Ciencias de la Salud
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Item “shock séptico por colangitis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Naranjo Castillo, Andrea Carolina; Vásquez Cepeda, Fernando Xavier Dr. Esp.The case to be analyzed corresponds to a female patient of 52 years of age, with a history of Hypothyroidism 3 years ago on treatment with Levothyroxine 50 mcg, who goes to the emergency department for abdominal pain of 8 days of evolution that was exacerbated 24 hours, located in the right hypochondrium type of moderate intensity, radiating to ipsilateral dorsal-lumbar region, is accompanied by nausea that comes to vomit several times, so it is self-medicated tablets that does not specify, without clinical improvement. At the patient physical examination with Glasgow 15, TA: 124/80 FC: 86, FR: 22, SO2% 96%, icteric skin, painful abdomen on palpation at the level of the right hypochondrium, positive Murphy, complementary examinations are carried out and it is decided his admission to the surgery department with the diagnosis of acute cholecystitis, symptomatic cholelithiasis and choledocholithiasis. Procedures of endoscopic retrograde cholangiopancreatography are initiated through social work without a favorable response, it is performed 8 days later in a particular way, resulting in failure. After this patient develops unfavorably presenting with thermal boost, motor aphasia and right hemiplegia, surgical resolution is scheduled but family members do not authorize it. It is valued by Neurology who absolutely contraindicates surgical procedure. The Intensive Therapy service is consulted who values and recommends drainage of biliary obstruction, in spite of the risks. Surgical procedure is performed but cholecystectomy is not performed due to sepsis, it is postponed for second intervention. After this patient, he entered the Intensive Care Unit where, despite medical and surgical treatment, he progressed slowly, dying. Finally, a histopathological sample is received that reports stage IIIB vesicle cancer with metastasis to the liver, pancreas, bile duct and ganglion studied. The factors that led to aggravating the picture are then analyzed, conditioning its prognosis.Item “Shock séptico secundario a colangitis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Andrade Mariño, Luis Alejandro; Zavala Calahorrano, Alicia Marifernanda Dra.Ph.DThe cholangitis is pathology of relative frequency that produces a really dramatic illness that puts the patient's life at risk, being its precursor the choledocholithiasis either of primary or secondary origin, which occurs frequently in our society due to factors of prevalent risk in our environment. 95% of cases of cholangitis are caused by stones from the gallbladder; the remaining 5% has its origin in intra or extrahepatic ducts. The formation of stones has a complex pathophysiology with hereditary and alimentary components. The opportune diagnosis allows to make fast and effective decisions for the therapeutic of the picture, the delay in the therapeutic action produces the progression towards a sepsis and later septic shock with the consequent multiorgan failure that in a high percentage causes the death of the patient. The treatment of choice is the decompression of the biliary tract by retrograde endoscopic cholangio pancreatography as the first option, which is a timely, low cost, early recovery and good prognosis, however, sometimes it does not solve the problem and surgery is urgently needed. The adequate and multidisciplinary management improves the prognosis and reduces the potential complications during the hospital stay.