Paso Práctico Nº1 Abdomen

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Transcript of Paso Práctico Nº1 Abdomen

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8/19/2019 Paso Práctico Nº1 Abdomen

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.?2 >564?2 @82C1458412 2?71= A1 7?2 382C577? ^_F A523;4451=A8 3?25 B14C53?712 V?2C? 7? 3412C? 57G?3?F?645Y=A821 1= ?6?=538 V?35? ?=C14584 Q3898 7?2 9?=82 1= 782 687257782RE .?2 >564?2 9;23;7?412 7;1H8 21B;17B1= ?@8=1;4JC53?2 1= 7? .[N ? 91A5?7 D V?35? 5=>14584 1= 7? 7G=1? 12@5=8;965753?7 Q7G=1? A12A1 1789675H8 V?2C? 7? %'-)RE %2C8 >849? ;=? 7L95=? A1 >564?2 C1=A5=82?2 <;1 A13;2?= 1= 7? 7G=1? ?76? D 2138=C5=:?= 38= 7?2 A17 86753;8 5=C14=8 38=C4?7?C14?7E

01 12C1 98A8F 782 9:23;782 86753;8 1WC14=8 1 5=C14=8 38=C4?7?C14?712 >849?= 1= 38=U;=C8 ;= S9:23;78A5HL2C538TF ;= 9:23;78 38= A82 B51=C412 <;1 389@?4C1= ;= C1=AJ= 31=C4?7 389:= D C4?6?U?= 3898 ;=?287? ;=5A?AE M84 1U19@78F 17 86753;8 1WC14=8 A1413V8 D 17 86753;8 5=C14=8 5I<;514A8 ?3C:?= U;=C82 @?4?>71W58=?4 D 48C?4 17 C48=38 A1 >849? <;1 17 V89648 A1413V8 21 8451=C? V?35? 7? 3?A14? 5I<;514A?Q98B5951=C8 A1 C8425J= A17 C48=38RE

%7 684A1 5=>14584 A1 7? ?@8=1;48252 A17 86753;8 1WC14=8 12CL 1=H482?A8F D >849? ;=? 6?=A? >56482? <;1 213;4B? 5=>1458491=C1F 3;D8 684A1 75641 @82C14584 21 1WC51=A1 1=C4? 7? %'-) D 17 C;6Y43;78 A17 @;652F 1775H?91=C8 5=H;5=?7 Q75H?91=C8 A1 M8;@?4CRE '=>1458491=C1F 17 75H?91=C8 5=H;5=?7 21 38=C5=:? 38= 7? >?235?@48>;=A? A17 9;278E M84 78 C?=C8F 17 75H?91=C8 5=H;5=?7 =8 12 ;=? 12C4;3C;4? 5=A1@1=A51=C1F ?;=<;1 i

@84 2; ;C575A?A 3898 @;=C8 A1 41>141=35? i ? 91=;A8 21 41@4121=C? A1 12C1 98A8E -3C:? 389841C5=L3;78 Q6?=A? A1 282CY=R @?4? 7?2 12C4;3C;4?2 9;23;7?412 D B?23;78=14B582?2 <;1 A523;441= @84A16?U8 2;D8 D 1=C4?= 1= 17 9;278E .?2 @?4C12 5=>1458412 A1 782 A82 9:23;782 ?6A895=?712 ?=C1487?C14?712@48>;=A82 21 417?358=?= 1= 2; 845H1= 38= 7? @8435J= 7?C14?7 A17 75H?91=C8 5=H;5=?7E

[:23;78 86753;8 5=C14=8 A17 ?6A891=%7 86753;8 5=C14=8 A17 ?6A891= 12 17 9:23;78 @7?=8 ?6A895=?7 5=C1491A58E N8=25C2C1 1= ;=? A17H?A?7L95=? 9;23;7?4 <;1 21 ?641 1= >849? A1 ?6?=538E - 1I31@35J= A1 2;2 >564?2 9L2 5=>1458412 Q2;4H1= A1 7?95C?A 7?C14?7 A17 75H?91=C8 5=H;5=?7RF 2;2 >564?2 A523;441= @14@1=A53;7?412 ?7 86753;8 1WC14=8 Q8@;12C8 ?7?2 9?=82 1= 782 687257782RE );2 >564?2 C?965Y= 21 V?31= ?@8=1;4JC53?2 1= 7? .[N D @?4C535@?= 1= 7?>849?35J= A1 7? B?5=? A17 413C8E

