Ciencias de la Salud
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Item VISIÓN GENERAL SOBRE LAS NUEVAS TÉCNICAS EN EL MANEJO DE LA OSTEOMIELITIS AGUDA Y CRÓNICA(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2024-09-26) Cevallos Mejía, Ariel Mateo; Toctaquiza Silva, Roberto CarlosOsteomyelitis is an inflammatory disease that affects the bone and is caused by an infectious process that leads to inflammation. This process represents a high morbidity and as a consequence could lead to disability. The most common microorganisms related to the pathology are Staphylococcus aureus and Staphylococcus epidermidis. There are two well-defined forms, acute and chronic, which are differentiated by the presence of necrotic bone. Acute osteomyelitis is of hematogenous cause and is predominant in pediatric age, and it is important to note that in the initial stages we will not find dead bone; and the difference with chronic osteomyelitis is that here we do find necrotic bone, product of the arrival of pathogens to a bone affected by surgery or trauma. The therapeutic approach is multidisciplinary and depends on the stage of the disease and its classification, and is based on six fundamental pillars: surgical debridement, microbiological diagnosis, obliteration of the dead space, antibiotic therapy directed to the causative microorganisms and finally the reconstruction of soft tissues and bone.Item “Absceso pancreático secundario a pancreatitis aguda”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-10-01) Chamorro Barona, David Enrique; Guanuchi Quito, Franklin Dr. Esp.Pancreatic abscess is a circumscribed collection of pus, with little or no necrotic content. It is usually a complication of severe pancreatitis, four weeks after the onset of symptomatology, product of necrosis with subsequent liquefaction of tissue and secondary infection, constituting the abscess, and located in the vicinity of the affected organ. The symptomatology is non-specific, so the finding of gas is the only specific radiological sign, and percutaneous bacteriology is the only method to confirm the diagnosis in the preoperative period. Translated with www.DeepL.com/TranslatorWe present the case of a male patient of 27 years old, who was treated in the emergency service of the Ambato General Teaching Hospital for abdominal pain, which was catalogued as surgical problem, an exploratory laparotomy was performed, finding steate necrosis on the epiplon, and purulent collections on the pancreas’s tail and body, as well as purulent fluid on retroperitoneum. The abscess was drained and 3 drainages were put, 2 of the, on epigastrium and the last one on the left parietal-colic slide, the patient was also treated with broad spectrum antibiotics. The present work pretends to identify the critical points of the attention, proposing a therapeutic and diagnostic strategy for the management of severe pancreatitis and complications.Item Pancreatitis Aguda Necrótica Infectada con Fistula Enterocutánea(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Rodríguez Conza, Diana Karolina; Rodas Álvarez, Fausto Patricio Dr.Acute pancreatitis is a relatively common disease. With an incidence of 35-80 cases for 100.000 people every year. The clinical results of the AP depend of the presence of necrosis and systematic complications. Among the facts that are associated with the worst prognosis are precisely necrosis, infection and multiple organ failure, which can have a mortality rate as high as 50%. In the case of infected pancreatic necrosis the Guidelines by the International Association of Pancreatology recommended that surgery should be performed between the third and fourth week of the onset of symptoms, there is an association between mortality and time of pancreatic surgery. Necrosectomy within two weeks of admission, is associated with a mortality of 100%, probably because of hemorrhage, in a situation where the obliteration of arterioles is not total, the longer allows areas of necrosis are organized demarcate and thus achieving a better debridement of necrotic tissue in a single surgical procedure, reducing complications and costs. This clinical case corresponds to a male patient of 65 years with personal medical history of hypertension treated with Losartan 100 mg orally QD, Diabetes Mellitus type 2 in treatment with Vildagliptin 50 mg orally QD, habits: Alcohol: every 15 days to arrive drunkenness, until 30 years ago, snuff: from age 18, smoking two cigarettes a day. Who came for presenting abdominal pain high intensity, 7 days evolution, Omeprazole 20 mg orally BID self-medicate with what pain partially stopped, 6 hours ago the problem is exacerbated and nausea is added that arrives vomiting, more apparently blackish deposition, the physical examination reveals slightly tense abdomen, nonpitting, painful on palpation in epigastric and right upper quadrant, decreased bowel sounds, laboratory test results report amylase: 3110 U/L and lipase 786.7 U/L besides neutrophilic leukocytosis, abdominal CAT reports acute pancreatitis type C, so he is interned in ICU, within 72 hours of hospitalization is repeated abdominal CAT scan reporting acute pancreatitis type E, abdominal ultrasound reports: cholelithiasis, RX ray shows bilateral pleural effusion, antibiotic treatment is started, the 5th day refers to patient General Surgery where he remained hospitalized for a period of 15 days after presenting a favorable evolution of its case of pancreatitis, tolerate oral doses, asymptomatic way, it is decided high and surgery on an outpatient basis is planned, the 5th day of patient discharge is hospitalized for abdominal + vomiting + jaundice pain again, ultrasound reporting choledocholithiasis so it is sent to ERCP, it is realized that it failed due to elimination of purulent fluid in the second portion of duodenum and not identify papilla is planned TAC + drain intrapancreatic collection, it reports necrosis >50% + multiple intrapancreatic collections so that no drainage is due to risk of gastric perforation, is transferred to a unit of third level where abdominal sepsis is diagnosed by infected pancreatic necrosis + pancreatic abscess + acute cholecystitis and drainage of pancreatic abscess + necrosectomy + cholecystectomy and the patient is transferred to the ICU of the English Hospital, where it remains hospitalized for three weeks; 4 months later is interned again in the Department of General Surgery for opening enterocutaneous fistula (pancreatic), which is progressing well and achieves the closure of fistula by conservative treatment.Item 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 Necrosis Ganglionar Cervical Secundaria a Neoplasia(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Sánchez Barrionuevo, Rodrigo Sebastián; Romo López, Ángel Geovanny Dr. Esp.This case corresponds to a male patient, 84 years old, born in Guaranda and Ambato resident, married, primary education level, with a history of hypertension, COPD, coronary syndrome. Patient admitted to the ENT service of Hospital IESS Ambato, with progressive dysphonia, in addition to dyspnea great efforts, accompanied by cough with yellow sputum in moderate amounts, it has received multiple antibiotic therapy without resolution of symptoms regarding the service of Internal Medicine multiple findings of lymphadenopathy. At slightly erythematous ORF physical examination, lymphadenopathy was confirmed in right supraclavicular chain, no axillary lymphadenopathy. TAC Neck: cervical lymph nodal image shown right, with necrotic center, measures 2.6 x 2.2 cm in infratiroidea location. Chest CT: moderate pericardial effusion seen. Lymphonodal multiple images with necrotic center in all the major chains mediastinal masses in left hilar region is in intimate contact with thoracic vessels, including wraps the left lung field. Nasofibrolaryngoscopy erythema is evident at the regional level supra glottal, with the presence of increased vascularization also shift it to right medial latero paralysis aritenoides, vocal cord and left ventricular band, fold arietenoepiglotico tense presence of abundant secretion is observed. The patient is transferred to Oncology Unit to present symptoms compatible with adnexal mass ganglionic chain. clinical status, evolution, treatment, prognosis, as well as the critical points in patient care is analyzed and guidelines for improvement arises.Item “Tratamiento quirúrgico y clínico y su incidencia en pacientes con pie diabético en el área de medicina interna del hospital provincial general docente Ambato en el período enero- diciembre 2009”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2010-03-01) Pérez Ortiz, Jadira Alexandra; Dr. Bolívar Guerrero