructivo Secundario a Herniación Inguinal
(2016-12-01) Medina Aguilar, Mireya Andrea; Pozo Mayorga, Fernando Patricio Fernando Patricio Dr.
The following case raised in the Provincial General Hospital of Latacunga. It relates about a 78 years old male patient, in which it shows continuum pain at an inguinal level with an evolution of 24 hours approximately. The frame is accompanied with the inability of ambulation, for this reason the patient attends the physician. The initial physical examination shows pain when performing the palpation at an inguinal region level, besides it can be palpated non reducible mass in the same place with solid consistency. The laboratory examinations are performed with normal results, however the image examinations are altered and show a gaseous pattern that suggest an acute abdomen of obstructive kind. The patient is urgently taken to the operations room, determining a peritonitis which requires a Bogota bag to be constructed. 48 hours later, a cavity washing is performed including its closure. Yet, the patient presents a lousy evolution which requires him to be taken once again to the operations room where it can be evidenced a perforation of the small intestine bail which does resection and ileostomy, later, it is complicated by the respiratory system with a frame of dry cough. In the image examination it can be seen the presence of infiltrators at a base level which are added to the nosocomial pneumonia pathology. The patient is transferred to tertiary level attention for its treatment
Inercia Colónica en Paciente Femenina de 19 años, con Diagnóstico Inicial de Abdomen Agudo
(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Sailema Sailema, Gabriela Ximena; Arguello Guanotasig, Santiago Alexis Dr. Esp.
Colonic inertia occurs primarily in young women and is characterized by severe defecation infrequency, which can reach even one to two monthly depositions. This case is a female patient 19 years old; Pathologic Personal Background: Pneumonia Bilateral more Febrile Seizures, chronic constipation more parasitosis by Ameba Histolytica, Abdomen Obstructive; Surgical Background: Appendectomy. Attends the H.P.G.L to present about 2 days as apparent date, abdominal pain, cramping, intense, EVA scale (9/10), does the same that is located in epigastric, lower abdomen and radiates right upper quadrant and is accompanied by bloating and nausea refers this pain then appeared intake of chicken soup more aromatic water Physical examination patient conscious, oriented, afebrile, álgica;Abdominal surgical scar about 3 centimeters in length located in the right iliac fossa, distended abdomen, bowel sounds decreased in the entire large bowel, presence of tympanic to percussion, nonpitting abdomen, painful on palpation and generalized depth is observed, without signs of peritoneal irritation. It is worth emergency surgery guard who request additional examinations and decide their income in general surgery with partial presumptive diagnosis of acute obstructive abdomen. After conducting further investigations, more repetitive representations of constipation and clinical evaluation of the patient, Inertia Colonic diagnosed, so we decided to perform surgical treatment: left hemicolectomy + anastomosis colorectal term omentectomy + terminal + partial placement of drainage; during laparotomy is: left colon increased in size and length. Favorable postoperative course so the 29 days of hospitalization is decided hospital in good general conditions and outpatient control.
Isquemia mesenterica en paciente con cardiopatia previa, reporte de un caso
(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2021-06-01) Fantoni Añazco, Mateo Josué; Yépez Yerovi, Fabián Eduardo Dr. Esp.
Introduction: Mesenteric ischemia is defined as the total or partial loss of blood flow to the small intestine and / or right colon. This is one of the most frequent causes of hospital admission. It presents with non-specific symptoms which makes its diagnosis a challenge. Objective: To describe a clinical case of mesenteric ischemia in a patient with previous heart disease. Materials and methods: A retrospective descriptive study based on clinical case analysis is carried out. Discussion: A case report is made of a 68-year-old patient with a history of essential arterial hypertension, hypothyroidism, acute myocardial infarction 5 years ago, diverticular disease, irritable bowel syndrome. She presented pain at the epigastric level for two days, accompanied by vomiting on several occasions. The condition is classified as constipation without clinical suspicion of mesenteric ischemia. Conclusion: The patient had risk factors for developing mesenteric ischemia. Furthermore, the clinical picture presented by the patient resembles that described in the literature. It is worth mentioning that determining the origin of the ischemia is very difficult according to the patient's symptoms, for this reason it was identified that the moment of the surgical act was of arterial origin
Necrosis Intestinal Infantil Post Traumática
(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Zurita Mayorga, Lineth Carolina; Sánchez Miño, Jorge Isaac Dr.
Femenine patient of 1 year 10 months, born and resides in Ambato (Pasa), product of second poorly, controlled pregnancy feat, well tolerated, domiciliary eutocic birth at nine months gestation, crying immediately after birth, underfed, imunizations complete for the age, adequate psychomotor formation, no personal or family history of pathologic significance. Patient 48 hours ago suffered a fall down steps (aproximately 5 steps) impacting their abdomen on concrete, 24 hours ago displays abdominal distention, refuses to eat, is found hyperactive, so they will lead to the emergency of the Provincial General Teaching Hospital in Ambato, the physical exam FC 100 beats a minute, FR 60 a minute, axillary temperature 36.2 0C, weight 10.3 kg. The examination hyperactive, irritable, oropharynx erithmatous, congestive, abdomen distended, RHA absent, tympanic percusión painful. Placed nasogastric tube being obtained 200 ml of greenish liquid, with a diagnostic of acuto abdomen obstruction and normocytic anemia, recieve hydration, analgesic, antibiotic therapy (Ampicilin and Sulbactam), labaratory exams, alkaline phosphatase: 292u/lm TP:24, 33, HB:8.4, HTC:26.4, leucocytes:22430, neutrophils: 17.59. Evaluated for surgery hyperactive is established patient with respiratory dificulty, abdomen very distented, RHA absent. In the X-ray of abdomen air fluid levels it is noted. Exploratory laparotomy found a heamoperitoneum of aproximately 800 ml in abdominal cavity, ruptura of intestinal meso with active bleeding, intestinal necrosis of aproximately 60 cm of the Treitz angle, rest of intestine with signs of edematous ischemia, spleen and liver of normal characteristics, with ileus anastomosis- ileal, released 60 cm from the angle of treitz and abdominal wash. Continues hospitalized in ICU for postsurgical control during four days displaying good clinical evolution, later it is transferred to Pediatric Services with diagnosis of closed trauma of the abdomen, ruptura of the intestinal meso, intestinal necrosis with ileus anastomosis- ileal, released after 28 days of hospitalization with frank improvement of their situation.
“Quiste hepático gigante a propósito de un caso”
(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-10-01) Quelal Zurita, Alex Dario; Guanuchi Quito Dr. Esp., Franklin Hernán
TECHNICAL UNIVERSITY OF AMBATO FACULTY OF HEALTH SCIENCES MEDICAL CAREER “GIANT LIVER CYST” - Author: Quelal Zurita, Alex Dario. TUTOR: Dr. Esp. Guanuchi Quito Franklin Hernán Date: october 2019. SUMMARY Objective: To characterize the patients who present giant liver cysts and identify the possible complications that these present. Materials and methods: Retrospective descriptive study of clinical case analysis. Discussion: A case of a 41-year-old male patient with a very intense abdominal pain picture of a few days of evolution, located in the right hypochondrium, is reported. It is diagnosed as pancreatitis of biliary origin but after that, with pertinent studies the diagnosis of the presence of liver cyst that includes segments IV, V and VIII is reached, so drainage is done to remove it. Conclusions: The problems related to the present clinical case, as well as the literature review, are analyzed in this way, patients with giant liver cysts are characterized, as well as their management and possible complications.