EXAMEN FÍSICO TÓRAX Y ABDOMEN 2.docx

REPUBLICA BOLIVARIANA DE VENEZUELA UNIVERSIDAD NACIONAL EXPERIMENTAL EXPERIMENTAL DE LOS LLANOS CENTRALES ROMULO GALLEGOS FACULTAD DE ODONTOLOGÍA

GERONTOLOGIA SEMIOLOGIA DE TÓRAX Y ABDOMEN

 Autor: Odon. Amur! Brr"r# L$%"& E'().**+.+,-

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INTRODUCCIÓN S0 30"n 30"n / #"m0 #"m0o/ o/o4 o45 5 "#tu "#tu6o 6o %or %or un t0"m t0"m%o %o /4o /4o %"rd %"rd0d 0d  ! 7u" 7u" r""m%/&d %or "/"m"nto# t"8no/$408o#1 9 #0do 6/0dd nu"6m"nt" %or  "#tud0o# d" 6/or %r"d08t06o %o#0t06o ! d" 6/or %r"d08t06o n"4t06o1 "# d"80r1 %or %or / "#t "#td5 d5#t #t08 08. . Por Por ""m ""m%/ %/o1 o1 #0 %"n# %"n#m mo# o# ;u" ;u" un %80 %80"n "nt" t" t0"n t0"n" " n"umon51 ! %r"#"nt 70"3r"1 "# 70"3r" t0"n" un 6/or %r"d08t06o %o#0t06o ;u" 0nd08 ;u" "#" %80"nt" t0"n" un 80"rt %ro330/0dd d" t"n"r n"umon5. E# d"80r1  tr6<# d" / #"m0o/o45 uno %u"d" 70rmr o d"#8rtr un %o#03/" d04n$#t08o.

INTRODUCCIÓN S0 30"n 30"n / #"m0 #"m0o/ o/o4 o45 5 "#tu "#tu6o 6o %or %or un t0"m t0"m%o %o /4o /4o %"rd %"rd0d 0d  ! 7u" 7u" r""m%/&d %or "/"m"nto# t"8no/$408o#1 9 #0do 6/0dd nu"6m"nt" %or  "#tud0o# d" 6/or %r"d08t06o %o#0t06o ! d" 6/or %r"d08t06o n"4t06o1 "# d"80r1 %or %or / "#t "#td5 d5#t #t08 08. . Por Por ""m ""m%/ %/o1 o1 #0 %"n# %"n#m mo# o# ;u" ;u" un %80 %80"n "nt" t" t0"n t0"n" " n"umon51 ! %r"#"nt 70"3r"1 "# 70"3r" t0"n" un 6/or %r"d08t06o %o#0t06o ;u" 0nd08 ;u" "#" %80"nt" t0"n" un 80"rt %ro330/0dd d" t"n"r n"umon5. E# d"80r1  tr6<# d" / #"m0o/o45 uno %u"d" 70rmr o d"#8rtr un %o#03/" d04n$#t08o.

SEMIOLOGÍA DEL TÓRAX Concepto: E/ t$r= "# / %rt" d"/ 8u"r%o 9umno ;u" "#t> "ntr" / 3#" d"/ 8u"//o ! "/ d07r4m. Cont0"n"  /o# %u/mon"#1 / 8or&$n1  4rnd"# 6#o# #n4u5n"o# 8omo / rt"r0 ort ?#8"nd"nt"1 r8o ! d"#8"nd"nt"@1  / 6"n 86 0n7"r0or1  / 8d"n 4n4/0onr #0m%>t08 d" dond" #/"n /o# #%/>8n08o#1 / 6"n >804o# m!or ! m"nor1 / "#$74o1 8ondu8to tor>808o ! #u d060#0$n "# "/ m"d0#t0no.

