Ciencias de la Salud
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Item Coledocolitiasis con cáncer de hígado(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2021-06-01) Santamaría Correa, Mayra Alexandra; Chicaiza Tayupanta, Jesùs Onorato Dr. EspObjetive: To analyze the clinical manifestations, diagnosis and treatment of choledocholithiasis in a patient with an incidental finding of liver cancer for a timely diagnosis and proper management. Discussion: The case of a 52-year-old female patient is presented, who presents a clinical picture of abdominal pain, located in the epigastrium of mild to moderate intensity that radiates to the right hypochondrium, colic type, accompanied by choluria, laboratory tests are performed and image reaching the diagnosis of choledocholithiasis that following the ASGE criteria there are 2 very strong criteria that indicate the performance of ERCP, during the procedure the patient presents cardiorespiratory arrest so he is admitted to the ICU where he presents multiple complications and several laboratory and imaging studies are performed obtaining the diagnosis of cholangiocarcinoma in metastatic stage, reason for which he presents multiorgan failure, reason for which he dies. Conclusions: Materials and methods: After the analysis of the clinical case and the bibliography it is concluded, the ASGE criteria for choledocholithiasis are not totally effective for the diagnosis and management of this pathology since, as in the present case, there was a basic pathology that was cholangiocarcinoma that could have been detected by means of other diagnostic imaging methods since this pathology generally presents symptoms in late stages, for which other methods are currently being studied so that this pathology can be diagnosed early.Item Manejo de coledocolitiasis mediante la colangiopancreatografía retrograda endoscópica (CPRE) en pacientes geriátricos: a propósito de un caso(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2021-01-01) Beltrán López, Édison Gabriel; Yépez Yerovi, Fabian Eduardo Dr. Esp.Choledocholithiasis is considered the main cause of bile duct obstruction, it occurs in 5 to 10% of clinical patients with symptomatic cholelithiasis and in up to 18 to 33% of clinical patients with biliary pancreatitis. It is a frequent pathology that the general surgeon is faced with, although in the medical literature there are different tools for its diagnostic approach depending on whether the patient has a high or low probability of having it from the result of paraclinical studies (Hepatic profile and hepatobiliary ultrasound). These scales were developed to be applied in patients with or without gallbladder in situ, for an adequate diagnosis and therapeutic management. There are studies that have shown that the paraclinical laboratory and imaging results may have variations, which is why the feasibility of using the ASGE scale as predictors of choledocholithiasis in these patients has been proposed. Using this scale, it would help us to better determine the study of these cases, saving Hospital resources, by defining which patients benefit from extension studies such as cholangioresonance or ERCP, taking into account the possible complications associated with this procedure.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.Item Fistula Biliar con Síndrome de Mirizzi(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) Salguero Lozada, Johana Monserrath; Blacio Villa, Carlos Omar Dr.SUMMARY This study analyzes the clinical case of a patient Fistula Bladder Syndrome Mirizzi, disease, biliary tract is one of the most common diseases in the surgery department, and Mirizzi syndrome is one of the infrequent complications of these pathologies but with timely and appropriate treatment can be prevented. This is a female patient of 22 years who presented to the Emergency “Hospital Provincial Docente Ambato” on several occasions for a month to present epigastric pain radiating to the right upper quadrant where it is treated as a disease peptic acid, the day of admission exacerbated box, characterized by abdominal pain of great intensity that is accompanied by nausea, vomiting arriving food content once. Patient oriented physical painful on palpation examination consents right upper quadrant, abdominal soft depressible. Where it is treated with acid peptic disease diagnosis by not improve the picture communicates surgery which valued decide, request additional examinations and imaging; eco reports cholecystitis - cholelithiasis so their income is decided and surgical treatment is performed to the three patient days jaundice and decided to perform ERCP reporting dilated bile duct 8mm, 5mm choledocholithiasis with calculation. Papillotomy calculation is performed and is removed, after which bile output is displayed in height forming a small cystic bilioma.