Abstract Body

Primary umbilical endometriosis (PUE), a rare and benign entity, accounts for 0.4-1% of extragenital endometriosis, the most common extrapelvic location. Presentation: palpable nodule, cyclic bleeding and skin color changes in the affected region. Diagnosis: established by clinical examination, imaging and lesion biopsy.

A 45-year-old woman, without relevant history or medication, resorted to her GP complaining of pain and umbilical edema, protrusion and hemorrhage, with 1month of evolution, no menstrual cycle connection. Ultrasound: hypoechogenic ovular mass without intra-abdominal endometriosis. ER: considered omphalitis, flucloxacillin was prescribed. Endometriosis was suspected after recurrent complaints and association with her menstrual cycle. Following new evaluation, ultrasound and General Surgery consultation, the mass was excised with posterior umbilical reconstruction. Histopathology: hemorrhagic endometrial tissue compatible with endometriosis. Reassessment after 3 months without recurrence.

PUE, develops spontaneously. Pathogenesis: unknown, theories include the spread of endometrial cells to the umbilicus through the abdominal cavity, via the lymphatic system or the embryonic remnants in the umbilical folds. Symptoms: umbilical swelling, cyclical pain and bleeding. Differential diagnosis: granuloma, umbilical polyps, haemangioma, melanocytic nevus, seborrhoeic keratosis, granular cell tumour, umbilical hernia. Investigations: ultrasound assesses echogenicity and vascular involvement. Medical treatments: contraceptive pill or GnRH analogues, can be temporarily effective, but symptoms recur after cessation. The definitive management is surgical.

Pelvic endometriosis is a common condition, but the diagnosis of PUE is difficult. It should be considered when a woman of reproductive age presents with an umbilical swelling. By increasing the awareness of PUE, we hope this condition will be recognized and treated accordingly.

Abstract Body

Takotsubo cardiomyopathy is a myocardial disease that is structurally and functionally abnormal in the absence of structural cardiac alterations. It is often indistinguishable from acute coronary syndrome (ACS) and usually preceded by stress, hence it´s also called “broken heart syndrome”.

Woman, 49 years, divorced and hairdresser. Background: dyslipidemia, excess weight, reflux esophagitis and anxiety disorder. Presently medicated with proton pump inhibitors.

In September 2014, in consultation with her General Practitioner (GP) due to retrosternal pain with cervical irradiation and dyspnea, she was referred to the emergency department. Being tachypneic and tachycardic, with increased cardiac markers, electrocardiographic changes and chest X-ray with pulmonary congestion, was diagnosed with ACS. Echocardiogram showed acute heart failure (AHF) with severe impairment of left ventricular systolic function (LVSF). Coronary angiography didn´t reveal CAD, assuming AHF of unclear cause. She was discharged after rapid improvement and complete recovery of her cardiac function.

In consultation with her GP: asymptomatic but distressed by the past episode. After reavaluation, the GP concluded that the triggering factor was stress motivated by her work. In a new Cardiology consultation: assumed the final diagnosis of Takotsubo syndrome.

In subsequent consultations, the GP intervened scheduling frequent consultations where therapeutic listening played an influential role in teaching anxiety management to prevent recurrence.

Although an increasingly investigated entity, the number of cases described is small and much is still unknown. This case intends to emphasize the importance of the GP in the differential diagnosis of this syndrome, given its comprehensive knowledge of the patient´s biopsychosocial context.

Abstract Body

Microscopic colitis is a chronic inflammatory disease of the colon that is characterized by chronic, watery, non-bloody diarrhea (usually of an insidious onset) and normal or almost normal endoscopic appearance of the colon. It has a female preponderance, with a mean age at diagnosis of 65 years.

We present the case of a 74 year old female patient, referred to the Gastroenterology department due to an 8 month history of diarrhea (no blood or mucus), preceded by colicky abdominal pain (relieved after defecation). There was no history of fever or weight loss. She reported a change in her bowel movement pattern a year earlier. Her medical history was notable only for osteoarticular disease, medicated with NSAIDs (sos), which she took more frequently over the last year.

Physical examination revealed lower quadrants tenderness to palpation. Laboratory evaluation showed only CRP 41.7 mg/L. Abdomen X-ray and Abdominopelvic CT showed dilated colic segments with hydro-aeric levels.

Colonoscopy was performed with normal findings, but no biopsies. Despite some clinical improvement with symptomatic medication there was still a reference to diarrhea. Following this, flexible rectosigmoidoscopy was requested to exclude microscopic colitis, and biopsies were compatible with collangenous colitis.

This condition is complex and multifactorial. Medications (such as NSAIDs, PPI) have been associated with an increased risk. As it is associated with significant symptom burden and an impaired health-related quality of life, it is crucial to discuss the clinical and treatment aspects of this condition among general practitioners, often the first contact care for most patients.

Abstract Body

WHO and UNICEF have long recognized the need to promote exclusive breastfeeding in the first 6 months of life and sustained breastfeeding, along with appropriate complementary foods up to 2 years of age or beyond. USF São João do Estoril is currently applying for ACES Cascais Accreditation as a Baby-Friendly Health Centre and preparing a notebook with the 10 Steps of Breastfeeding. The third step includes counseling and informing all pregnant women and their families about the benefits and practice of breastfeeding.

We created a Breastfeeding Counselling Stamp to add to the Pregnant Health Bulletin - a tool for transmitting health data between primary health care and hospitals. This Stamp should complement the existing data in the Bulletin, addressing the desire of the pregnant women to breastfeed after birth and guarantee that the counselling is standardized, in the best interest of women and new-borns. The counselling must be given in at least two Maternal Health Medical or Nursing appointments and the Stamp must be filled out.

The main goal is to improve counselling and empower all pregnant women on breastfeeding. Additionally, address the impact of the Breastfeeding Counseling Stamp and standardize the information given to pregnant women between both primary health care and hospitals.

With the Breastfeeding Counselling Stamp we should be able to improve breastfeeding counselling and highlight the pregnant women’s desire to breastfeed with the hospital professionals where delivery will take place.