Anatomía E/ t$r= "#t> 7ormdo %or 2+ %r"# d" 8o#t0//# rt08u/d# "n "/ dor#o 8on /# 6# d" #"r 0m%ortnt" %r /# "#tru8tur# ;u" o8u%n %rt" d"/ 3dom"n ! / %rt"

0n7"r0or d"/ t$r= 8omo1 %or ""m%/o1 954do ! 3&o. S" 7orm "/ >n4u/o 8o#t/ "ntr" /o# r"3ord"# ! "/ "=tr"mo 0n7"r0or d"/ "#t"rn$n.  %or /t0mo /# 8o#t0//# 22 ! 2+ d"nom0nd# 7/otnt"# ! ;u" no #" rt08u/n 8on "/ "#t"rn$n. E/ >n4u/o d" Lou0# ;u" #" 7orm "ntr" "/ mnu3r0o ! "/ 8u"r%o d"/ "#t"rn$n 8orr"#%ond" / %unto d" r"7"r"n80 d" / + 8o#t0// 7undm"nt/ "n "/ "=m"n d" 954do: #" 3u#8 "/ >n4u/o d" Lou0# %r #5 "n8ontrr "/ + EI D! #" %"r8ut" "n #"nt0do d" / /5n" m"d0o 8/608u/r %r d"#t8r / mt0d"& 9"%>t08 E/ %%u/ ?>n4u/o 0n7"r0or@ 8on /o# 3r&o# 8o/4ndo "#t>  n06"/ T'T(. E#t" %unto #0r6" d" r"7"r"n80 %r 98"r %un80on"# %/"ur/"# 8undo "/ "#%80o "#t> o8u%do %or /5;u0do. L %$70#0# "#%0no# d" C1 %rom0n"nt" "n / 3#" d"/ 8u"//o1 8orr"#%ond" / t808#. Todo /o nt"# m"n80ondo 8orr"#%ond"  %unto# d" r"7"r"n80 ;u" #" "m%/"n durnt" "/ "=m"n 75#08o d"/ t$r=. E/ t$r= 8ont0"n" 7undm"nt/m"nt" %u/mon"# ! "#tru8tur# d"/ m"d0#t0no. L# "#tru8tur# d"/ m"d0#t0no #on "/ 8or&$n ! /o# 4rnd"# 6#o# ?ort ! 86 #u%"r0or@1 t0mo ! 4n4/0o# /0n7>t08o# ;u" #on mu! 0m%ortnt"# "n %ro8"#o# tumor/"#1 "#$74o1 tr>;u" ! / 307ur880$n 3ron;u0/.

Examen í!"co #e$ T%&ax L "=%/or80$n 75#08 o "=m"n 75#08o "# "/ 8onunto d" %ro8"d0m0"nto# o 930/0dd"# d" / 80"n80 d" / S"m0o/o45 8/5n081 ;u" r"/0& "/ m
d"/ 8u/ #" #o/080tn o no d"t"rm0nd# "=%/or80on"# 8om%/"m"ntr0#1 ;u" 8on70rm"n "/ d04n$#t08o d" un #5ndrom" o "n7"rm"dd.  Un "=m"n 75#08o t5%08o 8om%r"nd": In#%"880$n ?o3#"r6r "/ 8u"r%o@. P/%80$n ?#"nt0r "/ 8u"r%o 8on /o# d"do# o /# mno#@. •

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 Au#8u/t80$n ?"#8u89r /o# #on0do#@. P"r8u#0$n ?%rodu80r #on0do#1 4"n"r/m"nt" dndo 4o/%"# #u6"# "n >r"# "#%"85708# d"/ 8u"r%o@.