[:23;78 C4?=2B1428 A17 ?6A891=%2 17 9L2 5=C14=8 A1 782 C412 9:23;782 ?6A895=?712 @7?=82E );2 >564?2 A523;441= V845I8=C?712F 1W31@C8 7?25=>1458412 <;1 28= @?4?717?2 ?7 86753;8 5=C14=8E ); 8451=C?35J= @1495C1 389@45954 17 38=C1=5A8?6A895=?7 D ?;91=C?4 7? @4125J= 5=C14=? A17 ?6A891=E );2 >564?2 >5=?75I?= 1= ;=? ?@8=1;48252 <;138=C456;D1 ? >849?4 7? B?5=? A17 413C8E %=C41 17 86753;8 5=C14=8 D C4?=2B1428 A17 ?6A891= 21 ;653? ;=@7?=8 B?23;78=14B5828F <;1 21 384412@8=A1 38= ;= @7?=8 25957?4 1=C41 782 12@?3582 5=C14382C?712 Q?7 12C?41=C41 7? 3?@? 91A5? D @48>;=A?RE N8=C51=1 ?4C145?2 D =14B582 @?4? 7? @?41A ?=C1487?C14?7 A17 ?6A891=E

[:23;78 413C8 A17 ?6A891=%2 ;= 9:23;78 ?35=C?A8F 7?4H8 D ?=3V8E M45=35@?7 9:23;78 B14C53?7 A1 7? @?41A ?=C1487?C14?7 A17 ?6A891=E

)8= A82 D 12CL= 21@?4?A82 @84 7G=1? ?76?E %2 ?=3V8 Qe B1312 9L2 <;1 1= 5=>14584R D A17H?A8 V?35?2;@14584F D 12C413V8 D H4;128 V?35? 5=>14584F A8=A1 21 1=3;1=C4?= 9;D @4JW5982E %2CL 1=3144?A8 1= 7?B?5=? A17 9:23;78 413C8 A17 ?6A891=E

N;?=A8 17 9:23;78 21 C1=2?F 7?2 L41?2 1=C41 7?2 5=C14213358=12 C1=A5=82?2 286412?71=E .?2 5=C14213358=12F21X?7?A?2 @84 2;4382 1= 7? @517 1=C41 7?2 @48C;614?=35?2F 21 1=3;1=C4?= H1=14?791=C1 ? =5B17 A17 @483128W5>85A12 A17 12C14=J=F A17 89675H8 D ? 91A58 3?95=8 1=C41 12C?2 A82 12C4;3C;4?2E %2 5445H?A8 @84 7?2?4C145?2 1@5HL2C453?2 2;@14584 1 5=>14584E

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Y:  (<@<GIC@>?<@ =< P<AG>< I@<;AMC@A<=: &C=<G>H;CA GH; B<@CD <NDHL>;<= J GHLBH@I<L>C;IH C;BF;IHA DZN>=CA DC =< L>AL<:

.?2 2;@14>53512 ?=C14584 D @82C14584 A1 782 C412 9:23;782 @7?=82 12CL= 3;6514C?2 @84 ;=? 3?@? A1 >?235??6A895=?7 A1 41B12C5951=C8E %= H1=14?7F 12C?2 3?@?2 =8 21 B1=F 1W31@C8 7? 3?@? @48>;=A? A17 9:23;78C4?=2B1428 A17 ?6A891= Q7? >?235? C4?=2B142?7RF <;1 12CL 9L2 A12?44877?A?E

