Medicina
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Item Útero de Couvelaire y Óbito Fetal tras desprendimiento Normoplacentario en embarazo de 31.5 semanas(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Pérez Salazar, Carlos Andrés; Castro Acosta, Norma del Carmen Dra. Esp.Female patient of 31 years old, who is in her second pregnancy, currently 31.5 weeks of pregnancy with no medical or family history of importance, who has about 6 hours ago abdominal pain, cramping, located in the lower abdomen and irradiated region lumbar, high intensity +++ / +++ (hand intensity from 0 to three crosses), its accompanied by vaginal bleeding, glittering red in small quantities, why go to health center where evaluating Quero and refer to emergency service HPDA so it is entered the service of Gynecology and Obstetrics. With a Pregnancy diagnosed of 31.5 weeks + placental abruption + fetal death, so that emergency caesarean section was performed, finding a womb Couvelaire more stillbirth procedure continues with Hysterectomy, the service is requested interconsultation Intensive Care who value and enter that area, diagnosed with hypovolemic shock, Hysterectomy, placental abruption, renal failure.Item Hematoma Subcapsular Hepático como Complicación del Procedimiento Colangiopancreatografía Retrógrada Endoscópica (Cpre)(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) Areopaja Escobar, Ana Gabriela; Pancho Zela, Marlon Mauricio Dr.In order to know the causes that lead to liver subcapsular hematoma post Endoscopic retrograde cholangiopancreatography (ERCP), the following case is analyzed occur. 47-year-old cholecystectomiced 10 years ago; 3 months entered in the service of General Surgery, abdominal pain of great intensity and jaundice, through laboratory tests are diagnostic of acute pancreatitis lithiasic origin, it is sent to perform an ERCP where they observe dilated bile duct and perform endoscopic sphincterotomy makes biliary stent placement, posterior apparent improvement icterohemorrhagic presented obstructive picture for which he was discharged. At 10 days post ERCP comes a new abdominal pain of great intensity, perform abdominal ultrasound which reported fluid collection in volume of approximately 240 ml located between the diaphragm and the right lobe of the liver, which indicate drainage directed the Subdiaphragmatic liquid which is not performed risk of acute bleeding, as was compatible with hepatic subcapsular, probably secondary to complications of the procedure ERCP, hematoma indicate conservative clinical treatment with antibiotics, and wait reabsorption of hematoma or decide to transfer to tertiary hospital for probable surgical resolution. It is not transferred and expectant management is decided, the next few days continues with analgesics and intravenous antibiotic, the patient has adequate hemodynamic stability and decides to discharge. Patient came to controls with ultrasounds results where reported that the collection had been reabsorbed liquid 110ml, 100ml and after continuing indicated Watchful waiting for the full resorption of hematoma. ERCP is a complex procedure, ideally endoscopists are highly trained; however, you can not avoid complications in most cases.