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      "body": "Congratulations @abril28! You received a personal award!\n\n<table><tr><td>https://steemitimages.com/70x70/http://steemitboard.com/@abril28/birthday1.png</td><td>Happy Birthday! - You are on the Steem blockchain for 1 year!</td></tr></table>\n\n<sub>_You can view [your badges on your Steem Board](https://steemitboard.com/@abril28) and compare to others on the [Steem Ranking](http://steemitboard.com/ranking/index.php?name=abril28)_</sub>\n\n\n**Do not miss the last post from @steemitboard:**\n<table><tr><td><a href=\"https://steemit.com/japanese/@steemitboard/new-japanese-speaking-community-steem-meetup-badge\"><img src=\"https://steemitimages.com/64x128/https://cdn.steemitimages.com/DQmRWbAjbeETEaqSPLcpwYX1JN5pZhdPffv4q6DaBs6xvZm/image.png\"></a></td><td><a href=\"https://steemit.com/japanese/@steemitboard/new-japanese-speaking-community-steem-meetup-badge\">New  japanese speaking community Steem Meetup badge</a></td></tr></table>\n\n###### [Vote for @Steemitboard as a witness](https://v2.steemconnect.com/sign/account-witness-vote?witness=steemitboard&approve=1) to get one more award and increased upvotes!",
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      "author": "abril28",
      "body": "# <center>HEMORROIDES (un problema de muchos) </center>\n\n \n<div class=\"text-justify\"><p> Hola amigos de Steemit, hoy voy a hablarles de una patología muy frecuente, 50-60% de la población lo padece, aunque algunos les da pena admitirlo... Esta patología es la Enfermedad hemorroidal. </p></div> \n\n<center>![PRIMERA FOTO.jpg](https://cdn.steemitimages.com/DQmYJEoaWb1tTnEBKCkiYx7Yk9mFpvYCw4esup9z2efaVtg/PRIMERA%20FOTO.jpg) </center>\n \n<div class=\"text-justify\"><p><center>La enfermedad hemorroidal se define como  dilataciones venosas en el canal anal</center>\n\n# <center>¿Quiénes son más propensos a padecer de hemorroides??  </center>\n\n  Pacientes con estreñimiento, permanecer largos periodos de tiempo en el baño, poca fibra en la dieta, embarazo, estar largas horas sentado o parado, el uso de objetos vía rectal.     </p></div>                                                       \n<center>![foto 2.jpg](https://cdn.steemitimages.com/DQmWabDHpGw81NtcU9UkzDBHRzBGxFG5KJCrnhJNHi4wAAp/foto%202.jpg) </center>\n\n# <center>¿Cómo se clasifican las hemorroides? </center>\n\n \n<div class=\"text-justify\"><p>Hemorroides externas: aquellas que aparecen por debajo de la línea pectínea, son esas que podemos palpar alrededor del orifico anal, como especie de colgajo de piel.\n<b><i>Hemorroides internas: </i></b> aquellas que aparecen por encima de la línea pectínea, normalmente no son palpables a menos que protruyan, por lo que estas se clasifican en:\n\n•\t<b><i>Grado I: </i></b> Sobresalen únicamente a la luz del canal anal.\n\n•\t<b><i>Grado II: </i></b> Sobresalen durante la defecación por fuera del canal anal, pero reducen espontáneamente. \n\n•\t<b><i>Grado III: </i></b> Sobresalen durante la defecación por fuera del canal anal, pero requieren de maniobras manuales para su reducción. \n\n•\t<b><i>Grado IV: </i></b> Permanecen prolapsadas, por fuera del canal anal y son irreductibles. </p></div>\n\n<center>![tipos de hemorroides foto 3.jpg](https://cdn.steemitimages.com/DQmbCBP1v3JEHn39YQEDHJqyCNgcuDJYN1GnoPoEbTrxx4w/tipos%20de%20hemorroides%20foto%203.jpg) </center>\n \n \n# <center>¿Cuáles son los síntomas? </center>\n \n<div class=\"text-justify\"><p>  Prurito (picor), tenesmo rectal, sensación de peso a nivel del recto, sangrado (rectorragia o hematoquecia) observado en el papel higiénico o en las heces, dolor (poco frecuente, ocurre cuando estamos en presencia de una de sus complicaciones, como: hemorroides trombosadas, estranguladas, fisura anal, absceso, cáncer de recto). </p></div>\n\n<center>![foto 4 (2).jpg](https://cdn.steemitimages.com/DQmXeepp9hrDxz9bzbT6k13gaJJPSUhzy3HDJ2i2X9jXz56/foto%204%20(2).jpg) </center>\n\n \n# <center> ¿Cómo prevenir la Enfermedad hemorroidal? </center>\n\n<div class=\"text-justify\"><p>•\t Dieta rica en fibra (vegetales, avena, granos, frutas) \n\n•\tAumentar la ingesta de líquidos (2litros de agua al día)\n\n•\tCrear hábitos de evacuación adecuados, tales como evitar el esfuerzo, pujo prolongado y limitar de tiempo en el inodoro, ya que estas prácticas se han asociado con tasas más altas de hemorroides sintomáticas. \n\n•\tHacer ejercicio, ya que mejora el tránsito intestinal \n\n•\tEn caso de estreñimiento pueden usar ablandadores de heces (Metamucil, polietilenglicol) </p></div>\n\nAquí un video de cómo es la mejor posición para evacuar, menos presión intrabdominal, menos riesgo de Enfermedad Hemorroidal. (Video,ese ya te lo envié)\n\n \n<div class=\"text-justify\"><p>Diagnóstico diferencial: abscesos anoperineales, condilomas acuminados, cáncer de recto, papilas anales hipertróficas, pólipos rectales pediculados, prolapso rectal. </p></div>\n\n# <center>IMPORTANTE!!! </center>\n \n1.