.? >?235? C4?=2B142?7 12 ;=? 3?@? 38=C5=;? A1 >?235? <;1 413;641 7? 3?B5A?A ?6A895=?7 D 38=C5=:? 1= 7?3?B5A?A @Y7B53?E N4;I? 7? 7G=1? 91A5? 1= 7? @?4C1 ?=C14584 ;=5Y=A821 ? 7? >?235? C4?=2B142?7 A17 8C48 7?A8 DC51=1 38=C5=;5A?A 38= 7? 2;@14>5351 5=C14=? A17 A5?>4?H9?E %= 7? @?4C1 @82C14584 12 38=C5=;? 38= 7? >?235?@48>;=A? <;1 3;641 782 9:23;782 A1 7? @?4C1 @82C14584 A17 ?6A891= D 21 5=214C? 1= 7? >?235?C84?387;96?4E

012@;Y2 A1 5=214C?421 1= 7? 3412C? 57G?3?F 7? >?235? C4?=2B142? <;1 3;641 782 9:23;782 417?358=?A82 38= 7?241H58=12 2;@1458412 A1 782 V;1282 A1 7? @17B52 D 38= 7?2 >?235?2 25957?412 <;1 3;641= 782 9:23;782 A1 7?3?B5A?A @Y7B53?E %= 12C1 @;=C8 21 38=831 3898 >?235? @Y7B53? @?451C?7 Q8 1=A8@Y7B53?RE M84 78 C?=C8F 1W52C1

;=? 3?@? 38=C5=;? A1 >?235? 48A1?=A8 7? 3?B5A?A ?6A895=?7 <;1 12 H4;12? 1= ?7H;=?2 I8=?2F >5=? 1=8C4?2F 5=214C?A? 8 75641F <;1 @?4C535@? 1= 7? >849?35J= A1 12C4;3C;4?2 12@135?75I?A?2E

-@48W59?A?91=C1 1= 7? 95C?A 7?C14?7 A17 75H?91=C8 5=H;5=?7F 7? >?235? C4?=2B142?7 A12351=A1 V?2C? 7?>?235? 57G?3? D 21 38=>;=A1 38= 177?E ]?35? 7? @?4C1 91A5? A17 75H?91=C8 5=H;5=?7 1=3;1=C4? 78217191=C82 A17 384AJ= 12@149LC538F <;1 21 5=C48A;31= 1= 17 ?=5778 ; 845>5358 5=H;5=?7 @48>;=A8E[1A5?791=C1 ?7 75H?91=C8 5=H;5=?7F 7? >?235? C4?=2B142?7 3;641 7? 3?4? @82C14584 A17 75H?91=C8 A1 ]1=71D A17 413C8 A17 ?6A891= D 21 >5U? 1= 17 7?658 @82C14584 A17 684A1 2;@14584 A17 @;652E

[:  ";<=>?<@ =HA BF;IHA DZN>=CA DC =< B<@CD <NDHL>;<=5 DCAG@>N>@ AF PH@L<G>Q; J C=CLC;IHA EFC =<<I@<M>CA<;

.82 @;=C82 AY65712 A1 7? @?41A ?6A895=?7 28= 782 @;=C82 A1 91=84 41252C1=35?F D 12C82 28=K/  (>G<I@>? FLN>=>G<= Q89675H8RK ?VG =8 V?D ?@8=1;48252F 2878 V?D @517 D H4?2? 2;63;CL=1?E M84 ?VG

@?2? 7? 7G=1? ?76?F V?D ;=? 5=C144;@35J= A1 7? ?@8=1;48252F =8 12CL 2177?A?E [L2 V?35? @82C14584F

12CL 7? >?235? <;1 413;641 ? 782 9:23;782 @84 7? 3?4? 5=C14=?E

j%2C? ?@8=1;48252 21 38=831 3898 "#$%# &' ()* +,*-.()* /'-0)*F D 12CL >849?A? @84 7?

