Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Femenina de 31 años con fiebre, soplo cardíaco y hepatosplenomegalia.

2.854 visualizaciones

Publicado el

Reto clínico de la semana, PERLAS CLÍNICAS. (jrminterna.blogspot.com). Femenina de 31 años con fiebre, soplo cardíaco y hepatosplenomegalia.

Publicado en: Educación
  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí

Femenina de 31 años con fiebre, soplo cardíaco y hepatosplenomegalia.

  1. 1. Femenina de 31 años con fiebre, soplo cardíaco y hepatosplenomegalia Jessica Londoño, residente de MedicinaJessica Londoño, residente de Medicina Interna, UdeAInterna, UdeA Visita el blog perlas clínicas (jrminterna.blogspot.com) paraVisita el blog perlas clínicas (jrminterna.blogspot.com) para más casos clínicos y otros contenidos interesantes enmás casos clínicos y otros contenidos interesantes en Medicina Interna.Medicina Interna.
  2. 2. IDENTIFICACIÓN: • Edad: 31 años • Raza: Indígena • Pertenece a la comunidad indígena Morro Nauca • Alto Baudó (Chocó) • Ocupación: ama de casa • Vive con su esposo, tres hijos y abuela.
  3. 3. Antecedentes personales: • Patológicos: ▫ Síndrome de HELLP en el penúltimo parto ▫ Malaria por P. Falciparum y P. vivax reciente • Alérgicos: Niega • Hospitalizaciones previas: no refieren • Tóxicos: Humo de leña >20 años • Medicamentos: No refieren consumo rutinario • Ginecológicos: ▫ G6P5A1V3 – 2 lactantes muertos por diarrea ▫ FUP: Hace 3 meses ▫ Síndrome HELLP hace 3 años
  4. 4. … • Epidemiológicos: ▫ Niega contacto con sintomáticos respiratorios ▫ cría cerdos y convive con un pato, en oportunidades come Cangrejos y caracoles cocinados.
  5. 5. MC: “Fiebre” • Enfermedad Actual: Paciente con cuadro de 34 días de evolución que inició con fiebre, adinamia, malestar general. En su sitio de residencia hacen diagnóstico de malaria por P. Falciparum para lo cual recibe tratamiento.
  6. 6. … Sin embargo persistió sintomática y febril por lo cual realizan nueva gota gruesa que reporta malaria por P. Vivax. Describen tratamiento en Hospital de Quibdó con artemether 20 mg y lumefantrine 120 mg, no tuvo mejoría por lo cual se sospecha malaria complicada y se inicia tratamiento con artesunato + clindamicina. Continua febril por lo cual deciden remitir al HUSVF.
  7. 7. REVISIÓN POR SISTEMAS • Dolor en hombro derecho y cadera derecha desde 3 días antes de llegar al hospital. • Niega tos, diarrea o síntomas urinarios.
  8. 8. EXAMEN FÍSICO: Regulares condiciones generales PA 120/45, FC 130, FR 20, SatO2 87% con FiO2 al 21%, Tº 39.8º Mucosas secas, hemorragias conjuntivales Nº 2 en ojo izquierdo RsCsRs con soplos sistólico grado III/VI, aórtico irradiado al foco pulmonar. Murmullo vesicular conservado. Abdomen: blando, depresible, con hepatometalia 8 cm por debajo del reborde costal, se palpa polo esplénico.
  9. 9. … Extremidades: llenado capilar <2 seg, con hemorragias en astilla en las uñas de ambos dedos índices. Dolor a la movilización del hombro y la cadera derecha, sin signos inflamatorios cutáneos. Adenopatía epitroclear derecha. Neurológico: alerta, orientada, sin signos meníngeos. Fondo de ojo sin hemorragias.
  10. 10. PLAN • ¿Endocarditis? Inicio empírico de Piperacilina/tazobactam + Vancomicina (31/agosto)
  11. 11. PARACLÍNICOS INGRESO • Hemograma: Globulos blancos 9000 /uL, Neutrófilos 6500/uL, Linfocitos 1300/uL, Eosinófilos 500/uL, Monocitos 700/uL. Glógulos rojos 390000/uL, Hb 7.9, Hematocrito 8, VCM 97.8 ADE 19.1 Plaquetas 9000/uL, Volumen plaquetario 8.3 fl. • ESP: Macroplaquetas + Se observan plaquetas escasas con ocasionales agregados plaquetarios escasos. Aglutinación de globulos rojos +++. Leucocitos de aspecto normal Recuento de retículocitos 0%
  12. 12. • Ferritina 57 ng/ml Fe sérico 23 Capacidad de fijación de Fe 362 Indice de saturacion de transferrina 6.3% • Ácido fólico: 19.5 ng/ml • Vitamina B12 890 pg/ml
  13. 13. … • Gases arteriales: pH 7.49, pCO2 24, pO2 64.7, HCO3 21.8, EB -5.1 • Hemocultivos de aerobios negativos • Función hepática: AST 17, ALT 32, BT 0.36, BD 0.2, Fosfatasa alcalina 150, LDH 363 Albúmina 2.3 g/dL Lactato 12.2 mg/Dl • Función renal: Cr 0.9, BUN 23 Na 136, K 4, Ca corregido 8.3, Mg 1.9 • Orina: Amarilla, clara, pH 6.5, Densidad 1015, eritrocitos 6-8 xCAP.
  14. 14. Estudios microbiológicos iniciales • Hemocultivos # 2 negativos. • Urocultivo negativo • VDRL: No reactivo • Leptospira Ac IgM: Negativo • Elisa VIH: no reactivo • Gota gruesa Nº 4 negativas
  15. 15. Estudios microbiológicos iniciales • Hepatitis B Ag superficie negativo • Ac central IgM No reactivos • Hepatitis B Ac contra Ag superficie e IgG anti central reactivo de 357 • Hepatitis C Ac no reactivo • Prueba de tuberculina negativa
  16. 16. Rx de torax • Opacidades intersticiales peri hiliares • Cardiomegalia • Hilios pulmonares prominentes a expensas de la vasculatura
  17. 17. TACAR # 1
  18. 18. • Aorta y arterias pulmonares de curso y calibre normal. • Existe prominencia del hilio pulmonar derecho, probable relación con presencia adenopatías, algunas de ellas calcificadas. • Se identifica área de consolidación vs cicatriz, comprometiendo el segmento apical del lóbulo superior derecho. Atelectasias laminares bibasales. • No observo líquido pleural ni neumotórax. No se identifican nódulos, masas, áreas de enfisema ni opacidades en vidrio esmerilado. • En lo visualizado del abdomen no se observan alteraciones por este método • Estructuras óseas y tejidos blandos alteraciones.
  19. 19. TC abdomen
  20. 20. • Hígado aumentado de tamaño de contornos y densidad normal sin evidencia de lesiones focales ni difusas. • Bazo aumentado de tamaño, con múltiples lesiones hipodensas en cuña en relación a infartos esplénicos. • Aumento en el diámetro de la porta secundario a hiperesplenismo. • Ambos riñones son de tamaño, forma y configuración normal, con áreas hipodensas en cuña a nivel de la corteza en relación a infartos renales de forma bilateral. • No hay dilatación de las cavidades pielocolectoras, no hay masas ni cálculos. • Glándulas adrenales sin lesiones.
  21. 21. Ésta paciente tiene al menos dos diagnósticos: • Plantea el diagnóstico infeccioso • Plantea el diagnóstico hematológico

×