\t<div class=\"text-justify\"><p>El 50-60% de la población tiene Hemorroides, de estos el 10% puede ameritar tratamiento quirúrgico (hemorroidectomia, hemorroidopexia) entre otros tratamientos como bandas, escleroterapia ó coagulación de infrarrojos.\n\n2.\tLos síntomas no son específicos para esta patología, pueden estar presentes en muchas otras bien sean benignas o malignas, como el Cáncer colorectal, he aquí la importancia de acudir al médico a tiempo para su descarte y tratamiento a tiempo.\n\n3.\tSignos de alarma (sangrado, pérdida de peso, cambios en el hábito intestinal, disminución de calibre de las heces ó heces acintadas), acudir al médico, puede estar en presencia de otra patología.\n\n4.\tEn caso de padecer de Hemorroides puedes usar analgésicos tópicos, baños de asiento (sentarse en agua templada durante unos 10 minutos, cada 4-6 horas y tras las deposiciones), Flebotónicos, ablandadores de heces, de no mejorar, acude al médico.\n\n5.\tPacientes con signos de alarma, mayores de 40 años y antecedentes familiares de cáncer tiene criterios de realizarse una colonoscopia para descarte de otras patologías. \n\nEspero haya sido de su agrado. Si tienen alguna duda, dejen su pregunta en los comentarios, que con gusto les responderé sus inquietudes.  Hasta un nuevo post!! Besitos. </p></div>",
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      "author": "jorquin",
      "body": "Que buen post. Me gusta ver esos casos, imagino que  ya estas acostumbrada a ver cosas fuertes con pacientes.",
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      "author": "abril28",
      "body": "# <center>INGESTION DE CUERPO EXTRAÑO. </center>\n<center><b><i> Hola mis amigos Steemians y cervantiles, espero la estén pasando super,  en esta oportunidad quiero compartirles este caso que llego a una de mis guardias en el Hospital donde trabajo, así que vamos a ello…</i></b></center>\n\n \n<p><div class=\"text-justify\"><p><b>CASO CLÍNICO: </b>  Paciente femenino de 36 años, sin antecedentes patológicos, quien acude a la emergencia por presentar hace 1 semana <b>posterior a ingestión de cuerpo extraño (espina de pescado), odinofagia, sialorrea</b>, dos días después se asocia a los síntomas, fiebre no cuantificada precedida de escalofrío, <b>vómitos</b> de contenido alimentario, <b>dolor retroesternal y halitosis</b>. Al examen físico: PA: 120/70mmHg FC: 97 FR: 19 temp: 37°C, hemodinamicamente estable, hidratada, con halitosis. Cuello: simétrico, móvil, en región paratraqueal se palpa enfisema subcutáneo (crepitación, se traduce en aire a nivel de la piel) doloroso ala palpación. Resto del examen físico sin alteraciones. Laboratorios: se evidencia Leucocitosis con neutrofilia: 18.000 seg: 86% linf 12% HB: 12 HTO: 36 Plaquetas: 236000 tiempos de coagulación normales. \n    En la radiografía de tórax PA<b> (foto 1) </b> no se observa nada así como en la de cuello AP <b> (foto 2)</b>, pero el RX de cuello lateral <b> (foto3) </b> se observa el aire, es decir el enfisema subcutáneo anterior a la tráquea. </p></div></p>\n<center><b>Foto 1</b></center>\n<center>https://cdn.steemitimages.com/DQmThBPRKHucq5svYnZHtprzNVkfNddxFpgwvS7e1JDcpsC/image.png </center>\n<center><b>Foto 2</b> </center>\n<center>https://cdn.steemitimages.com/DQmSYT2ZjTTdhpCGNL4US3tANCHPPX8wsmgUUWdS4zhndUh/image.png</center>\n<center><b>Foto 3</b> </center>\n<center>https://cdn.steemitimages.com/DQmbYSqKm1vtgqVm9CyDYzdbYH2vGairrwwn9sNVx2zo1KQ/radio-grafia.PNG </center>\n<p><div class=\"text-justify\"><p><b>En vista de la clínica, examen físico y paraclínicos, planteamos que la paciente tenía una perforación esofágica secundaria a la espina de pescado</b>,, por lo cual fue evaluada por Cirugía, quienes en vista del paciente ni la institución contar para realizar Tomografía de cuello o una serie radiología para ver donde esta perforación, solicitan por parte de nuestro servicio (gastroenterología) realizar una endoscopia digestiva superior y así tomar la conducta ante este caso.