In!pecc"%n: S" d"3" "=m0nr / 7orm d"/ t$r=1 "/ t0%o d" r"#%0r80$n1 / 7r"8u"n80 r"#%0rtor0. En 8udro# d" o3#tru880$n d" /# 65# 
'a$pac"%n: M"d0nt" / %/%80$n #" %u"d"n #"nt0r 603r80on"# ;u" #" 4"n"rn "n "/ 0nt"r0or d"/ t$r= ?%.".: 8undo "/ %80"nt" 93/@. S" #0"nt" un d0#8r"t 8o#;u0// "n / mno ?930tu/m"nt" #" u# tod / %/m d" / mno o "/ 3ord" 8u30t/@. S" /" #o/080t / %80"nt" ;u" r"%0t nm"ro# o %/3r# ?%.".: tr"0nt ! tr"#@. Con60"n" t"n"r un m
8om%rr /o# d0#t0nto# #"8tor"# d"/ t$r=. L #"n#80$n t>8t0/ ;u" #" /o4r" d"%"nd" d" 6r0o# #%"8to#: / 0nt"n#0dd ! /# 8r8t"r5#t08# d"/ ru0do ?%.".: "/ tono d" / 6o&@1 / &on ;u" #" %/% ?%.".: 8"r8 d" / tr>;u" #" #0"nt" m># 7u"rt"@1 "/ 4ro#or d" / 4r# #u38ut>n"1 / 0nt"4r0dd d"/ t"0do %u/monr1 ! "/"m"nto# ;u" #" 0nt"r%on4n "ntr" /o# 4rnd"# 3ron;u0o# ! / %r"d d"/ t$r= ?%.".: #0 9! 0r" o /5;u0do "n / 860dd %/"ur/1 / 603r80$n #" #0"nt" d<30/ o u#"nt" #0 "=0#t" un 8ond"n#80$n n"um$n081 #" %/% m># 8/rm"nt"@. S" //m 7r
'e&c(!"%n: En / #"880$n #o3r" /# t<8n08# d"/ "=m"n 75#08o #" r"60#$ /o 8on8"rn0"nt"  / %"r8u#0$n. Cundo #" "=m0nn /o# %u/mon"# #" u# %r0n80%/m"nt" "/ m "#8u89r#" un d0#t0nt #onor0dd. S" r"8om0"nd %"r8ut0r d"#d" &on# d" m!or #onor0dd 980 ;u"//# 8on #on0do mt". D" "#t 7orm #" d"/0m0t / 3#" d" /o# %u/mon"#. L 3#" d"r"89 "# m># /t ;u" / 0&;u0"rd. L 0n8ur#0$n d"/ d07r4m ! "/

d"#8"n#o d" /# 3#"# %u/monr"# #" 8om%ru"3n %0d0"ndo / %80"nt" ;u" 0n#%0r" %ro7undo ! 4unt" "/ 0r" m"d0nt" / %"r8u#0$n1 #" d"t"8t ;u" /# 3#"# #" mo60/0&n uno# )  , 8m.

A(!c($tac"%n: Con#0#t" "n "#8u89r tr"# t0%o# d" ru0do#: ?2@ /o# norm/"# ;u" #" 4"n"rn 8on / r"#%0r80$n1 ?+@ /o# 4r"4do# ?o d6"nt080o#@ ;u" #" 4r"4n "n 8ond080on"# norm/"#1 ! ?H@ / 7orm 8omo #" trn#m0t" / 6o& norm/ ! / ;u" "# %ronun80d "n 7orm d" #u#urro o 8u89089"o. Con60"n" t"n"r un ord"n %r u#8u/tr /o# %u/mon"# d" modo d" 8u3r0r todo# /o# #"8tor"#1 #0n o/60dr d" u#8u/tr d"3o d" /# =0/#. S" 6n 8om%rndo #"8tor"# 9om$/o4o# %r d"#8u3r0r d07"r"n80# "ntr" un /do ! "/ otro. A 6"8"# o8urr" un 80"rt d0708u/td %r #3"r #0 /o# ru0do# "#t>n um"ntdo#  un /do1 o d0#m0nu0do# / otro. Pr d"#%/&r /# "#8>%u/# 980 /o# /do# #" /" %0d" / %80"nt" ;u" 8ru8" /o# 3r&o# %or d"/nt". E/ "=m"n #" %u"d" "7"8tur "#tndo "/ %80"nt" d" %0"1 #"ntdo o 8o#tdo1 %"ro #"nt>ndo/o / mom"nto d" "=m0nr / "#%/d. A/ "=m0nr / %80"nt" 8o#tdo #" 98"n m># notor0# /# #030/n80# ! "n / mu"r / 0nt"r7"r"n80 d" /# mm# "# m"nor.

