Medicina
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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 “Intoxicacion aguda por paraquat”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-10-01) Freire Fiallos, Christian Gabriel; Luna Coba, Gonzalo Xavier Dr. Esp.Paraquat is a herbicide widely used in the population of Ecuador to prevent crop damage. In the province of Napo, cases of intoxication are reported monthly by this chemical, most of them due to auto-lytic attempts, since the product is free-sale and easy to access and has inadequate storage in the home, with the concern of the agricultural ones to obtain a product of greater quality. In this way giving a greater predisposition to its use either accidental or intentional, leading to cause systemic poisoning, with a liver, lung or kidney involvement, with the main organs affected and depending on the amount ingested. the symptomatology and the clinical picture, which in certain occasions leads to multiorganic failure causing death. Generally, patients intoxicated by paraquat receive supportive treatment based on hemoperfusion, hydration in conjunction with anti-inflammatory, antioxidant and immunosuppressive agents to help recovery and at the same time avoid complications depending on the severity of the condition.Item “Influencia de la tuberculosis pulmonar en la calidad de vida de los pacientes atendidos en el área de salud N.- 2 período enero - diciembre 2013”.(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2014-11-01) Carrillo Cunalata, Doris Marisol; Changoluisa Paredes, Edgar Ramiro Dr.Through the history of pulmonary tuberculosis has been considered a high-risk condition for life, although in Ecuador has only been handled medically , in order to manage the patient medically , controlling management treatment, more still has neglected the psychological level , which is involved in the quality of life of sufferers , affecting their health and changing sociability; However with technological advances has managed to find new treatments that have become more bearable lifestyle of patients affected by tuberculosis , within this research study is an analysis of the disease is detailed , the procedures used in the treatment so general and specifically the relationship between the disease and the quality of life of patients treated at this clinic in 2013 , through the implementation of a survey data could be obtained once we tabulated validate the hypothesis which has been the starting point for establishing the final proposal under the criteria of the development of a protocol for the treatment and improving lifestyle of patients with pulmonary tuberculosis.Item “Diverticulitis a repetición en paciente adulto mayor”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Llerena Jurado, María Ruth; Dr. Esp. Yépez Yerovi, Fabián EduardoDiverticular disease is a problem that affects the colon and causes a significant cost to health systems as it leads to significant morbidity and mortality associated with its complications, including abscess formation, perforation, bleeding and colonic obstruction. Most patients with colonic diverticula around 70-80% have no symptoms or complications related to them at any time. Diverticulitis is the most common complication of diverticular disease of the colon, occurring in 10-25% of patients. Diagnosis of diverticulitis can be made in 66% of patients solely on the basis of clinical history and physical examination. The abdominopelvic computed tomography is currently the imaging method of choice, providing prognostic and useful information in the differential diagnosis. The medical treatment based on the administration of antibiotics, aimed at covering gram-negative and anaerobic germs, will resolve 70-100% of cases of uncomplicated diverticulitis.Item “Enfermedad de still del adulto”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Guevara Gavilánez, Daniela Alejandra; Morocho Llanos, Domingo Dr. Esp.Adult Still's disease (ESA) is an infrequent pathology, with inflammatory characteristics, with a broad spectrum in its clinical presentation. This pathology occurs in people older than 15 years, since in younger patients is the clinical picture called juvenile idiopathic systemic arthritis or Still's disease. Its diagnosis is based fundamentally on the high clinical and analytical suspicion through the performance of basic complementary tests of infectious, autoimmune and neoformative causes of fever of uncertain origin. The presence of fever in all patients, without existing clinical or pathognomonic laboratory manifestations of any disease, initially makes it difficult to diagnose. Several criteria have been proposed for its detection, among which are those of Yamaguchi itself that helps us to approach an accurate diagnosis. Given its behavior and the lack of diagnostic tests, it is considered a diagnosis of exclusion. The pathophysiology of ESA has not yet been fully understood. Numerous causes have been postulated such as infectious agents, genetic factors, alteration of the regulation of the immune response and apoptosis, but there are still no specific data, although it is said that the immunological pathways of the disease have been attributed as the most significant in the physiopathology. Its treatment is clinical and is based on the use of a combined scheme. Most cases of ESA occur as a mild or moderate disease; however it should be considered that severe manifestations of the disease can occur that present with high mortality, mainly when associated with severe pulmonary manifestations.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 “Mielinolisis pontina secundaria a traumatismo craneoencefálico severo(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Gavilanes Acosta, Daisy Maribel; López Ulloa, Mario Orlando Dr. Esp.Deaths to traumatic brain injury are still among the main causes of mortality and disability, with the affections of the nervous system and hemorrhagic shock becoming its main contributors. The patient with traumatic brain injury (TCE) is forming a complicated group of patients that can present different types of brain injury, as a result of a closed lesion or an open lesion. TCEs are more frequent in males in all age groups. The causes of the TCE are related to the age of the subjects who suffer them, thus, falls are the most frequent etiology and traffic accidents correspond to the second cause in frequency. The central pontine myelinolysis is a rare pathology, characterized by a neurological alteration of undetermined etiology linked to various conditions such as serious diseases, in more than 50% of cases manifested in patients with chronic diseases with malnutrition or hydroelectrolytic disorders, being frequent, when Sodium levels rise too fast. The damage basically consists of