ileo intestinal
TRANSCRIPT
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ILEO INTESTINAL
FISIOPATOLOGIA
ETIOPATOGENIA
DIAGNOSTICO DIFERENCIAL
DR. FABIAN LERDANUEVO HOSPITAL SAN ROQUE
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ILEO INTESTINAL
EILEÓS – ILÈUS COLICO VIOLENTO
SINDROME DETERMINADO POR LA INTERRUPCION
EN EL TRANSITO DEL CONTENIDO INTESTINAL
FUNCIONAL U OBSTRUCTIVO
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ILEO INTESTINAL
• CAUSA MAS FRECUENTE DE ABDOMEN AGUDO
CONSULTA TARDIA
• DIAGNOSTICO DIFERIDO
ERROR DIAGNOSTICO
ADHERENCIAS POSOP.
• 80 % DETERMINADO HERNIA ESTRANGULADA
CANCER DE COLON
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ILEO INTESTINAL
• IMPORTANTE MORBI MORTALIDAD *
8 % ILEO OBSTRUCTIVO SIMPLE
30% ILEO OBSTRUCTIVO ESTRANGULANTE
• REPERCUSION LOCAL Y SISTEMICA
• DISTRIBUCION POR EDAD Y SEXO DEPENDE
DE LA ETIOLOGIA
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ILEO INTESTINAL
CLASIFICACION TOPOGRAFICA
ALTAS
• INTESTINO DELGADOBAJAS
VALVULA CONTINENTE
• COLONVALVULA INCONTINENTE
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ILEO INTESTINAL
CLASIFICACION FISIOPATOLOGICA
• FUNCIONAL PERITONITICO
PARALITICONO PERITONITICO
• MECANICOSIMPLE
ESTRANGULANTE
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ILEO INTESTINAL FUNCIONAL
PARALITICOS
• ABOLICION PERISTALTICA
• PERITONITICO
• NO PERITONITICO
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ILEO FUNCIONAL PARALITICO
PERITONITICO
• REGIONAL o DIFUSO
PANCREATITIS AGUDA
• INFLAMATORIOS APENDICITIS AGUDA
DIVERTICULITIS AGUDA
• VASCULAR : INFARTO INTESTINO MESENTERICO
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ILEO INTESTINAL PARALITICO
NO PERITONITICO
• POSOPERATORIO
• REFLEJO : COLICO HEPATICO - RENAL
• METABOLICO : HIPOPOTASEMIA - UREA
• TRAUMATICO : TRAUMA ABDOMINAL HEMOPERITONEO
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ILEO FUNCIONAL
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ILEO MECANICO SIMPLE
ALIMENTOS
VERMES
BEZOARES
LITIASIS ILEO BILIAR
INTESTINO DELGADO
INTRALUMINAL
INFLAMATORIO
NEOPLASICO
TUMORPARIETAL
QUIRURGICAESTENOSIS
PERITONITIS PLASTICACOMPRESIONES
EXTRINSECO
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ILEO MECANICO ESTRANGULANTE
• HERNIA ESTRANGULADA
• BRIDAS POSOPERATORIAS
• VOLVULO INTESTINO DELAGADO
• INVAGINACION ESTRANGULADA
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ILEO MECANICO ESTRANGULANTE
• INFARTO INTESTINO MESENTERICO
OCLUSION VASCULAR
ISQUEMIA INTESTINAL
ILEO
• OCLUSION COLONICA CON VALVULA CONTINENTE : ASA CERRADA *
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FISIOPATOLOGIA
OBSTRUCCIONOBSTRUCCIONABOLICION
PERISTALTICAABOLICION
PERISTALTICA
ACUMULACION PROGRESIVA
SECRESIONESDIGESTIVAS *SECRESIONESDIGESTIVAS *
GAS INTESTINAL *
GAS INTESTINAL *
DISTENSIONDISTENSION
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FISIOPATOLOGIA
ALTERACIONINTESTINALALTERACIONINTESTINAL
VOMITOSVOMITOS
ALTERACION CARDIO RESPIRATORIA
ALTERACION CARDIO RESPIRATORIA
ALTERACION MEDIO INTERNOALTERACION
MEDIO INTERNO
DISTENSION
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COMPROMISO INTESTINAL
HIPERTONIA PARALISIS
ALTERACIONPERISTALTICA
ALTERACION PARIETAL *
ESTASISVENOSA
TRANSUDACION INTERSTICIAL
ISQUEMIA
NECROSIS
PERFORACION
HIDROELECTROLITICASEROHEMATICA
PERITONITIS
SHOCK I.R.A
ALTERACION INMUNOLOGICA
REDUCCION Ig A
PROLIFERACIONBACTERIANA
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COMPROMISO INTESTINAL
E. COLI C. WELCHI
PROLIFERACIONBACTERIANA *
ALTERACION SECRESION ABSORCION
AUMENTOSECRESION
DISMINUCIONABSORCION
SHOCK
DIFUSION TRANSMURAL
BACTERIAS Y TOXINAS
SEPSIS
HIDROELECTROLITICA
TERCER ESPACIO
I.R.APARALISIS
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COMPROMISO CARDIO RESPIRATORIO
CARDIACO
DISMINUCIONRETORNO VENOSO
DISMINUCIONGASTO CARDIACO
SHOCK
RESPIRATORIO
DISMINUCIONVOLUMEN CORRIENTE
COLAPSOPULMONAR
ATELECTASIAHIPOXEMIA
INSUFICIENCIA RESPIRATORIA
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COMPROMISO MEDIO INTERNO
ALTERACION HIDROELECTROLITICA
PERDIDA
AGUASALES
DESHIDRATACION
SHOCK
I.R.A *
HIPOCLOREMIAHIPONATREMIA
HIPOPOTASEMIA
ACIDOSIS *
ALCALOSIS
ALTERACIONMETABOLICA
VOMITOS - 3º ESPACIO
ALTERACIONPROTEICA
PERDIDAPROTEINAS
HIPOALBUMINEMIA
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FISIOPATOLOGIA OBSTRUCCION COLONICA
• VALVULA INCONTINENTE = ILEO INTESTINO DELGADO
OBSTRUCCION EN ASA CERRADA
MENOR PERDIDA H.E.