LESIONES DE LA 'ARED TOR)CICA De*o&m"#a#e! ! d"7orm0dd"#1 ;u" #0n #"r tr03utr0# d" trtm0"nto ;u0rr408o %or  n"8"#0dd1 %u"d"n t"n"r r"/80$n 8on 8u/;u0"r t0%o d" 0nt"r6"n80$n ;u0rr408.

T%&ax en tone$: A / 0n#%"880$n %r"80mo# ;u" "/ d0>m"tro nt"ro %o#t"r0or ! /t"r/ #on %r"o#. G"n"r/m"nt" 8orr"#%ond"n  %80"nt"# "n70#"mto#o# ;u" #o%ortn m/ / n"#t"#0.

'ect(m exca+at(m : S" %r"80 un d"%r"#0$n "n / %rt" 3 d"/ t$r= "n / %rt" 7ront/1 8orr"#%ond0"ndo / "=tr"mo 0n7"r0or d"/ "#t"rn$n ;u" "n o8#0on"# %u"d" %on"r "n 8ont8to "#t# "#tru8tur# 8on / 8o/umn 6"rt"3r/ d"#%/&ndo "/ 8or&$n. A/ 04u/ ;u" "/ nt"r0or %u"d"n %r"#"ntr  tr#torno# "n / 6"nt0/80$n. D"#d" "/ %unto d" 60#t "#t
T%&ax &et&aí#o: S" o3#"r6 un 9"m0t$r= m># %";u"o ;u" "/ otro dond" /# 8o#t0//# #" "n8u"ntrn mu! un0d#1 8on "#%80o# 0nt"r8o#t/"# mu! "#tr"89o# o 0n"=0#t"nt"# ! "n o8#0on"# /# %ro%0# 8o#t0//# 83/4ndo un# #o3r" otr#. S" %r"#"nt "#t d"7orm0dd "n 7"880on"# 8r$n08# %u/monr"# 8omo 703ro#0#. S" %r"8" / 8udro d" /# 807o#8o/0o#0#1 8on 8ur6tur d" / 8o/umn 6"rt"3r/ 980 "/ /do 7"8to1 #$/o ;u" %or otr 8u#. L tr>;u" tm30ndo/ "n / 3#" d"/ 8u"//o. E/ "#tr"89m0"nto d" /o# "#%80o# 0nt"r8o#t/"# %r80/ o tot/ d" un 9"m0t$r= 8on r"tr880$n d"/ m0#mo ! d"#6080$n d" / tr>;u" 980 "/ /do 7"8to1 #" %u"d" 6"r tm30
T%&ax a,om,a#o: E# "/ 8#o 8ontrr0o / nt"r0or1 dond" un 9"m0t$r= #" "n8u"ntr m># 3u/tdo ;u" "/ otro1 8on /o# "#%80o# 0nt"r8o#t/"#  "n#n89do#. Pu"d" #"r %or d06"r## 8u##1 %"ro 4"n"r/m"nt" #" trt d" 8o/"880on"# /5;u0d# "n "/ "#%80o %/"ur/. Otr# 8u## %u"d"n #"r tumor"# d" 4rn tmo d"/ %u/m$n o %/"ur ! #" d"#8r03"n tm30t08# 4rnd"#. En o8#0on"# "/ 3om3m0"nto "# #$/o %r80/1 o8u%ndo / 7o# #u%r' 8/608u/r1 "n 8u!o 8#o %u"d" #"r d"30do  8umu/o d" 4r# o / %r"#"n80 d" un tumor ;u" %u"d" #"r un d"no%t5 "n o8#0on"# m"t#t#08# o d"/

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"#tr 8om%do d" un 0rr0t80$n d"/ #0m%>t08o 8on "/ #04no d" Pour7our du P"t0t1 8on "=o7t/mo# ! m0dr0#0# "n "/ oo d"/ /do 7"8to1 o d"#tru880$n d"/ %ro%0o #0m%>t08o "n 8u!o 8#o #" %rodu8" "/ #04no d" C/ud" B"rnrd orn"r  8on "n o7t/mo# ! m0o#0#.