\n<center><b>Video endoscópico</b> </center>\n<center>https://www.youtube.com/watch?v=3oO7ysG66nQ</center>\n\n<p><div class=\"text-justify\"><p><b><i>A los 13-15 cm de la arcada dentaria, por debajo del esfínter esofágico superior se observan dos orificios uno de 8 mm aprox y otro de 1,5 cm (el orificio del centro es la luz del esófago) con salida de secreción purulenta fétida, con  mucosa adyacente congestiva. No se visualizó la espina de pescado, probablemente ya había sido digerida. </i></b>\n\nServicio de cirugía realizó drenaje de absceso cervical y mediastino superior, esofagostoma cervical y gastrostomía de alimentación. El hallazgo fue una perforación 2 cm de diámetro y otra de 5 mm en esófago cervical con absceso paraesofágico. La paciente evoluciono favorablemente, cumplió 7 días de tratamiento antibiótico y se otorgó alta institucional con control ambulatorio.\n\n<center><b>Discusión</b> </center>\n   Los cuerpos extraños (CE) en esófago (CEE) son una de las emergencias que con mayor frecuencia se presenta en los servicios de gastroenterología e involucra especialidades como cirugía, otorrinolaringología y radiología. Cuando se alojan en el esófago se clasifican en dos grandes grupos: Impactación de bolos alimentarios y verdaderos cuerpos extraños. \n El tipo de CEE y su incidencia varía según la región geográfica y la edad de los pacientes. En niños los más frecuentes son las monedas que representan 50 a 60% de todos los casos, en cambio en los adultos, los más comunes son la impactación <b>de comida (lo más común bolo de carne) y las espinas de pescado. </b> Entre el 80 y 90% de los cuerpos extraños pasan espontáneamente a segmentos distales del tracto gastrointestinal y el resto, 10 a 20%, quedan impactados, generalmente a nivel de los estrechamientos fisiológicos del esófago (esfínter esofágico superior, arco aórtico y hiato diafragmático). El <b>diagnóstico</b> se sospecha con la historia clínica y es importante interrogar al paciente o a sus familiares sobre el tiempo que ha transcurrido desde la ingesta del CE hasta la consulta, el tipo de elemento que se ingirió, si realizó maniobras para intentar extraerlo o si tiene prótesis dentales así como estudios complementarios como estudios radiológicos, Tomografía de ser necesario. Los<b>síntomas</b> más frecuentes son la disfagia, odinofagia, sialorrea y sensación de cuerpo extraño. En niños menores debe sospecharse cuando hay pérdida súbita del apetito o dificultad respiratoria.  <b>La tríada clásica es dolor, fiebre y presencia de aire subcutáneo o mediastínico y en el caso de la ruptura espontánea se distingue: el dolor torácico, vómitos y enfisema subcutáneo (triada de Mackler) </b>, pero sólo se presenta en aproximadamente 50% de los casos.\n<b><i><center>Fuente: Rev Col Gastroenterol / 21 (3) 2006</center></i></b>\n\n  <b> El tiempo de evolución es proporcional a la mortalidad, es por esto que se hace énfasis en el planteamiento temprano de esta entidad y que los pacientes acudan al médico lo antes posible. </b>\nEn cuanto al tratamiento hay que individualizar cada caso, dependiendo de la localización del cuerpo extraño, extensión y complicaciones, será el tratamiento. Lo más común es la resolución endoscópica, con ella nos sirve de diagnóstico (visualizara el cuerpo extraño en el tracto digestivo superior) y tratamiento ( extracción del mismo), pero existen otros casos como el que les comente, que la resolución es quirúrgica..\n<b><i>NOTA: me han llegado casos como ingestión de huesos de pollo, prótesis dentales, mondadientes, alfileres, bolos de carne, espina de pescado entre muchos otros… Así que amigos, mucho cuidado al ingerir los alimentos, mastiquen muy bien y tenga cuidado al tener objetos extraños en la boca porque si no tendrán que salir al gastroenterólogo a que les haga una endoscopia para su extracción jeje. </i></b>\n<center>![jdjdjdjdj.gif](https://cdn.steemitimages.com/DQmNeh3oRYUHpYDRPMy8Ka4o1K3kokD6ZdvGtEKMNTqg32t/jdjdjdjdj.gif) </center>\n<center>Gracias por leerme y nos vemos en una próxima oportunidad… saludos y besitos. </center></p></div></p>",
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