Medicina
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Item “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 HernánTECHNICAL 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.Item “Crisis addisoniana aguda secundaria a suspensión abrupta de corticoides”(Carrera de Medicina, 2019-06-01) Rojas Paz, María Cristina; Bedoya Vaca, Patricio Aníbal, Dr. Esp.Adrenal cortical insufficiency is a rare pathology, however it can compromise the life of the patient. They usually show signs and symptoms of cortisol deficiency, a hormone belonging to the group of glucocorticoids, sometimes there is also aldosterone deficiency. The signs and symptoms characteristic of an adisonian crisis usually appear after infections, situations of stress, suspension of treatment or injuries that involve the loss of sodium, the clinic is usually pain in the lower back, abdomen or legs, decreased pressure arterial and in severe cases shock and loss of consciousness. The Adison crisis is endangering the patient's life because it lowers blood glucose levels. The treatment is usually based on the adequate administration of hydrocortisone, hydration and glucose. The present case describes a 20-year-old patient with a history of adrenal insufficiency for 12 years in treatment with prednisone, calcitriol and hydrocortisone, hypothyroidism 2 years ago without treatment. He comes to present diaphoresis about 24 hours, with accompanying symptoms of general malaise, vomiting three times of food content, paraesthesia of lower and upper extremities, physical examination patient conscious, oriented, vital signs within normal parameters, skin and slightly pale facets, soft abdomen depressible positive ureteral points with a result of infectious uroanalysis: bacteria +, leukocytes ++, pyocytes 25-30 / field; blood count: leukocytes 15,100 / mm3, neutrophils 79.8%, lymphocytes: 16.4%, hemoglobin 13.44g / dL. Electrolytes: sodium 121mmol / l, potassium 4.70 mmol / l, chlorine 87 mmol / l and calcium 6.55 mmol / l. The treatment was restitution of sodium and liquids, corticotherapy and antibiotic therapy, the evolution was favorable.Item “Absceso pancreático secundario a pancreatitis aguda”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-10-01) Chamorro Barona, David Enrique; Guanuchi Quito, Franklin Dr. Esp.Pancreatic abscess is a circumscribed collection of pus, with little or no necrotic content. It is usually a complication of severe pancreatitis, four weeks after the onset of symptomatology, product of necrosis with subsequent liquefaction of tissue and secondary infection, constituting the abscess, and located in the vicinity of the affected organ. The symptomatology is non-specific, so the finding of gas is the only specific radiological sign, and percutaneous bacteriology is the only method to confirm the diagnosis in the preoperative period. Translated with www.DeepL.com/TranslatorWe present the case of a male patient of 27 years old, who was treated in the emergency service of the Ambato General Teaching Hospital for abdominal pain, which was catalogued as surgical problem, an exploratory laparotomy was performed, finding steate necrosis on the epiplon, and purulent collections on the pancreas’s tail and body, as well as purulent fluid on retroperitoneum. The abscess was drained and 3 drainages were put, 2 of the, on epigastrium and the last one on the left parietal-colic slide, the patient was also treated with broad spectrum antibiotics. The present work pretends to identify the critical points of the attention, proposing a therapeutic and diagnostic strategy for the management of severe pancreatitis and complications.Item “Megacolon agangliónico congénito”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Molina Pinto, Janine Alejandra; Sunta Ruiz, Mario LeopoldoDr. Esp.The congenital aganglionic megacolon is the absence of parasympathetic ganglion cells in the myenteric and submucosal plexus of the rectum, extending to the colon, caused by the failed migration of the ganglion cells of the colon during gestation. This leads to an aganglionic segment that can not relax, producing a functional obstruction of the colon. The predisposing risk factors to develop congenital aganglionic megacolon are: the genetic predisposition that is given by the EDN3 genes located in the long arm of chromosome 20, and EDNRB located in the long arm of chromosome 13 and RET; it is more frequent in the male sex in a ratio of 3-5: 1. The symptoms and signs that the pediatric population presents are: severe constipation, diarrhea, anemia, growth retardation, hyporexia, abdominal distension. The timely recognition and immediate treatment are essential to reduce the mortality and mortality associated with its more frequent complication, such as necrotizing enterocolitis. Early diagnosis is important, the method of choice is suction biopsy, it detects hypertrophic nerve trunks and the absence of ganglion cells in the colonic submucosa. Its treatment is surgical, obtaining good results, being few cases that have presented recurrences. There are congenital malformations that can be associated with the congenital aganglionic megacolon, such as: heart disease, bone dysplasia, renal and urinary tract malformations such as bilateral pyeloureteral layering that occurred in this case, some form part of syndromes such as Down syndrome, Smith syndrome, Lemli-Opitz, Waardenberg syndrome, among others. The present case describes an 8-year-old patient with a history of chronic constipation, attended emergency due to constipation of more than 1 month of evolution, abdominal distension, hyporexia and vomiting, examinations and is admitted with presumptive diagnosis obstructive abdomen, is evaluated by the surgical service who analyze the case and decide surgical behavior, after which patient presents improvement of clinical picture, biopsy analysis is performed which confirms the diagnosis of congenital aganglionic megacolon, to the box