Medicina
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Item “Obstrucción de intestino delgado secundario a ascariasis masiva”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-10-01) Casa Yugcha, Nataly Silvana; Viteri Carrillo, Juan Pablo Dr. Esp.Las infecciones parasitarias siguen constituyendo un gran problema de salud pública. Se estima que a nivel mundial más de un tercio de la población está afectada por parásitos intestinales, encontrándose las tasas más altas en los niños de edad escolar.4 En base a estudios realizados por la Organización Mundial de la Salud, se estiman que 2000 millones de personas están en riesgo de enfermar, 300 millones tienen morbilidad severa asociada y 155000 mueren anualmente en todo el mundo por presentar enfermedades causadas por parásitos intestinales; y de ellos en Latinoamérica entre el 20% al 30% de las personas se encuentran afectados con parasitosis, aumentando en un 50/% a 95% en las zonas rurales, por las condiciones de vida que incluyen la falta de servicios básicos, escasos conocimientos de la población sobre la salud, falta de condiciones sanitarias, entre las principales. 24 Las helmintiasis transmitidas por el suelo son una de las parasitosis más comunes en todo el mundo y afectan a las comunidades más pobres y desfavorecidas. Son transmitidas por los huevecillos de los parásitos eliminados con las heces fecales de las personas infestadas, los que a su vez contaminan el suelo en zonas donde el saneamiento es deficiente.3 A. lumbricoides es el nematodo intestinal de mayor tamaño, cuyas hembras adultas producen gran cantidad de huevos fértiles no embrionados que son eliminados en las heces de un individuo parasitado, contaminando el suelo, en donde, si existen condiciones favorables, pueden embrionarse en un lapso de dos a ocho semanas; las personas pueden infestarse al consumir agua o alimentos contaminados.4 La infestación masiva por áscaris lumbricoides es una de las causantes principalesde obstrucción intestinal, siendo la población infantil la más afectada ya que por su conformación anatómica presenta intestinos más pequeños y delgados haciendo más fácil la obstrucción, otros factores coadyuvantes en niños son:desnutrición, déficit higiénico, ausencia de controles médicos y desparasitaciones constituyéndose en factores potenciales para el desarrollo de infestación por parasitos.14Item “Fístula enterocutánea secundaria a adherencias intestinales + resección de segmento intestinal por laparotomía con anastomosis de termino terminal por isquemia intestinal + abdomen congelado”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Pacheco López, Carolina Lissette; Vélez Salgado, Jaime Efraín Dr. Esp.The Enterocutaneous fistulas are pathologies that represent a very large problem in surgical practice. They usually present in postoperative processes developing 90% after surgery. Despite medical advances, morbidity and mortality rates remain high. In the clinical case studied, three complications were identified: electrolyte imbalance, levels of malnutrition and sepsis. The objective of the management of the presented clinical case is the spontaneous closure and the installation of an adequate nutritional support to achieve the success of the treatment. The control of sepsis is a priority, uncontrolled sepsis must be attacked quickly because it is the main cause of death. Spontaneous closure has increased in recent years; however, it is likely that still a large part of the patients merit surgical treatment, and this must be done at the right time.Item “Abdomen agudo obstructivo secundario a íleo biliar”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Jiménez Espín, Galo Paúl; Pozo Mayorga, Fernando PatricioDr. Esp.Gallstone ileus is a serious condition due to not being diagnosed opportunely caused by the migration of a stone to the intestinal lumen through a biliary fistula being a rare cause of acute obstructive abdomen representing 1% to 4% of cases. Mortality rates of between 12 to 27% and morbidity of up to 50% have been described due to the critical state in which most of these patients are found (3). A 72-year-old male patient presents with generalized abdominal pain of great intensity without apparent cause of 5 days of evolution and nausea that reaches content vomiting. In pharmacy they prescribe paracetamol and hyoscine bromide without improvement. Physical examination: BP: 110/60 CF: 84X', BF: 20X', ° T: 36.5 °, O2: 84% Weight: 56kg. Patient awake, obeys verbal orders, semi-humid oral mucous membranes. Cardiovascular: rhythmic, normofonetic heart sounds, no murmurs are heard. Respiratory: decreased vesicular murmur, presence of rales in both lung bases. Abdomen: distended, painful to superficial and deep palpation Blumberg (+), increased tympanic percussion and decreased hydro-aerial sounds with metallic tone. Laboratory and imaging tests were requested: leukocytes13600, hemoglobin 21.4g / dL, hematocrit 75%, platelets 358000, neutrophils 88.3%, lymphocytes 6.6%. Urine: bacteria +++, pyocytes 15-18xc, red blood cells 1-2xc. Abdominal ultrasound: Gallbladder inside it is observed multiple lithiasic images, in addition to important dilation of bowel loops with fluid and peristalsis of fight. Abdominal x-ray: intestinal dilation and presence of hydro-aerial levels. Hydration, antibiotic, and laparotomy are started by finding the jejunum and ileum dilated with a +/- 5cm long by 3cm diameter, before which we decided to extract more primary raft of the ileum. He remains hospitalized for 7 days and evolves without complications.Item Adenocarcinoma de Colon(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Moreno Proaño, Verónica Katherine; Yépez Yerovi, Fabián Eduardo Dr.In this case of a male patient of 46 years is admitted emergency to present acute abdomen is analyzed. It is operated on performing a laparotomy diagnosed with intraoperative finding of a mass of about ascending colon, hard attached to retroperoitoneo, and liver nodules and macronodular liver which is subjected to histopathological analysis, reaching the diagnosis of colon adenocarcinoma. The