38=B14H1=35? A1 7?2 ?@8=1;48252 A17 9:23;78 86753;8 1WC14=8F 86753;8 5=C14=8 D C4?=2B1428F 1=

7? 7G=1? 91A5?F 3143? A1 7? 3;?7 21 1=3;1=C4?= 782 9:23;782 413C82F @84 78 C?=C8 7?2 e

?@8=1;48252 >849?= 12C1 389@71U8 ?@8=1;4JC538 <;1 782 1=B;17B1E .? ?@8=1;48252 A17 86753;8

5=C14=8 21 A5B5A1F ;=? V8U? @?4? @84 7? 3?4? ?=C14584 D 8C4? @84 @82C14584 A17 9;23;78 413C8F D 21>;258=?= =;1B?91=C1 1= 7? 7G=1? 91A5?E

]8U? ?=C14584K 86753;8 1WC14=8 k 7?95=? ?=C14584 A17 86753;8 5=C14=8

]8U? @82C14584K C4?=2B1428 k 7L95=? @82C14584 A17 86753;8 5=C14=8

4K;C< <=N<\ 7? ?@8=1;48252 A17 9:23;78 86753;8 1WC14=8 21 H1=14? 7;1H8 A1 <;1 Y2C1 21 5=214C?

1= 7? 3412C? 57G?3? D 7? 12<;5=? 57G?3?F 3;?=A8 21 C4?=2>849? 1= ?@8=1;48252F 7? 3;?7 25H;1 2;

C4?D13C8 V?35? 7? 7G=1? 91A5?=F A8=A1 21 >;258=? 38= 7? A17 7?A8 8@;12C8 D ?2G >849? 7? 7G=1?

?76?E

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4K;C< ACL>=F;<@\  7G=1? A1 C4?=2535J= 1= 17 @?28 A17 C1U5A8 9;23;7?4 ?7 C1U5A8 ?@8=1;4JC538F ?

=5B17 A17 9;23;78 C4?=2B1428 A17 ?6A891=E

/  4K;C< <@EFC<D< DC =< M<>;< DC =HA @CGIHA\  Z/\ 39 5=>14584 ?7 89675H8F 7? V8U? @82C14584 A1 7?

B?5=? A1 782 413C82 A12?@?4131F 1=C8=312 7?2 e 7L95=?2 ?@8=1;4JC53?2 @?2?= @84 ?=C14584 ? 782

9:23;782 413C82E %2C? 2;2@1=25J= A1 7? V8U? @82C14584 H1=14? ;=? 9?43? 8 684A1F <;1 21 38=831

38=8 7? 7G=1? ?4<;1?A? A1 7? B?5=? A1 782 413C82E V8U? @82C14584 A1 7? B?5=? A1 782 413C82 <;1 215=C144;9@1

/  (H;DFGIH >;SF>;<=\ 12 ;=? 389;=53?35J= 1=C41 7? 3?B5A?A ?6A895=?7 D 7? 2;@14>5351 A1 7? @?41A

?6A895=?7E &51=1 >849? A1 3575=A48 Q=8 12 41A8=A8F 25=8 ?>7?;C?A8R D A52@82535J= 86753;?F 38= _

1WC41982 ; 845>53582 5=H;5=?712K ;=8 2;@14>535?7 D 8C48 @48>;=A8 Q17 2;@14>535?7K ;653?35J=

?=C14584F 91A5?7 1 5=>14584 38= 412@13C8 ?7 @48>;=A8RE

%2 @?4?7178 ?7 4138445A8 A17 75H?91=C8 5=H;5=?7E %= 2; 38=2C5C;35J= @?4C535@?= 782 17191=C82 A1 7?

@?41A Q86753;8 1WC14=8F 86753;8 5=C14=8F C4?=2B1428 D >?235? C4?=2B142?RE

M?41A ?=C14584K ?@8=1;48252 A17 86753;8 1WC14=8E -7 >5U?421 1= 17 75H?91=C8 5=H;5=?7 D

V?35? 91A5?7 1= 17 @;652F >849? _ @57?412 <;1 >849?= 17 ?H;U148 5=H;5=?7 2;@14>535?7E

M?41A @82C14584K >?235? C4?=2B142?! 

