Medicina
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Item Pancreatitis Aguda Necrótica Infectada con Fistula Enterocutánea(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Rodríguez Conza, Diana Karolina; Rodas Álvarez, Fausto Patricio Dr.Acute pancreatitis is a relatively common disease. With an incidence of 35-80 cases for 100.000 people every year. The clinical results of the AP depend of the presence of necrosis and systematic complications. Among the facts that are associated with the worst prognosis are precisely necrosis, infection and multiple organ failure, which can have a mortality rate as high as 50%. In the case of infected pancreatic necrosis the Guidelines by the International Association of Pancreatology recommended that surgery should be performed between the third and fourth week of the onset of symptoms, there is an association between mortality and time of pancreatic surgery. Necrosectomy within two weeks of admission, is associated with a mortality of 100%, probably because of hemorrhage, in a situation where the obliteration of arterioles is not total, the longer allows areas of necrosis are organized demarcate and thus achieving a better debridement of necrotic tissue in a single surgical procedure, reducing complications and costs. This clinical case corresponds to a male patient of 65 years with personal medical history of hypertension treated with Losartan 100 mg orally QD, Diabetes Mellitus type 2 in treatment with Vildagliptin 50 mg orally QD, habits: Alcohol: every 15 days to arrive drunkenness, until 30 years ago, snuff: from age 18, smoking two cigarettes a day. Who came for presenting abdominal pain high intensity, 7 days evolution, Omeprazole 20 mg orally BID self-medicate with what pain partially stopped, 6 hours ago the problem is exacerbated and nausea is added that arrives vomiting, more apparently blackish deposition, the physical examination reveals slightly tense abdomen, nonpitting, painful on palpation in epigastric and right upper quadrant, decreased bowel sounds, laboratory test results report amylase: 3110 U/L and lipase 786.7 U/L besides neutrophilic leukocytosis, abdominal CAT reports acute pancreatitis type C, so he is interned in ICU, within 72 hours of hospitalization is repeated abdominal CAT scan reporting acute pancreatitis type E, abdominal ultrasound reports: cholelithiasis, RX ray shows bilateral pleural effusion, antibiotic treatment is started, the 5th day refers to patient General Surgery where he remained hospitalized for a period of 15 days after presenting a favorable evolution of its case of pancreatitis, tolerate oral doses, asymptomatic way, it is decided high and surgery on an outpatient basis is planned, the 5th day of patient discharge is hospitalized for abdominal + vomiting + jaundice pain again, ultrasound reporting choledocholithiasis so it is sent to ERCP, it is realized that it failed due to elimination of purulent fluid in the second portion of duodenum and not identify papilla is planned TAC + drain intrapancreatic collection, it reports necrosis >50% + multiple intrapancreatic collections so that no drainage is due to risk of gastric perforation, is transferred to a unit of third level where abdominal sepsis is diagnosed by infected pancreatic necrosis + pancreatic abscess + acute cholecystitis and drainage of pancreatic abscess + necrosectomy + cholecystectomy and the patient is transferred to the ICU of the English Hospital, where it remains hospitalized for three weeks; 4 months later is interned again in the Department of General Surgery for opening enterocutaneous fistula (pancreatic), which is progressing well and achieves the closure of fistula by conservative treatment.Item Calidad de Diagnóstico de un Seudoquiste Pancreático(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Sánchez Centeno, Edgar Israel; Atiaja Arias, Jeanet Verónica Dra. Esp.The Pancreatic pseudocyst is a collection of fluid encapsulated with an inflammatory wall defined usually outside the pancreas with minimal or no necrosis. Rich in amylase and other pancreatic enzymes without communication with the main conduit. They occur after 4 weeks after the onset of acute pancreatitis, and develops as a postsurgical complication. The case of a female patient of 22 years with a clinical picture of 15 days of evolution is presented. Physical examination unquantified characterized by abdominal pain and asthenia, nausea, vomiting, mild headache holocraneana, thermal rise. The Eco and Computed Tomography (CT) Abdominal concluded with the diagnosis of pancreatic pseudocysts so he was made a cistoyeyunoanastomosis splenectomy and distal pancreatectomy more. After two weeks the patient comes predominance presenting abdominal pain at the site of surgical intervention, so he entered. He underwent an ECO and an abdominal CT scan which concludes with ileus Intestinal hospitalized for 6 days, receiving good response after treatment and discharge decide on favorable terms. At three weeks after discharge the patient comes presenting moderate abdominal pain accompanied by nausea, vomiting, malaise and signs of dehydration. It is assessed by the Internal Medicine concluded as a diagnostic electrolyte imbalance and dehydration. Receive analgesia and hydration treatment, no complications so it is given a medical discharge. Next control is indicated but no go.Item Insuficiencia Renal Aguda por el uso de Aines(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Curipallo Caiza, Andrea Carolina; Lituma Jumbo Dra. Esp., Rosalina de LourdesIntroduction. Acute renal failure (ARF) is defined as the decreased ability of the kidneys to eliminate nitrogenous waste products, which is established in hours to days. The etiology may be pre-renal, among them the use of NSAIDs decreases prostaglandins, who regulate vasodilation glomerular or there is an infiltration of inflammatory cells in the interstitium of the kidney, also it presented by renal causes and post-renal. So it is necessary to detect the initial damage to prevent progression and initiate timely treatment and if necessary the use of renal replacement therapy techniques are valued Objective. thoroughly analyze the clinical case to arrive at a proper diagnosis of ACUTE RENAL Development. This case corresponds to a male patient of 23 years without a history major, who came to the emergency room for posterior lumbar pain trauma inebriated (fall in tiers from his own height) is analgesic treatment for 3 times for long time, 8 days after Acute renal failure has apparently NSAID use the same treatment expectantly recovers Conclusions. There are multiple causes of renal failure, one NSAID use so it should be avoided in patients at risk and renal failure especially in the hospital setting.