the destruction of the myelin sheaths, leaving the cylinders undamaged, affecting part or the entire base of the protuberance symmetrically. There are a variable percentage of patients in brain death situations who have developed diabetes insipidus. To continue the clinical case is about a male patient of 14 years of age, who while doing extreme sports (Downhill), without a helmet, he suffers a fall of his bicycle in motion, with displacement of approximately 2 meters and frontal impact of his skull against a rocky surface (stones), then ECU 911 transfers him to the Pediatric Emergency Service of the IESS Ambato General Hospital. On physical examination, the positive: the patient with a tendency to sleep, disoriented, with pain, Glasgow Scale: 13/15 (O: 3, V: 4, M: 6). Head: evident hematoma in the frontal region, with left palpebral edema, localized ecchymosis, palpable bone crax in the frontal region, pupils: mydriatic, hyporeactive. CT was performed immediately, showing a fracture line at the level of the frontal bone, extending from the frontoparietal suture to the left orbit, with signs of an epidural hematoma, deciding to admit it for hospital management because he has a severe traumatic brain injury. Neurosurgery is consulted, they indicate that at the moment he does not require surgical resolution, so he decides clinical management, with advanced airway management, sedoanalgesia and later is admitted to the Intensive Care Unit Evolution in the ICU: Hemodynamically unstable, brain MRI is performed where it is evident: signs of pontine myelinolysis, results of examinations are obtained revealing the following: hypernatremia + low density + low urinary sodium + urinary hypoosmolarity + plasma hyperosmolarity related to Diabetes Insipid Central, with poor clinical evolution, he does not respond to treatment and he dies.Item “Quiste maxilar secundario a ameloblastoma”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-03-01) Campos Moposita, María de los Ángeles.; Alfonso Morejón, Eduardo Arsenio Dr.The aim of this present case is to analyze the maxillary cyst secondary to ameloblastoma in a 23-year-old patient living in Latacunga, with a history of sinusitis treated empirically, in addition to the third trimester of pregnancy; Goes to health home, for presenting a slow and progressive growth of mass in right hemicara causing deformity, pain, paresthesias and eye discomfort. Axial and computerized tomography shows a cystic lesion located in the right maxillary antrum which causes expansion and destruction of the medial wall and the anterior wall of the same, towards its upper portion attached to the floor of the orbit is a corresponding tooth to the canine with bone destruction. Maxillo Facial Surgeon who diagnoses maxillary cyst decides its surgical resolution due to the functional and aesthetic commitment, performing mass exceresis and establishing a diagnosis of solid ameloblastoma. The objective of the case analysis is to analyze the different diagnostic and therapeutic methods for the detection, intervention and treatment of immediate and timely cases of ameloblastoma. At the conclusion of the case analysis, we identified the risk factors that influence the clinical picture, such as the growth of the mass for approximately 3 centimeters, inflammation processes and paresthesias as a secondary symptom. The visit to the specialist by private consultation managed to establish an adequate follow-up to avoid possible complications. Finally the surgical treatment used is described, being the exceresis and plaque placement recovering the functionality and aesthetics of the affected part. The aim of this present case is to analyze the maxillary cyst secondary to ameloblastoma in a 23-year-old patient living in Latacunga, with a history of sinusitis treated empirically, in addition to the third trimester of pregnancy; Goes to health home, for presenting a slow and progressive growth of mass in right hemicara causing deformity, pain, paresthesias and eye discomfort. Axial and computerized tomography shows a cystic lesion located in the right maxillary antrum which causes expansion and destruction of the medial wall and the anterior wall of the same, towards its upper portion attached to the floor of the orbit is a corresponding tooth to the canine with bone destruction. Maxillo Facial Surgeon who diagnoses maxillary cyst decides its surgical resolution due to the functional and aesthetic commitment, performing mass exceresis and establishing a diagnosis of solid ameloblastoma. The objective of the case analysis is to analyze the different diagnostic and therapeutic methods for the detection, intervention and treatment of immediate and timely cases of ameloblastoma. At the conclusion of the case analysis, we identified the risk factors that influence the clinical picture, such as the growth of the mass for approximately 3 centimeters, inflammation processes and paresthesias as a secondary symptom. The visit to the specialist by private consultation managed to establish an adequate follow-up to avoid possible complications. Finally the surgical treatment used is described, being the exceresis and plaque placement recovering the functionality and aesthetics of the affected part.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 Abdomen Agudo por Absceso Tubárico Secundario A Enfermedad Inflamatoria Pélvica más Apendicitis Aguda(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Guamancuri Silva, Jorge Gabriel; Pozo Mayorga, Fernando Patricio Dr. Esp.At the Hospital Provincial Docente Ambato (HPDA), the acute abdominal pain is the most frequent cause of query. In the Hospital Provincial Docente Ambato (HPDA), acute abdominal pain is the most frequent cause of consultation. By the other hand, the Gíneco-obstetric pain constitutes the second cause of hospitalization, being in this way the Emergency Service the first contact with the patient. For this reason, is really vital to know about the different pathologies which causes the acute abdomen, and so confront them in the better way. Likewise, it is crucial to determine the first instance if it’s about of a quirurgic acute abdomen and if it needs immediate hospitalization. The most important factor in this situation, because of our environment, is discard a pregnancy at the beggining of the evaluation in a female patient. Considering the possibility of a broken ectopic pregnancy that could turn it in a death or life event, becomes essential. The opportune pelvic acute ache diagnosis is vital, at the first instance, because the delay in the diagnosis increases in a devastating proportion the mortality, and consequently, the recovery time for the patient, the inherent economic spending, and even, in these time too hostile with the medicine career, because of the legal demands.