• VALVULA CONTINENTE HIPERTENSION ENDOLUMINAL *
COMPROMISO CIRCULATORIO
PERFORACION INTESTINAL
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CAUSAS DE MUERTE
� SHOCK
� SEPSIS
� INSUFICIENCIA RENAL AGUDA
� INSUFICIENCIA RESPIRATORIA AGUDA
SINDROME DE FALLA MULTIORGANICA
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CARACTERISTICAS CLINICAS
� DOLOR
� DISTENSION ABDOMINAL
� DIFICULTAD EN LA ELIMINACION DE GASES Y M. F
� VOMITOS
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DOLOR
AUSENTEFUNC. NO PERITONITICO
CONTINUO / REACCION PERITONEALFUNC. PERITONITICO
COLICO SIN IRRADIACIONOCLUSIVO ESTRANGULANTE
COLICO SIN IRRADIACION *OCLUSIVO SIMPLE BAJO
COLICO SIN IRRADIACION *OCLUSIVO SIMPLE ALTO
CARACTERISTICACARACTERISTICAILEOILEO
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DISTENSION ABDOMINAL
LEVE - MODERADOFUNC. NO PERITONITICO
LEVE - MODERADAFUNC. PERITONITICO
MODERADAOCLUSIVO ESTRANGULANTE
SEVERAOCLUSIVO SIMPLE BAJO
LEVE – MODERADAOCLUSIVO SIMPLE ALTO
CARACTERISTICACARACTERISTICAILEOILEO
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DIFICULTAD EVACUATORIA *
AUSENTEFUNC. NO PERITONITICO
PSEUDO DIARREAFUNC. PERITONITICO
AUSENTEOCLUSIVO ESTRANGULANTE
AUSENTEOCLUSIVO SIMPLE BAJO
AUSENTEOCLUSIVO SIMPLE ALTO
EVACUACION INTESTINALILEOILEO
* MONDOR MONDOR ““ SINTOMA FUNCIONAL POR EXCELENCIASINTOMA FUNCIONAL POR EXCELENCIA ““
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VOMITOS
POCO FRECUENTESFUNC. NO PERITONITICO
PRECOCES - RETENCIONFUNC. PERITONITICO
PRECOCES - PORRACEOSOCLUSIVO ESTRANGULANTE
TARDIOS – FECALOIDEOSOCLUSIVO SIMPLE BAJO
PRECOCES - PORRACEOSOCLUSIVO SIMPLE ALTO
CARACTERISTICASILEOILEO
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EXAMEN FISICO - SISTEMICO
� FASCIE DE DESASOSIEGO
� DESHIDRATACION
� PALIDEZ – ICTERICIA
� FIEBRE
� HIPOTENSION ARTERIAL
� TAQUICARDIA
� TAQUIPNEA
� OLIGOANURIA
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EXAMEN FISICO - ABDOMEN
HERNIAS
CICATRIZ QUIRURGICA
• INSPECCION DISTENSION ABDOMINAL
ONDAS PERISTALTICAS
DOLOR ESPONTANEO – PROVOCADOCONTRACTURA – DEFENSA
• PALPACION FECALOMA
TUMOR INFLAMATORIO - NEOPLASICO
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EXAMEN FISICO - ABDOMEN
AUMENTADOS : I.O.S / I.O.E
• AUSCULTACION RUIDOS H.AAUSENTES : I.F
• PERCUSION HIPERSONORIDAD – SUBMATIDEZ
MANIOBRA DE YODICE
• TACTO RECTAL SANGRE
AMPOLLA RECTALFECALOMA
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LABORATORIO
DACO3H-
DDCL -
ADK +
DN - DNa +
DApH
DNPROTEINAS
AN - AUREA
AALEUCOCITOS
AN - AHEMATOCRITO
TARDIOPRECOZ
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RADIOLOGIA
TORAX• SIMPLE
ABDOMEN
• CONTRASTADA COLON POR ENEMA
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RADIOLOGIA
SIMPLE TORAX
• ELEVACION DIAFRAGMATICA
• NEUMOPERITONEO
• ATELECTASIA
• INFILTRADOS
• DERRAME PLEURAL
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RADIOLOGIA
SIMPLE ABDOMEN
• IMAGEN EN PILA DE MONEDAS PLIEGUES DE KERCKRING
• REVOQUE DE PASMAN ENGROSAMIENTO ENTRE NIVELES *
• SIGNO DE SIMON GAS EN VIA BILIAR – ILEO BILIAR
