Ciencias de la Salud
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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 “Cuidados de enfermería en paciente pediátrico con pancreatitis idiopática y su influencia en la calidad de vida”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Enfermería, 2018-04-01) Clavijo Gallegos, Angie Teresa; Gavilanes Fray, Verónica del Pilar Lcda. Mg.Pancreatitis is an atypical pathology in children, which is why it represents a diagnostic challenge for the entire health team. Although the majority of cases of pancreatitis in adults is caused by gallstone and exaggerated alcohol intake, the etiology for pancreatitis in children is varied. That is why in young patients it is necessary to suspect hereditary, infectious or traumatic causes. Our objective is to analyze the specific causes of pancreatitis disease in relation to nursing care through a literature review and clinical history. This present analysis is a quasi-experimental research of community testing, which allowed to establish contact with the reality of the patient, conducting a direct interview, review of documentation, books, scientific articles and clinical history. It was carried out with the purpose of identifying the influence of the nursing team in the prevention and promotion of health in nursing care in patients with Pancreatitis. During the development of this work we could see a patient who does not have a good quality of life, identified several risk factors and some critical points. The critical points that were found in the present clinical case were established, where when assessing the nutritional status of the child it is affected due to the fact that in his home there is not the necessary education and knowledge about an adequate and balanced dietItem “Paciente con pancreatitis postraumática y la influencia de los cuidados de enfermería.”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Enfermeria, 2017-05-01) Chávez Fajardo, Alexandra Belén; Zabala Montes de Oca, Magali Verónica Lic.Introduction: Traumatic lesions of the pancreas are uncommon but they are accompanied by a great morbidity and mortality, especially if the diagnosis is delayed and consequently the treatment, a relatively common thing given its poor symptomatology. Objective: To analyze the pathogenesis and risk factors involved in the development of pancreatitis in a patient with closed thoracic trauma and the influence of nursing care for its treatment and recovery. Methodology: Descriptive and field, which allowed to establish contact with the patient's reality, conducting direct interviews, surveys that will be supported with bibliographical sources, books, documents, scientific articles. Results: This analysis was carried out with the purpose of identifying the influence of the nursing team in the prevention and promotion of health in nursing care in patients with Posttraumatic Pancreatitis. During the development of this work it was possible to appreciate a patient who does not have a good quality of life, several risk factors and some critical points were identified. Conclusions: Based on the identification of different needs, a Guide to activities aimed at satisfying the needs presented by the patient is proposed. Among the improved aspects we have lifestyles, self-esteem and self-care.Item “Pancreatitis aguda durante el embarazo”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-02-01) Villacís Recalde, Richard Guillermo; Salazar Faz, Fernando AbelDr. Esp.Item Coledocolitiasis en adolescente de 14 años de edad.(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Villafuerte Jaramillo, Silvana Cristina; Bracero Tobar, Wellington Ivar Dr.By clinical problems present a case of a male patient of 14 years old, Hispanic, unmarried, Catholic, student, born and living in Ambato, without personal and surgical medical history. Presents five days of abdominal pain, unexplained, colicky, located in epigastric and right upper quadrant, high intensity, accompanied by asthenia, 24 hours after jaundiced skin and sclera, nausea arriving vomiting of food content and dark urine. Eco abdominal roundworm reported in bile duct, 4 days later ERCP rule roundworm and retirement calculation of Oddi. ERCP is complicated with acute pancreatitis (3) which resolved spontaneously with supportive treatment in 15 days. We conclude that although it has been reported high percentage of common bile áscaris. (18) ERCP is the standard to identify the cause of obstruction Gold because the echo just have a sensitivity and specificity in identifying the cause that does not exceed 40% (4)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 Calidad de Diagnóstico de un Seudoquiste Pancreático(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Sánchez Centeno, Edgar Israel; Atiaja Arias, Jeanet Verónica Dra. Esp.The Pancreatic pseudocyst is a collection of fluid encapsulated with