Medicina
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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 “Enfermedad de Hirschsprung en niño de 2 años con diagnóstico inicial de abdòmen obstructivo”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-02-01) Iza Tutillo, Johanna Maribel; Reina Naranjo, José Patricio Dr. Esp.Hirschsprung disease or aganglionism is considered a congenital disease characterized by the absence of ganglion cells in the myenteric plexus of Auerbach and in the submucosal of Meissner, it is produced by a halting in the migration of the cells of the neural crest during the embryological period At the twelfth week of gestation, the earlier this arrest is, the longer the segment will be affected, the pectine line being the lower limit of the disease, thus affecting the rectum and other segments of the colon in ascending form. This alteration produces an abnormality of intestinal motility, which frequently manifests as a functional intestinal obstruction with an incidence of 1 case per 5,000 live births, more frequent in males in a 3-5: 1 ratio. This ratio decreases to 2: 1 when the affected segment is longer. The disease usually presents with abdominal distention, progressively constipation, vomiting, anorexia, fatigue, physical inactivity, pondoestatural deficit, tendency to enteral infections. The disease can be associated with other medical syndromes, more than 90% corresponds to Down syndrome. It is important to make a timely diagnosis, especially in the neonatal period. The first diagnostic orientation is given by radiography, which can be very helpful in giving a first approach to diagnosis. Anteroposterior and lateral abdominal radiographs, which show abnormal distribution of intestinal air, rectum empty and sometimes signs of obstruction, are required for the definitive diagnosis. An intestinal biopsy is performed in which there is absence of parasympathetic plexus ganglia and the entlex plexus. Its treatment is always surgical in order to eliminate the affected colonic segment. The present case is a 2-year-old boy, who consults with the Emergency Service of the General Provincial Hospital Latacunga, for having vomiting, abdominal distention, and has not performed bowel movements for 6 days. After being assessed, he is admitted to the diagnosis Presumptive obstructive abdomen. In order to corroborate the diagnosis, laboratory tests and an abdominal radiograph were urgently requested.