M528K 75H?91=C8 5=H;5=?7

&13V8K 38=B14H1=35? A1 86753;8 5=C14=8 D C4?=2B1428E -7 A545H5421 ?7 @;652 >849?= ;=

?438F <;1 @1495C1 17 @?2?U1 A17 384AJ= 12@149LC538 V?35? 17 1WC14584E .;1H8 A1 >849?4 17

?438F 21 5=214C? 1= 17 @;652 H4?35?2 ?7 >?721 5=H;5=?7E

N8=C1=5A8K 2?71 A17 845>5358 @48>;=A8 ?7 2;@14>535?7E 3<AGF=>;H">;=G3;78 12@149LC538

Q@1AG3;78 A17 C12CG3;78F A8=A1 B? 7? BG? 12@149LC53?F ?4C145?2F B?282 75=>LC5382 D B1=8282RF

PCLC;>;H"75H?91=C8 41A8=A8 A17 :C148 Q419?=1=C1 196458=?458 A17 38=A;3C8

9128=Y>4538RF 21 @514A1 1= 17 C1U5A8 38=13C5B8 A1 782 7?6582 9?D8412E

N;?=A8 7? 5=21435J= A17 86753;8 5=C14=8 D C4?=2B1428 12 389:= V?35? 91A5?7F ? =5B17 A17 @;652F 21

38=831 3898 C1=AJ= 38=U;=C8E

•  P?235? C4?=2B142?K ;653?A? V?35? 17 >8=A8 A17 38=A;3C8F C4?=2@?41=C? 78 @82C14584 ? 177?F

17 C1U5A8 ?A5@828E ]?35? 7? @?41A @82C14584 C?965Y= V?D B?282F 7? 34;I?= A1 >849?

A5?H8=?7F B?282 1@5HL2C45382 5=>1458412F <;1 B51=1= A1 7? ?4C145? 575?3? 5=C14=?F <;1 7;1H8

5=H412?= ? 7? B?5=? A1 782 413C82F @?4? ?=?2C8982?4 38= 782 1@5HL2C45382 2;@1458412E .?

;653?35J= A1 12C82 B?282 A5B5A1 7? @?41A @82C14584 A17 38=A;3C8 1= _ I8=?2K

[1A5?7 ? 782 B?282 1@5HL2C45382K @?41A @82C14584 A17 38=A;3C8F 41B12C5A? 2878 @84

>?235? C4?=2B142?E

!  .?C14?7 ? 782 B?282 1@5HL2C45382K 845>5358 5=H;5=?7 @48>;=A8E M84 ?VG 5=H412? 17

384AJ= 12@149LC538 ?7 38=A;3C8E/ 

(H;DFGIH PCLH@<=\  12 9L2 91A5?7 38= 412@13C8 ? 782 B?282 >1984?712E 5=>14584 ?7 75H?91=C8

5=H;5=?7F @1495C1 17 @?28 A1 782 B?282 575?382 5=C14=82 @?4? C4?=2>849?421 1= >1984?712 3;?=A8

5=H412?= ?7 9519648 5=>14584E -<;G 21 >849?= 7?2 V14=5?2 >1984?712 8 34;4?712F @84 5=>14584 ?7

38=A;3C8 >1984?7F 1= 417?35J= ? 7? 4?GI A17 9519648 5=>14584 Q@41A895=?= 1= 7?2 9;U1412RE

]><IHA P@Z;>GHA\ 12@?3582 <;1 =8 28= V149YC5382F 1=C41 782 >?23G3;782 9;23;7?412 A17 A5?>4?H9?E

M;1A1= @48C4;54 3514C?2 12C4;3C;4?2F >849L=A821 7?2 V14=5?2 A5?>4?H9LC53?2E

/  )@>T;SF=HA =FLN<@CA\ 1= 7? @?41A @82C14584 A17 ?6A891=E

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&45L=H;78 7;96?4 5=>14584K 7? 9;23;7?C;4? A1 7? @?41A @82C14584 12 7? 9L2 @48>;=A?F @148

