Medicina
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Item “Tumor anexial en paciente adolescente”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2020-01-01) Freire Narváez, Juan David; Mena Villarroel, Luis ByronDr. Esp.Ovarian lesions represent a wide range of pathologies; they range from functional cysts to highly aggressive tumors. About 35% of these lesions in adolescent age are malignant and represent approximately 1% to 1.5% of all cancers at that age. They manifest themselves nonspecifically; sudden pelvic-abdominal pain, mass sensation, precocious puberty caused by endocrine abnormalities or asymptomatic behavior and be the casual finding to the clinical or imaging examination. Its diagnosis, in particular, that of malignant etiology occurs late given the low index of suspicion and the unspecific symptoms, in addition, a subsequent pathological study needed. This case corresponds to a 14-year-old adolescent with a history of mild hepatic steatosis and polycystic ovaries of casual diagnosis without treatment that came due to a history of pelvic-abdominal colic pain for 5 days accompanied by nausea and vomiting. Imaging studies demonstrate large mass in the pelvic cavity without altering tumor markers; In stable conditions, an exploratory laparotomy is performed, evidencing the right Ovarian Cyst of approximately 10 x 8 centimeters, polycystic left ovary and tubes and uterus of normal size and macroscopic characteristics. Right ovarian cystectomy is performed without oophorectomy and without complications during or after surgery with favorable evolution.Item “Ülceras cutáneas en insuficiencia venosa en pacientes con falla renal crónica”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Monge Riofrio, Christian Paul; Dr. Esp. Toapanta Yugcha, Iván GuillermoMale patient of 75 years of age, married, driver, born and resident of Coca, with a personal history of chronic renal insufficiency without treatment, venous insufficiency without treatment, arterial hypertension, without family, surgical or allergies. Patient is admitted to the surgery service from an outpatient clinic in the Coca hospital, since from 4 months he has pain in the lower limbs with a predominance of the right leg, of moderate intensity, as an apparent cause of having been in water at rest, as well as polyuria and nocturia from 3 months ago, it was accompanied by pruritus that ended up causing excoriations until reaching ulceration 3 months ago. To the patient physical examination consents, oriented, hydrated, FC 80, FR 20, systolic BP 120/80 diastolic mmHg, SO2 92% ambient air, T 37,6 C Skin and phantoms slightly pale, moist oral mucosal. Expandable, normal cardiopulmonary Thorax without added noises.Abdomen: Soft depressable painful to palpation in hypogastrium.Lower limbs: hyperpigmented skin Rots 2/5. Edema (++ / ++++) depression of up to 4mm and disappearance in 15 seconds that leaves no fovea with flushing and local heat, presence of ulcers in right leg in anterolateral side of lukewarm with purulent exudate of delimited edges excavated from granulomatous background. Exams: Ecodoppler of lower limbs reports chronic venous insufficiency. Blood chemistry reports creatinine of 3.36 mg / dl, urea of 81 mg / dl. Kidney echo and urinary tract: Kidney Right size and normal position of regular edges, homogeneous texture with increased echogenicity, several cystic images are visualized inside, small images of lithiasis are visualized towards its lower calyx of 0.60 cm not dilatation of the excretory duct. Left Kidney: retains its normal position, irregular contours increased its normal echogenicity, presence of renal cyst to its lower pole measuring 2.94 x 3.72cm, no dilation of its excretory system.Item “Artritis reumatoide seronegativa en paciente con complicación séptica pulmonar.”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Rodríguez Jordán, Jessica Alexandra; Morocho Llano, Domingo Dr. Esp.Rheumatoid arthritis is a systemic, chronic disease characterized mainly by inflammation of the joints, producing pain, deformity and difficulty in movement, although it can also affect other parts of the body, presenting extra-articular manifestations. The cytokines act as soluble mediators responsible for the inflammatory process, affecting, mainly the synovial membrane of the joints, with an estimated prevalence of 0.5-1% of the world population. The onset of the disease is usually insidious, with the predominant symptoms of pain, stiffness and joint edema. The early use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying drugs and tumor necrosis factor inhibitors can significantly change the clinical course of RA, thus preventing joint damage and disability. It presents a low frequency of spontaneous healing, with an optimal treatment a good control of the disease is achieved in most cases.Item “VIH más enfermedades añadidas orientadas con la atención de enfermería”(2017-09-01) Paredes Rodríguez, Gabriela Alexandra; Gavilanes Fray, Verónica del Pilar Lcdo. Esp.HIV / AIDS is a major medical, political and social concern, it is considered a public health problem, the number of cases has increased, the majority of the population that 15-49 years of age, which is a major health issue, the MSP plans to intensify HIV prevention among young people, transgender people, persons deprived of their liberty and sex workers in addition to eliminating stigma And discrimination based on sexual orientation, sex work, gender status, or living with HIV, the present case analysis presents a 36-year-old male, unmarried, childless patient who has been diagnosed with HIV A year ago, for which he has been admitted for 4 times to health care homes, the last time he was admitted to the REGIONAL TEACHING AMBATO hospital because of a referral from the center E salud THE MILAGROSA MEDAL for anemia, dehydration, oral candidiasis and HIV already diagnosed for which treatment was received, control after two days was discharged and receives control by external consultation. At present his state of health is in balance, attends periodically to the health center for their respective controls, there have been some health problems that have been treated and are response to the deficiency of his immune system, his emotional state is In constant changes because he does not have the support he needs. AIDS is the final stage of a chronic, transmissible progressive disease of viral cause in which a very diverse relationship is established between the host and the virus as the immunodeficiency progresses and the higher the virus replication will appear opportunistic diseases. During the investigation it was evidenced that the patient has an emotional state deteriorated by the disease that presents, in which different critical points were identified, risk factors that contributed to the appearance of new inconveniences that deteriorate their health day by day through the bibliographic review From different sources, interview and analysis of the clinical history, it has been possible to improve their average life style and the realization of a guide that presents the care that the patient must take. The guide designed for patients with HIV in which hierarchizes the needs they present, while helping to establish a balanced lifestyle, the development of a scientific article that will help identify the most frequent opportunistic diseases or infections in patients with HIV positive.Item Embarazo Ectópico Abdominal y Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Aucapiña Rodríguez, Luz Cecilia; Gavilanes Sáenz, Víctor Patricio Dr.The abdominal ectopic pregnancy is an exceptional anomaly that represents 1% of ectopic pregnancies; it is associated with high morbidity and mortality, maternal and fetal. The risk of maternal mortality is 7 to 8 times greater than a tubal pregnancy and it is 90 ectopic times greater than an intrauterine pregnancy. This is a pathology of difficult diagnosis that, in many cases, belatedly established and it is considered an obstetric emergency. Female patient of 23 years old who presents an abdominal pain of 2 months evolution and amenorrhea of approximately 17 weeks, she is admitted to Hospital General Puyo by abdominal pain in study and hypovolemic shock, βHCG is performed with positive result and eco FAST showing free liquid in abdominal cavity and an appearance of embryo outside the uterine cavity with movement, so it is considered a probable accident ectopic pregnancy. On physical examination is hypotensive, tachycardic with generalized pallor, Algic facies, oral mucosal semihumid. An Emergency exploratory laparotomy with identification of abdominal ectopic pregnancy, salpingectomy, right oophorectomy, partial omentectomy is performed. Also, compensation with blood products for trans-surgical cardiovascular instability is indicated. The patient is transferred to intensive therapy to control and manage cardiovascular. Presenting a satisfactory evolution and at 17 hours of admission she is discharged to continue handling by gynecology and obstetrics where she remains hospitalized 2 days and sent homeItem 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.