 T(mo&e! L"poma! - .("!te! !e,/ceo!: Pu"d"n #"r o3#"r6do# "n 8u/;u0"r  #0t0o d" / %r"d d"/ t$r=1 #o3r" todo "n / %rt" %o#t"r0or1 8omo un um"nto d" 6o/um"n /0#o ! r"4u/r1 ;u" 8undo #" %/%n #" %u"d" %r"80r ;u" no "#t>n d9"r0do#  /o# %/no# %ro7undo# n0  / %0"/ "n /o# 8#o# d" /0%om# ! d9"r0do#  / %0"/ #0 #on ;u0#t"# #"3>8"o#.

Sa&coma!: Son tumor"# 7r"8u"nt"# "n / %r"d d"/ t$r= ! #" 6"n 8omo un um"nto d" 6o/um"n  6"8"# 0rr"4u/r.

Ne(&o*",&oma!: S" %r"80n 8omo tumor"# r"dond"do#1 %rom0n"nt"# ! m/t0%/"#. S" 6"n "n / "n7"rm"dd d" Von R"J/0n9u#"n.

Con#&oma!: A%r"8"n 8omo tumor"#1 ;u" o8u%n / %o#080$n / un0$n d" /# 8o#t0//# 8on /o# 8rt5/4o# 8o#t/"# "n 7orm d" tumor %rom0n"nt"1 ;u"  / %/%80$n #" "n8u"ntrn 70o# / %/no m># %ro7undo.

Ane(&"!ma #e $a ao&ta: S" %u"d" 6"r 8omo un tumor r"dond"do1 3#tnt" /o8/0&do "n / 8r nt"r0or d"/ t$r=1 "n "/ 9"m0t$r= 0&;u0"rdo  n06"/ d" /o# %r0m"ro# "#%80o# 0nt"r8o#t/"# ! d / 0m%r"#0$n d" t"n"r  #%"8to 0n7/mtor0o. E# mu! rro 6"r/o "n / 8tu/0dd1 %"ro #" d"3" t"n"r  %r"#"nt" ! no 8on7und0r/o 8on un 3#8"#o d" / %r"d ;u" %ud0"r %/nt"r / 0n80#0$n ! dr"n". L# 8on#"8u"n80# d" "#t" "rror1 #"r>n d"##tro##. In7"880on"#:

o&0nc($o! - a,!ce!o!:  Como "n "/ r"#to d"/ 8u"r%o #" %u"d"n o3#"r6r "#t# /"#0on"#1 ;u" #" %r"#"ntn 8on /# 8r8t"r5#t08# d" /# In7"880on"# /o8/0&d#1 "# d"80r1 tumor1 do/or ! ru3or. A 6"8"# #on ;u0#t"# #"3>8"o# 0n7"8tdo#.

)nt&ax: E# rro 6"r/o# "n "/ t$r=1 ! ;u" / /o8/0&80$n m># 7r"8u"nt" "# "n "/ 8u"//o1 %"ro 8undo %r"8"n1 #" %r"#"ntn 8omo un &on 3u/td1 "nro"80d1 8on m/t0%/"# or07080o#1 %or dond" #/" %u#. En "#to# 8#o# d"m># #" d"3" 0n6"#t04r un %o#03/" d03"t"#.

T"&a1e Cundo "=0#t" un %ro8"#o o3#tru8t06o d" 65# r"#%0rtor0# /t# d" m!or o m"nor ur4"n801 #" %u"d" o3#"r6r #o3r" todo "n n0o# %";u"o#1 dond" "/ t$r= "# m># 7/"=03/"1 / d"%r"#0$n d" /o# "#%80o# 0nt"r8o#t/"# ! %rt" 3 d"/ "#t"rn$n 8on "/ %
C"ano!"!: E#t 8o/or80$n &u/o# trdu8" %or #u%u"#to 9"mto#0# d0708u/to#. Pu"d" #"r d"30d  %ro8"#o# o3#tru8t06o# ;u" r";u0"r"n un t"r%
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r"#%0r80on"# #u%"r7080/"#1 %u"d" d"notr un %ro8"#o #<%t08o. L d0708u/td

