{"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<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_89 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">A seguir, voc\u00ea vai saber:<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/revisamed.com.br\/blog\/questoescomentadasresidenciamedica-revisamed\/#_Tratamento_de_ulcera_perfurada_questao_comentada_Revisamed\" >\u00a0 \u00a0 \u00a0 Tratamento de \u00falcera perfurada: quest\u00e3o comentada Revisamed<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/revisamed.com.br\/blog\/questoescomentadasresidenciamedica-revisamed\/#Alternativas\" >Alternativas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/revisamed.com.br\/blog\/questoescomentadasresidenciamedica-revisamed\/#Resposta\" >Resposta<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/revisamed.com.br\/blog\/questoescomentadasresidenciamedica-revisamed\/#Comentario\" >Coment\u00e1rio<\/a><\/li><\/ul><\/nav><\/div>\n<h5 class=\"wp-block-heading\" id=\"h-tratamento-de-ulcera-perfurada-questao-comentada-revisamed\"><span class=\"ez-toc-section\" id=\"_Tratamento_de_ulcera_perfurada_questao_comentada_Revisamed\"><\/span>\u00a0 \u00a0 \u00a0 Tratamento de \u00falcera perfurada: quest\u00e3o comentada Revisamed<span class=\"ez-toc-section-end\"><\/span><\/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\"><span class=\"ez-toc-section\" id=\"Alternativas\"><\/span>Alternativas<span class=\"ez-toc-section-end\"><\/span><\/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\"><span class=\"ez-toc-section\" id=\"Resposta\"><\/span>Resposta<span class=\"ez-toc-section-end\"><\/span><\/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\"><span class=\"ez-toc-section\" id=\"Comentario\"><\/span>Coment\u00e1rio<span class=\"ez-toc-section-end\"><\/span><\/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 v28.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Tratamento de \u00falcera perfurada. 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