{"id":1949,"date":"2019-06-28T13:12:30","date_gmt":"2019-06-28T13:12:30","guid":{"rendered":"https:\/\/revisamed.com.br\/blog-wp-teste\/2019\/06\/28\/questoescomentadasresidenciamedica-revisamed\/"},"modified":"2023-05-11T19:50:46","modified_gmt":"2023-05-11T19:50:46","slug":"questoescomentadasresidenciamedica-revisamed","status":"publish","type":"post","link":"https:\/\/revisamed.com.br\/blog\/questoescomentadasresidenciamedica-revisamed\/","title":{"rendered":"Tratamento de \u00falcera perfurada. Veja quest\u00e3o comentada"},"content":{"rendered":"<figure class=\"wp-block-video\"><video controls src=\"https:\/\/revisamed.com.br\/blog\/wp-content\/uploads\/2019\/06\/cd8a6d2cdec0a44c-WhatsApp-Video-2019-07-16-at-10.04.17-2-1.mp4\"><\/video><\/figure>\n<h5 class=\"wp-block-heading\" id=\"h-tratamento-de-ulcera-perfurada-questao-comentada-revisamed\">\u00a0 \u00a0 \u00a0 Tratamento de \u00falcera perfurada: quest\u00e3o comentada Revisamed<\/h5>\n<p>Um homem de 47 anos \u00e9 admitido no pronto-socorro com queixa de dor abdominal h\u00e1 3 dias, com piora s\u00fabita h\u00e1 8 horas.Conta uso de diclofenaco ( 3 comprimidos ao dia) h\u00e1 1 semana, por dor lombar ap\u00f3s esfor\u00e7o f\u00edsico. Refere ser nervoso, mas nega antecedente m\u00f3rbido.<\/p>\n<figure class=\"wp-block-embed is-type-wp-embed is-provider-revisamed wp-block-embed-revisamed\">\n<div class=\"wp-block-embed__wrapper\">\n<blockquote class=\"wp-embedded-content\" data-secret=\"n80UN9Nsrl\"><p><a href=\"https:\/\/revisamed.com.br\/blog\/como-escolher-a-residencia-medica\/\">Como escolher a sua resid\u00eancia m\u00e9dica? Veja as dicas do Revisamed<\/a><\/p><\/blockquote>\n<p><iframe src=\"https:\/\/medprovas.com.br\/blog\/como-escolher-a-residencia-medica\/embed\/#?secret=acNi3hKadO#?secret=n80UN9Nsrl\" title=\"\u201cComo escolher a sua resid\u00eancia m\u00e9dica? Veja as dicas do Revisamed\u201d \u2014 Revisamed\" class=\"wp-embedded-content\" width=\"600\" height=\"338\" frameborder=\"0\" loading=\"lazy\" referrerpolicy=\"strict-origin-when-cross-origin\"><\/iframe>\n<\/div>\n<\/figure>\n<p>Ao exame, apresentava-se gemente, taquicard\u00edaco, com abdome \u201cem t\u00e1bua\u201d. O raio X revela pneumoperit\u00f4nio. Foi feita laparotomia exploradora cujo achado foi \u00falcera na regi\u00e3o do pr\u00e9-pil\u00f3rica com perfura\u00e7\u00e3o de 0,3 cm, sem calo ulceroso palp\u00e1vel, com l\u00edquido turvo na cavidade peritoneal.<\/p>\n<p>Das alternativas a seguir, a melhor para o caso \u00e9:<\/p>\n<h5 class=\"wp-block-heading\" id=\"h-alternativas\">Alternativas<\/h5>\n<p>A) Debriamento da borda da \u00falcera seguido de ulcerorrafia e vagotomia troncular<\/p>\n<p>B) Ulcerorrafia com procedimento de Graham modificado e uso de bloqueadores de bomba de pr\u00f3tons<\/p>\n<p>C) Gastrectomia parcial e gastroduodenostomia associado ao uso de bloqueadores de bomba de pr\u00f3tons<\/p>\n<p>D) Gastrectomia parcial e gastrojejunostomia<\/p>\n<p>E) Gastrectomia parcial e reconstru\u00e7\u00e3o \u00e0 Billroth II associado ao uso de bloqueadores de bomba de pr\u00f3tons<\/p>\n<h5 class=\"wp-block-heading\" id=\"h-resposta\">Resposta<\/h5>\n<p>B) Ulcerorrafia com procedimento de Graham modificado e uso de bloqueadores de bomba de pr\u00f3tons<\/p>\n<h5 class=\"wp-block-heading\" id=\"h-comentario\">Coment\u00e1rio<\/h5>\n<p>O tratamento cir\u00fargico da \u00falcera perfurada vai variar de acordo vai variar de acordo com o estado cl\u00ednico do paciente e do grau de contamina\u00e7\u00e3o da cavidade. No paciente est\u00e1vel e sem grande contamina\u00e7\u00e3o da cavidade, al\u00e9m do tratamento da perfura\u00e7\u00e3o, pode-se optar pelo tratamento cir\u00fargico da doen\u00e7a p\u00e9ptica: ex: antrectomia e vagotomia). Nos casos de instabilidade cl\u00ednica, ou contamina\u00e7\u00e3o importante da cavidade, (caso da quest\u00e3o), opta-se por uma abordagem mais r\u00e1pida, com fechamento da perfura\u00e7\u00e3o. Al\u00e9m da ulcerorrafia, \u00e9 indicato o revestimento da linha de sutura com segmento epiploico (epiploplastia Graham). Em todos os casos, o tratamento cl\u00ednico de suporte e o uso de IBP est\u00e3o indicados.<\/p>\n<nav class=\"post-tags\" aria-label=\"Tags do conte\u00fado\"><a href=\"\/tag\/especialidades-medicas\/\">especialidades m\u00e9dicas<\/a><a href=\"\/tag\/gastroenterologia\/\">gastroenterologia<\/a><\/nav>\n","protected":false},"excerpt":{"rendered":"<p>\u00dalcera p\u00e9ptica perfurada \u00e9 uma emerg\u00eancia cir\u00fargica e \u00e9 associada com a mortalidade a curto prazo de at\u00e9 30% dos pacientes e morbidade em at\u00e9 50%.<\/p>\n","protected":false},"author":2,"featured_media":1950,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,9,11],"tags":[24,280],"rvm_specialty":[],"class_list":["post-1949","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dicas-de-residencia-medica","category-provas-de-residencia-medica","category-videos","tag-especialidades-medicas","tag-gastroenterologia"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.7 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Tratamento de \u00falcera perfurada. 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