"n / 0n#%0r80$n ;u" r";u0"r" "#7u"r&o ! 8ontr880$n "=4"rd d" /o# m#8u/o# tor>808o# "# #04no d" o3#tru880$n d" /# 65# 
'a$pac"%n Expan!"%n #"!m"n("#a: Cundo "# "n 7orm 30/t"r/ %u"d" #"r d"30d  un o3#tru880$n d" /# 65#  o3#"r6r "n 7orm un0/t"r/ "n 8#o# d" 8o/"880$n 
2",&ac"one! +oca$e!: E=0#t" d0#m0nu80$n d" /# 603r80on"# 6o8/"# "n un 9"m0t$r= o %rt" d"
T(mo&e! L"poma!: 8on#0#t"n80 3/nd1 no d9"r0do#  %/no# #u%"r7080/"# n0 %ro7undo#. u0#t"# #"3>8"o#: 8on#0#t"n80 70rm"1 no d9"r0do#  %/no# %ro7undo# %"ro #0  / %0"/. Am3o# #on d" #u%"r7080" /0# ! r"4u/r. Sr8om# ! 8ondrom#: d" 8on#0#t"n80 dur1 70rm" ! d9"r0do#  %/no# %ro7undo#. Su%"r7080" /4o 0rr"4u/r. M"t>#t#0# "n 7o# #u%r8/608u/r ! 6
'e&c(!"%n Mat"#e3: A%r"8" "n / &on o8u%d %or un 8o/"880$n /5;u0d "n "/ "#%80o %/"ur/. S0 "# #$/o /5;u0do1 "/ /5m0t" #u%"r0or #04u" un /5n" o3/08u

980 rr03 ;u" "# / 8ur6 d" Dmo0#"u. Tm30 %r"80r un mt0d"& "n / 3#" d"/ 9"m0t$r= 8orr"#%ond0"nt". En "#to# 8#o# #" d07"r"n80 d" un d"rrm" %/"ur/ "n ;u" "n "/ 3#8"#o #u37r
T"mpan"!mo: S" "n8u"ntr "n /o# %80"nt"# 8on n"umot$r=1 "n /o# ;u" #" 9 8o/"880ondo 0r" "n / 860dd %/"ur/. Pu"d" "=0#t0r t0m%n0#mo /o8/0&do "n %80"nt"# 8on "n70#"m /o8/0&do d"/ %u/m$n1 /o ;u" %u"d" #"r un #04no %r"8o& d" 8>n8"r d"/ %u/m$n %or o3#tru880$n %r80/ d" un 3ron;u0o. Cundo "n / 860dd %/"ur/ #" 8umu/ 0r" ! /5;u0do1 <#t" o8u% / %rt" 0n7"r0or ! "nton8"# "/ /5m0t" #u%"r0or d" "#t" d"rrm" "# un /5n" 9or0&ont/.

A(!c($tac"%n C&ep"tante! - !(,c&ep"tante!: A%r"8"n "n &on# dond" "=0#t" /4n %ro8"#o 0n7/mtor0o d"/ %u/m$n 8omo n"umon5#.

Roce p$e(&a$: S" "#8u89 "n ;u"//o# 8#o# ;u" 9n %r"#"ntdo un d"rrm" %/"ur/ ! "# un #"8u"/ d"/ m0#mo.

S"$enc"o a(!c($tato&"o: E=0#t" "n /o# 8#o# d" 8o/"880$n /5;u0d o 4#"o# d" / 860dd %/"ur/. Pu"d" #"r /0m0tdo  un &on o d" todo un 9"m0t$r=. Tm30
TORAX EN EL TRAUMA C"ano!"!: E# uno d" /o# %r0m"ro# #04no#  o3#"r6r1 8undo "# 4"n"r/0&d1 d"not tr#torno r"#%0rtor0o #"6"ro ;u" %u"d" "#tr "n r"/80$n 8on / %r"#"n80 d" un 8u"r%o "=tro "n /# 65# ;u"1 /r0n4" o / %r"#"n80 d" un 9"mo%"r08rd0o. R";u0"r" d" / 8tu80$n r>%0d %r 3u#8r %"rm"30/0dd d" 65# 408#. S" trt "nton8"# d" un #70=0 trum>t08 %or 8om%r"#0$n d"/ t$r=1 ;u" t0"n" m"or %ron$#t08o.