• ILEO REGIONAL DE DEL CAMPO PANCREATITIS AGUDA
• IMAGEN EN MIGA DE PAN GAS ATRAPADO EN FECALOMA
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RADIOLOGIA
SIMPLE ABDOMEN
NUMEROSOS - LOCALIZADOS I.F.P
NIVELES * NUMEROSOS – CENTRALES I.O.B
HIDROAEREOS ESCASOS – CUADRANTE S.I. I.O.A
GRANDES CAMARAS AEREAS SIN NIVEL I.O.COLON
ACUMULACION GASEOSA DIFUSA SIN NIVEL I.F. NP
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RADIOLOGIA
COLON POR ENEMA
• IMAGEN EN DESFILADERO : CA. OCLUSIVO COLON
• IMAGEN DE MANZANA MORDIDA : CA. OCLUSIVO COLON
• IMAGEN EN PICO DE PAJARO: VOLVULO SIGMIDEO
• IMÁGENES DIVERTICULARES
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DIAGNOSTICO DIFERENCIAL“LA GRAN MAYORIA DE LOS ABDOMENES AGUDOS
EN ALGUN MOMENTO DE SU EVOLUCION SE ACOMPAÑAN DE ALGUN GRADO DE ILEO ”
SIMPLE
ILEO MECANICOESTRANGULANTE
PERITONITICO
ILEO FUNCIONAL
NO PERITONITICO
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TRATAMIENTO
• DIAGNOSTICO OPORTUNO – PRECOZ
• ABORDAJE INTERDISCIPLINARIO
• REANIMACION INMEDIATA
MEDICO
QUIRURGICOOCLUSIVOS
FUNCIONALES
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TRATAMIENTO
• REANIMACION EN U.T.I
• ESTRICTO MONITOREO DE FUNCIONES VITALES
• DESCOMPRESION INTESTINAL *
DISTENSION ABDOMINAL
DISMINUCION TENSION ENDOLUMINAL
ISQUEMIA PARIETAL
VOMITOS – BRONCOASPIRACION
* WANGESTEEN
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TRATAMIENTO
DESCOMPRESION INTESTINAL SONDA NASOGASTRICA o INTESTINAL DE MILLER ABBOTT
REAPARICION RUIDOS H.A
DESCOMPRESION ELIMINACION GASES
ACLARAMIENTO LIQUIDOS
EVOLUCION*
PERSISTENCIA ILEO DESCOMPRESIONQUIRURGICA
* TIEMPO PRUDENCIAL 24 – 36 Hs
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TRATAMIENTO
DESCOMPRESION INTESTINAL
• REMOSIÓN DE CUERPO EXTRAÑO
• DEVOLVULACION ENDOSCOPICA
• SONDA RECTAL
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TRATAMIENTO
• REANIMACION HIDROELECTROLITICA
PERIFERICA REPOSICION DE VOLUMEN
VIACENTRAL CONTROL DE P.V.C
SALINAS M. HIPOTONICOSOLUCIONES
GLUCOSADAS M. HIPERTONICO
APORTE ADECUADO DE POTASIO
SONDA VESICAL CONTROL DIURESIS HORARIA *
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TRATAMIENTO
• REPOSICION SANGUINEA - FACTORES DE COAGULACION
• REPOSICION DE PROTEINAS – ALBUMINA
• ANTIBIOTICOS * SANFORD GUIDE
1º CEFOTAXIMA / AM - SB
2ª CEFTRIAXONA / OXOFLACINA
1ª CEFOXITINA / IMIPENEM / AM – SB
2ª ORNIDAZOL + CEFALOSPORINA 2 / 3 / 4
SIN PERFORACION
CON PERFORACION
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TRATAMIENTO
• QUIRURGICO
SIMPLE DIFERIDOILEO MECANICO
ESTRANGULANTE URGENTE
PERITONITICO DIFERIDOILEO FUNCIONAL
NO PERITONITICO INFRECUENTE
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TRATAMIENTOQUIRURGICO
� LAPAROTOMIA EXPLORADORA
� REMOCION DEL AGENTE OCLUSIVO
� RESECCION
� ANASTOMOSIS
� OSTOMIAS
� LIBERACION DE ADHERENCIAS
� ASPIRACION INTESTINAL
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Fin
Esta clase fue presentada por el Dr. Aldo Fabián Lerda en ateneo de Cirugía en el Nuevo Hospital San Roque de la Ciudad de Córdoba