Medicina
Permanent URI for this collectionhttp://repositorio.uta.edu.ec/handle/123456789/815
Browse
3 results
Search Results
Item Hepatoesplenomegalia Secundario a Síndrome Antifosfolipídico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Lascano Laica, Gabriela Del Cisne; Mullo Guaminga, Guido Edgar Dr.Also called antiphospholipid syndrome antiphospholipid syndrome, anticardiolipin syndrome, antiphospholipid syndrome cofactor, Hughes syndrome; and in France known as Soulier-Boffe syndrome it is an autoimmune hypercoagulable state caused by antibodies directed against phospholipids of cell membranes, causing increased susceptibility to the formation of intravascular clots (thrombosis) in both arteries and veins, also complications related to pregnancy such as spontaneous abortions, fetal death, preterm delivery, or severe preeclampsia. The etiology and pathogenesis of these antibodies are not elucidated, the wide range of clinical manifestations could be explained by multiple mechanisms, it is said that this syndrome occurs due to an autoimmune disorder that leads to the production of autoantibodies directed against components of cell membranes called phospholipids (antiphospholipid antibodies or aPL). Thrombosis is a major disease mechanisms, primarily caused by the activation of endothelial cells, monocytes and platelets. Now it considered as one of the most frequently acquired and cerebrovascular accident (CVA) in under 50 causes of thrombophilia. More than 50% of lupus patients with aPL eventually develop SAF. The term "primary antiphospholipid syndrome" is used when the SAF occurs in the absence of other autoimmune diseases, while the term "secondary antiphospholipid syndrome" is used when the SAF occurs in the context of other autoimmune diseases such as systemic lupus erythematosus (SLE). In some rare cases, an EFF may lead to multisystem failure (multiple organ failure), sudden due to widespread thrombosis; in this case usually use the term catastrophic antiphospholipid syndrome, and presents a high risk of death. The evaluation is carried out mainly in a thorough medical history, physical examination and laboratory tests for antibodies phospholipid cardiolipin antibodies (aCL), anti beta2 glycoprotein I antibodies, lupus anticoagulant. For the diagnosis of antiphospholipid syndrome should be present at least one clinical and one laboratory finding. The goal of prophylactic treatment is to keep the patient INR between 2.0 and 3.0, however it is not often done with patients without any kind of thrombotic symptoms; During pregnancy, they heparins and low molecular weight low-dose aspirin instead of warfarin are used, due to the teratogenicity of warfarin. Women who have experienced recurrent spontaneous abortions are given prophylactic treatment with aspirin and initiate treatment with low molecular weight heparin disappears just recognize that their menstrual cycle. In refractory cases it can be used plasmapheresis.Item Síndrome Antifosfolipídico en adulto joven(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-08-01) Palate Amaguaña, Elsa Priscila; Mora Brito, Edgar VicenteDr.Male patient 39 years old. He born in Mother Earth in the province of Pastaza and resident in the Jatari community, mestizo, cohabiting marital status, complete secondary education, occupation agriculture, personal medical history of deep vein thrombosis 4 years ago. Patient comes upon referral Health Center to present about 24 hours ago abdominal pain, continuous type, 6/10, located in epigastric left upper quadrant radiating to further relates that fail nausea vomiting. Physical examination: blood pressure 105 / 78mmHg, heart rate 74 beats per minute, respiratory rate 22 breaths per minute, temperature 36.8ºC, BMI 26.6 m / kg. Abdomen presence of collateral venous network, tenderness epigastric and left upper quadrant, hepatomegaly two traverses palpated below the costal margin. Tips presence of violet plate 10 x 4 cm located in the left wing. According to the clinical and laboratory results, is suspected antiphospholipid syndrome, so tests that are processed through social work, they performed in a private laboratory, confirming the diagnosis so it is processed are prompted for an interconsultation to hematology in a third level institution also hepatosplenomegaly thought of the presence of portal vein thrombosis and Boud Chiari syndrome, which are discarded, continuing his study is studied. The patient is assessed by hematology treatment (enoxaparin 60 subcutaneous milligrams every 12 hours, warfarin 5 mg via daily oral), which evolves satisfactorily, therefore is discharged and continuous controls outpatient service is established, interconsultation also requested to hepatology.Item Acretismo Placentario(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) Buenaño González, Ricardo Andrés; Mera Ramos, Gerardo Vinicio Dr.Placenta accreta is a broad term that encompasses the conditions in which the placenta, in histopathological terms, can be accreta, increta or percreta. Being able to distinguish between these entities in clinical situations, is not easy. It remains a challenge even after diagnosis, except when the uterus is removed and subjected to pathological examination. Percreta placenta is the most serious placentas for their great invasion, and is associated with high maternal morbidity compared with other varieties. The case of a patient of 36 years old with a history of antiphospholipid antibodies and stillbirths syndrome occurs, is in her sixth pregnancy of 28.6 weeks and is diagnosed sonographically total occlusive placenta previa and placenta accreta. It is particularly treated with heparin and low molecular weight ASA. Prior to admission, heavy bleeding genital glittering red so it is transferred to Provincial Teaching Hospital Ambato, where diagnoses are confirmed. She underwent emergency caesarean with pregnancy diagnostics 28.6 weeks + Total occlusive placenta previa bleeding + antiphospholipid antibody síndrome + accretism + anticoagulated patient. As a complication of surgery percreta placenta is seen to vegija invasion, parametrial and cervix, so the total obstetric hysterectomy is performed without adnexectomy; hallo posteriormene is complicating bilateral ureteral ligation developing acute renal failure. Therefore it was necessary bilateral ureteral reimplantation, which yields box renal failure, and patient evolves favorably