is added recurrent urinary tract infection due to malformation in the urinary system Complications that occurred in the postoperative period were fecal incontinence, and periods of constipation which were identified in this case. Enterocolitis and enuresis are also described as possible complications.Item “Complicaciones articulares en pacientes con artritis reumatoide”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-02-01) Cunuhay Lozano, Alejandra Lizbeth; Morocho Llanos, Domingo Dr.Rheumatoid arthritis chronic systemic inflammatory disease, and autoimmune multifactorial cause, is characterized by pain and progressive joint damage disabilities. It affects 1% of the world population, is more prevalent in women than in men (3: 1), occurs most often between 30 and 60 years old. Typical symptoms include joint pain predominantly at night and morning, morning stiffness of joints for more than 15 minutes, swollen joints, typically the metacarpophalangeal joints, and proximal interphalangeal joints. General ill feeling. In the initial stage are affected a few joints, then polyarthritis develops. Diagnosis depends on the characteristics clinical alterations. The presence of morning stiffness or casual observation of subcutaneous nodules, the presence of rheumatoid factor, liquid inflammatory synovial and radiographic abnormalities bone demineralization and erosions in the affected joints, elevated erythrocyte sedimentation rate, the diagnosis is based on criteria American Rheumatism Association constituting a useful guide for diagnosis. Treatment is aimed at controlling the inflammatory activity, prevent the progression of structural joint damage. NSAIDs provide symptomatic relief, its effectiveness is only marginal, so that the treatment of this disease is based on the use of so-called modifying antirheumatic drugs disease. These agents have shown unique ability to act against different manifestations. There are two main groups of drugs that meet these characteristics: traditional DMARDs and biologic therapies called. The former are a group of small molecule chemical synthesis, whose mechanism of action is poorly defined sometimes or act against a specific therapeutic target involved in the pathogenic process of immune response. Biological therapies are products used in the treatment made from cultured cells of cell banks disease, these therapies have been designed so that act specifically against a therapeutic target.Item “Calidad en el manejo para el diagnóstico de un caso con Mixoma Atrial Cardíaco”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-01-01) Salinas Escobar, Christian Germán; Dr. Jácome López, Fredy MarceloThe cardiac tumors constitute a rare condition, can occur at any age, may be primary (originating from heart tissue) or secondary (caused by metastases), most cardiac tumors are benign especially in the adult population, being myxoma that tops the list of these and in childhood rhabdomyomas, but a small percentage especially the secundary are malignant, they can occupy any of the heart chambers, the risk factors to consider the clinical suspicion correlate with factors associated neoplasms of different types, in addition to involve certain hereditary load there in, their symptoms start to grow these tumors and lead to hemodynamic alterations whose presentation may be confused in other non cardiac pathologies, including valvular diseases, electrical conduction pathology or autoimmune, it is effective for diagnosis always consider the possibility of their presence and also keep handy complementary tests that can help us discern all hypotheses, especifics imaging test; transesophageal and the transthoracic ultrasound, computed tomography and magnetic resonance imaging, that contribute significantly for the diagnosis of tumors of the heart. The initial treatment has a base clinical, curative treatment is based on the surgical resolution, which has shown good results, with few cases that have presented recurrences, so the prognosis of patients diagnosed in time is good.Item “Artritis séptica complicada con osteomielitis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2016-08-01) Jiménez Laverde, Ana Belén; Jiménez Velasco, Miguel Ángel Dr.Bone and joint infection infectious disease more common in childhood, difficult to recognize in the early stages and pose problems in both diagnosis and therapeutic management, medical and surgical. Osteoarticular infections with a prevalence in developed countries 22 cases / 100,000 children. The male: female ratio is 1.2: 3.7 times. There predisposing factors that favor the development of an infection osteoarticular: Trauma, surgery, penetrating wounds, skin infections, prematurity, the majority occur in children without underlying disease. Osteomyelitis is usually unifocal, affecting the metaphyses of long bones. In the case of septic arthritis, single joint child, Joint Lowlife Being the most frequently affected Members. The microorganism more frequently in all ages is S. aureus, from birth to 3 months of age, the important pathogens S. agalactiae and Enterobacteriaceae especially E. coli, K. kingae prevalent is children between 3 and 5 months year old. The duration of treatment is 4-6 weeks author. Can fever without being present. More significant symptom is pain; immobility of the joint, the diagnosis is mainly clinical, based on markers of inflammation, and Image Analysis of synovial fluid. The citobioquímico of articular fluid is important, but not specific. The definitive diagnosis is established Crops joint fluid, blood or bone material. It must perform a simple radiograph of the affected area with the possibility of detecting other diseases or chronic changes. Ultrasound is useful in the initial assessment by its high sensitivity for the detection of increased articular fluid, if we suspect osteomyelitis, radiology is negative, you should perform a bone scan, magnetic resonance imaging test is more specific image.