V?D 8C4? 9;23;7?C;4? 9L2 2;@14>535?7 ? 17782E %=C41 17 A842?7 ?=3V8F 86753;8 1WC14=8 D

3412C? 575?3? 21 >849? 12C1 12@?358 C45?=H;7?4F 3;D8 >8=A8 8 @528 12 17 86753;8 5=C14=8 D

C4?=2B1428F D 3;?=A8 12C82 9:23;782 31A1=F 17 C45L=H;78 @48C4;D1" V14=5? 7;96?4E

&45?=H;78 7;96?4 2;@14584K >849?A8 @84 17 9;23;78 2144?C8 @82C1485=>14584F 17 86753;8

5=C14=8 D 17 41684A1 A1 782 9:23;782 1413C8412 A1 7? 387;9=?E %7 @528 8 >8=A8 A1 12C112@?358 12 7? ?@8=1;48252 A17 9:23;78 C4?=2B1428E

^: 

/CP>;>@ =< D>@CGG>Q; DC =< >@@>S<G>Q; DC =< B<@CD MC;I@H=<IC@<= DC= <NDHLC; J AC_<=<@ =HA B=<;HABH@ DH;DC D>AGF@@C; =HA C=CLC;IHA M<AGF=<@CA:

M45=35@?712 B?282 2?=H;G=182 A1 7? @?41A ?=C1487?C14?7 A17 ?6A891=/  %@5HL2C45382 2;@1458412 D 4?9?2 A1 782 B?282 9;23;78>4Y=5382F A1 782 B?282 C84L35382 5=C14=82E/  %@5HL2C45382 5=>1458412 D B?282 3543;=>71U82 57G?382 @48>;=A82F A1 782 57G?382 1WC14=82E/ 

N543;=>71U82 57G?382 2;@14>535?712 QA1 7? ?4C145? >1984?7R D 1@5HL2C45382 2;@14>535?712 QA1 7? B1=?2?>1=? 9?H=?RE

(?282 5=C14382C?712 @82C1458412F A17 ^^c 12@?358 5=C14382C?7 D 4?9?2 ?=C1458412 A1 782 2;6382C?712E

*@@>S<G>Q; <@IC@><=.? A52C456;35J= A1 782 B?282 2?=H;G=182 ?6A895=?712 @48>;=A82 41>71U? 7? A52@82535J= A1 782 9:23;782K

•  (?282 ?=C1487?C14?712K 25H;1= ;= @?C4J= 86753;8 3543;=>141=35?7E

•  (?282 A1 7? @?41A ?=C14584 31=C4?7K 8451=C?35J= 9L2 B14C53?7E.?2 ?4C145?2 B?= ?389@?X?A?2 A1 7?2 B1=?2 9L2 @48>;=A?2E

-4C145? 1@5HL2C453? 2;@14584N8=C5=;?35J= A1 7? <@IC@>< IH@TG>G< >;IC@;<E %=C4? 1= 7? B?5=? A17 413C8 A17 ?6A891= 2;@1458491=C1F ?

C4?BY2 A1 2; 7L95=? @82C14584E '445H? 7? @?4C1 2;@14584 A17 !"#$% '"( )*'%+",F D 21 ?=?2C8982? 38= 7??4C145? 1@5HL2C453? 5=>14584 1= 7? 41H5J= ;965753?7E

-4C145? 1@5HL2C453? 5=>14584"45H1= A1 7? <@IC@>< >=K<G< CXIC@;<F 2;@14584 ?7 75H?91=C8 5=H;5=?7E M?2? 2;@1458491=C1 @84 7? >?235?C4?=2B142?7F D 1=C4? 1= 7? B?5=? A17 413C8 A17 ?6A891=F 5=>14584 ? 7? 7G=1? ?4<;1?A?E %=C4? 1= 7? @?4C15=>14584 A1 12C1 9:23;78 D 21 ?=?2C8982? 38= 7? 1@5HL2C453? 2;@14584E

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