Presenter of 2 Presentations
ABDOMINAL AORTIC ANEURYSM, A SILENT DISEASE
Abstract
Abstract Body
Background and purpose
Abdominal aortic aneurysm (AAA) is the pathologic dilation of the abdominal aorta and is often asymptomatic but has high susceptibility to rupture.
Reported mortality rates for patients with a ruptured AAA are considerably higher than those for patients undergoing elective AAA repair, so it is imperative to diagnose AAA before rupture.
Major risk factors for AAA are age older than 65 years, male gender, smoking habits and family history.
Methods
A 66-year-old man presented to the health care center with a few months history of abdominal pain located in the periumbilical region. He had medical history of hypertension, hyperlipidemia, peripheral arterial disease and a 43 pack-year history of tobacco use.
Results of his physical examination included a soft mild distended abdomen with generalized tympanic sounds, except for the periumbilical region that presented with muffled sounds. Palpation was painless, no masses or organomegalies were palpated, although it seemed to present a “thickening” of the periumbilical region.
Results
The abdominal ultrasound revealed an aneurysmatic dilation of the juxtarenal abdominal aorta with an extension of 83mm and a diameter of 55 mm, showing a parietal thrombus with approximately 29mm.
The patient was proposed for surgery that underwent without any complications.
Conclusions
Since AAA are typically asymptomatic, screening with ultrasound is extremely important in the early detection of unknown AAA, specially in the elderly and those with risk factors.
Bearing this in mind, the adoption of screening programs plays an essential role in providing a beneficial outcome for these patients.
WHEN A CHILD REFUSES TO WALK: A CLINICAL CASE
Abstract
Abstract Body
Background and purpose
Acute muscle weakness in children is a pediatric emergency. Causes include a wide range of pathologies that can only be investigated using a detailed clinical history, a complete physical examination and directed diagnostic tests.
Finding the etiology is essential to execute treatment in a timely manner, improving the prognosis of affected children.
Methods
A 6-year-old girl presented to the health care center with a 7 day history of fever, cough and nasal obstruction worsened in the last 24 hours with pain of both knees and refusal to walk. There was no history of recent trauma.
Results of her physical examination included painful palpation of both knees, without apparent limitation of passive range of motion of the inferior limbs. The remainder of the physical examination was within normal limits.
Results
The child was referred to an emergency service for further investigation.
Peripheral blood examination showed elevated transaminases and creatine kinase. The remaining results were normal.
The diagnosis of viral myositis and hepatitis was considered and the child was hospitalized. A good clinical evolution was observed during hospitalization, with progressive improvement of pain complaints and analytical parameters.
Conclusions
Many of the conditions that cause acute muscle weakness are potentially life-threatening, so early diagnosis and treatment assume an essential role.
At a primary care health level, where there is no access to complementary diagnostic tests, it is even more important to be aware about the emergent character of acute muscle weakness in order to refer to hospital care in due time.