an inflammatory wall defined usually outside the pancreas with minimal or no necrosis. Rich in amylase and other pancreatic enzymes without communication with the main conduit. They occur after 4 weeks after the onset of acute pancreatitis, and develops as a postsurgical complication. The case of a female patient of 22 years with a clinical picture of 15 days of evolution is presented. Physical examination unquantified characterized by abdominal pain and asthenia, nausea, vomiting, mild headache holocraneana, thermal rise. The Eco and Computed Tomography (CT) Abdominal concluded with the diagnosis of pancreatic pseudocysts so he was made a cistoyeyunoanastomosis splenectomy and distal pancreatectomy more. After two weeks the patient comes predominance presenting abdominal pain at the site of surgical intervention, so he entered. He underwent an ECO and an abdominal CT scan which concludes with ileus Intestinal hospitalized for 6 days, receiving good response after treatment and discharge decide on favorable terms. At three weeks after discharge the patient comes presenting moderate abdominal pain accompanied by nausea, vomiting, malaise and signs of dehydration. It is assessed by the Internal Medicine concluded as a diagnostic electrolyte imbalance and dehydration. Receive analgesia and hydration treatment, no complications so it is given a medical discharge. Next control is indicated but no go.Item Embarazo + Pancreatitis Severa + Hipertensión Arterial Gestacional(2016-05-01) Gallegos Paredes, Manuel Humberto; Salazar Faz, Fernando Abel Dr.Acute pancreatitis (AP) during pregnancy is a rare cause of abdominal pain and, although rarely progresses to necrotizing form, it is a serious complication whose diagnosis often is difficult. There are many causal factors of AP during pregnancy; the most frequent is the gallstone disease of the bile duct, even though metabolic disorders such as hyperlipidemia may trigger it as well. Hypertension in pregnancy remains a major perinatal health problem worldwide. It is one of the biggest causes of premature birth, perinatal mortality and also figures among the leading causes of maternal death in both industrialized and developing countries. Statistical incidence ranges from 0.1 to 35%. The terminology used to refer to this disease has gone through altering. Currently the most widely accepted terms are pregnancy-induced hypertension, if it is not accompanied by proteinuria, and the term preeclampsia is used when proteinuria is present. Preeclampsia (PEE) is a multisystem disease of unknown causes that can manifest itself in the second half of pregnancy, childbirth or in the immediate postpartum period. It is characterized by an immunological- vascular maternal response, abnormal to the conceptus implantation. It is also manifested by an altered endothelial function which is represented by the activation of the coagulation cascade as well as an increase in the peripheral vascular resistance and platelet aggregation. The following case is of a female patient of 33 years of age, with a personal medical history of cholelithiasis diagnosed 7 months ago. The pacient´s gynecological and obstetric history does: G: 1 P: 0 C: 0 A: 0 HV. 0, LMP. 01/18/2015 and a gestational age of 35 weeks. The patient reports epigastric pain OF 9/10 VAS, around 24 hours ago. The pain was colicky, the same which radiated from the hemi-belt to the right dorsal region, with the apparent cause being the intake of a heavy meal. Patient reports presenting the same picture for 8 days which yielded with the intake of unspecified analgesics, the picture is accompanied by nausea that fails vomiting, anorexia, and generalized asthenia. For this reason, the patient is assisted in the emergency room of the IESS Hospital of Ambato, and after being assessed by medical specialists in surgery and gynecology, admission is decided, subsequently valuation to laboratory tests is required. Paraclinical tests showed elevated amylase and lipase amylase. AMYLASE 3322; LIPASE: 7823.1. In the physical examination; TA: 140/95 mm hg FC : 104 bpm FR: 17rpm T: 36.8 ° C Saturation O2: 94 %. Patient is conscious, oriented with time and space, dehydrated, conjunctives: slightly jaundiced, preserved cardiopulmonary. Abdomen: pregnant, epigastric pain, AFU: 32cm, negative uterine activity, single fetus, alive, head left oblique, FHR 140-150 bpm, fetal movements present. Inguinogenital region; external female genitalia: presence of urinary catheter with dark diuresis. Upper and lower extremities: symmetric. Presence of edema ++ / +++, proximal and distal pulses present. Tone strength and mobility preserved, no DTR. Because of the patient's clinical condition, admission to intensive care unit is decided. During the patient’s hospital stay, the patient presented thrombocytopenia, in addition to increased pancreatic enzymes making it a possible incomplete HELLP SYNDROME.