early diagnosis of this disease is directly related to life expectancy, which is essential knowledge and proper handling. The clinical case is presented interactively to achieve greater understanding and interest. Exhaustively analyzed medical history and physical examination performed during hospitalization. Subsequently reviewed generally the clinical presentation of the case, based on the initial diagnosis of acute abdomen patient. a differential diagnosis is based on clinical history and physical examination, laboratory tests, image and patient management. Finally a complete review of Colon Adenocarcinoma is performed.Item Linfoma no Hodgkin Intestinal como causa de Obstrucción Intestinal(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Escobar López, Gabriela Silvana; Yépez Yerovi Dr., Fabián EduardoFor female patient, 31 years old, with personal pathological history of hypertension 4 months without treatment, family medical history is presented; deceased sister 3 months ago with gastric cancer and systemic lupus erythematosus; and hypertensive mother. Patient comes to the emergency room with abdominal pain of a month of evolution, which intensifies 24 hours, located in epigastric cramping of great intensity that radiates flank and right iliac fossa, accompanied vomited food content three times and abdominal distention, constipation also relates a week ago. In the review of instruments and systems are asthenia and fine lees for about a month, weight loss of 10 kg 8 months ago. The patient consents physical examination oriented, algid, afebrile, hydrated. Abdomen globose, soft painful epigastric tenderness and right iliac fossa, Mac Burney and positive Bloomberg depressible. In laboratory tests striking a hemoglobin of 6.9 g / dL and a hematocrit of 24.4%, 54.4 MCV, MCH MCHC 15.4 and 28.3. The entry into service of surgery is decided with a diagnosis of acute abdomen and exploratory laparotomy was performed, in which tumor mass is at the level of terminal ileum 45 cm of ileocecal valve occluding the intestinal lumen 10 by 12 cm. And diverticulum ileal 50 cm of ileocecal valve. Diverticulum and tumor resection is performed with oncologic criteria with terminal end anastomosis, and sample is sent for histopathological examination; which reports intestinal non-Hodgkin lymphomItem Necrosis Intestinal Infantil Post Traumática(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Zurita Mayorga, Lineth Carolina; Sánchez Miño, Jorge Isaac Dr.Femenine patient of 1 year 10 months, born and resides in Ambato (Pasa), product of second poorly, controlled pregnancy feat, well tolerated, domiciliary eutocic birth at nine months gestation, crying immediately after birth, underfed, imunizations complete for the age, adequate psychomotor formation, no personal or family history of pathologic significance. Patient 48 hours ago suffered a fall down steps (aproximately 5 steps) impacting their abdomen on concrete, 24 hours ago displays abdominal distention, refuses to eat, is found hyperactive, so they will lead to the emergency of the Provincial General Teaching Hospital in Ambato, the physical exam FC 100 beats a minute, FR 60 a minute, axillary temperature 36.2 0C, weight 10.3 kg. The examination hyperactive, irritable, oropharynx erithmatous, congestive, abdomen distended, RHA absent, tympanic percusión painful. Placed nasogastric tube being obtained 200 ml of greenish liquid, with a diagnostic of acuto abdomen obstruction and normocytic anemia, recieve hydration, analgesic, antibiotic therapy (Ampicilin and Sulbactam), labaratory exams, alkaline phosphatase: 292u/lm TP:24, 33, HB:8.4, HTC:26.4, leucocytes:22430, neutrophils: 17.59. Evaluated for surgery hyperactive is established patient with respiratory dificulty, abdomen very distented, RHA absent. In the X-ray of abdomen air fluid levels it is noted. Exploratory laparotomy found a heamoperitoneum of aproximately 800 ml in abdominal cavity, ruptura of intestinal meso with active bleeding, intestinal necrosis of aproximately 60 cm of the Treitz angle, rest of intestine with signs of edematous ischemia, spleen and liver of normal characteristics, with ileus anastomosis- ileal, released 60 cm from the angle of treitz and abdominal wash. Continues hospitalized in ICU for postsurgical control during four days displaying good clinical evolution, later it is transferred to Pediatric Services with diagnosis of closed trauma of the abdomen, ruptura of the intestinal meso, intestinal necrosis with ileus anastomosis- ileal, released after 28 days of hospitalization with frank improvement of their situation.Item Ruptura Vesical en Trauma Abdominal Secundario a un Accidente de Tránsito(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Pazmiño Andrade, Roxana Cristina; Yépez Yerovi, Fabián Eduardo Dr. Esp.Abdominal trauma is a common worldwide entity with the main cause traffic accidents. In our country accidents are among the five leading causes of death in the general population, so the trauma is the leading cause of deaths unrelated to an underlying disease. In blunt abdominal trauma, bladder injury is a rare entity and must meet precise physiological characteristics as this is distended that the present conditions it to break up with a soft thump. Bladder rupture may go unnoticed when associated with severe trauma and substances that alter an adequate response as the intake of alcohol. For the above conditions the importance of appropriate initial assessment of the patient with a detailed medical history, a thorough analysis of all risk factors, mechanisms of injury, physical examination and additional tests to reach a true diagnosis is emphasized. The management of intraperitoneal bladder rupture through the years and until now has been considered a surgical emergency; based on a quick scan with repair and bladder drainage this being the mainstay of treatment. So obtaining an excellent prognosis. This clinical case is a 30 year old patient presenting bladder rupture blunt abdominal trauma. The analysis of this case aims to generate scientific basis about the subject.