Medicina

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    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
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    Embarazo Ectópico Accidentado mas Shock Hipovolémico
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Hidalgo Noroña, Tránsito Maricela; González Guevara, Laura Catalina Dra.
    Ectopic pregnancy is defined as the implantation of the fertilized egg outside the uterine cavity. In Ecuador, according to data released by the INEC in 2014, ectopic pregnancy is the fourth leading cause of maternal death with a result of 6.02%. The most common location of ectopic pregnancy is in the fallopian tube. There are multiple factors related to ectopic pregnancy and the prevalence of such factors is increasing, it correlates with a history of sexually transmitted diseases, ectopic pregnancy, tubal surgery, adult women and snuff disease. It is one of the most important causes of acute abdomen in obstetrics and despite progress in diagnostic and therapeutic methods, ectopic pregnancy continues to represent worldwide problem of maternal morbidity and mortality in the first trimester of pregnancy. This case describes a female patient of 29 years old with no medical history of importance, date of last menstruation know, go to the emergency room because of abdominal pain for about 2 hours, accompanied by tachycardia, hypotension and generalized pallor. Laboratory tests which report leukocytosis, decreased hemoglobin, hematocrit and positive BHCG are made. In addition to reporting abdominal ultrasound performed rugged ectopic pregnancy. Patient is assessed by emergency obstetric resulting test income is decided to surgical center for emergency laparotomy for ectopic pregnancy injured more hypovolemic shock finding free bleeding cavity more clots approximately 3000 milliliters, is administered crystalloid and packed red blood cells plus thereby controls the patient hemodynamically. Approximately 24 hours after the patient has difficulty breathing and chest x-ray desaturation is valued by internal medicine and cardiology who diagnostic acute pulmonary edema, treatment is established it is done. Patient course and is discharged 5 days later. Despite scientific advances in diagnosis, prevention and treatment of this disease is still left unnoticed patients of this kind, either suspicion at the time of care, delay in referral to areas of higher resolution, or perhaps for lack diagnostic tools that enable us to reach a concrete analysis quick and timely manner, it is important to consider the relevance of the investigation of this case report that aims to create a clear and precise understanding of the diagnosis and management of ectopic pregnancy for early intervention, for the benefit of the patient.
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    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.
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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.