 &ec(enc"a &e!p"&ato&"a R"#%0r80$n #u%"r7080/ ! do/oro# #o3r" todo "n uno d" /o# 9"m0t$r=. D"not / %o#030/0dd d" 7r8tur 8o#t/. R"#%0r80$n 7or&d1 8on 8ontr880$n d" /o# m#8u/o# d"/ t$r= ! t0r". S" %r"#"nt "n / o3#tru880$n d" /# 65# ;u" ! /r0n4"  Aum"nto d" / 7r"8u"n80 r"#%0rtor0 ! #u%"r7080/. Pu"d" "#tr "n r"/80$n 8on / 8o/"880$n d" /5;u0do1 0r" o m3o# "n / 860dd %/"ur/ %or un 9"mon"umot$r=.

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t%onm0"nto 8rd08o %or 9"mo%"r08rd0o. S" 8om% d" 9"r0d %r"8ord0/ ! %u/#o %"r07
 5ematoma! o e.("mo!"! Corr"#%ond"n  8ontu#0on"#1 ;u" d"3"n #"r mu! 30"n "=m0nd#1 %u"# d"3o %u"d"n %r"#"ntr todo t0%o d" /"#0on"#1 d"#d" / 7r8tur 8o#t/ 9#t un 9"mon"umot$r=1 %ro6o8do "n mu89# o8#0on"# %or / %ro%0 7r8tur 8o#t/1 uno d" 8u!o# 7r4m"nto# 90"r" / 8ort08/ d"/ %u/m$n. Cundo / 8ontu#0$n #" /o8/0& "n /# %rt"# 3# d"/ t$r=1 #" d"3" #o#%"89r "n "/ /do 0&;u0"rdo / ru%tur "#%/t08. En m3o# /u4r"# %u"d" tm30
Re!p"&ac"%n pa&a#%1"ca:  En / &on d" "#t# ";u0mo#0# #" %u"d" o3#"r6r  6"8"# ;u" un #"4m"nto d" / %r"d tor>808 ! "n o8#0on"# "n / r"40$n "#t"rn/1 #" d"%r0m" durnt" / 0n#%0r80$n ! %or "/ 8ontrr0o #" 3om3 durnt" / "#%0r80$n. E# %or "#to ;u" #" //m Kr"#%0r80$n %rd$081 ;u" o3"d"8"  7r8tur# m/t0%/"# d" 8o#t0//# "n do# %unto# d" #u /on40tud. E#to 98" ;u" #" %0"rd / r;u0t"8tur d" / %r"d. En "/ 8#o d"/ "#t"rn$n 04u/m"nt" o8urr"1 0n6o/u8r>ndo#" d"m># 6r0# 8o#t0//#. E#t" "# "/ 8udro 8ono80do 8omo Kt$r= 0n"#t3/" o K6o/"t 8o#t/. En o8#0on"# "# mu! 4r6" 8on 4rn 0n#u7080"n80 r"#%0rtor0. ! d"7orm0dd"#1 ;u" #0n #"r tr03utr0# d" trtm0"nto ;u0rr408o %or n"8"#0dd1 %u"d"n t"n"r r"/80$n 8on 8u/;u0"r t0%o d" 0nt"r6"n80$n ;u0rr408.

T%&ax en tone$: A / 0n#%"880$n %r"80mo# ;u" "/ d0>m"tro nt"ro %o#t"r0or ! /t"r/ #on %r"o#. G"n"r/m"nt" 8orr"#%ond"n %80"nt"#

"n70#"mto#o# ;u" #o%ortn m/ / n"#t"#0 .! d"7orm0dd"#1 ;u" #0n #"r  tr03utr0# d" trtm0"nto ;u0rr408o %or n"8"#0dd1 %u"d"n t"n"r r"/80$n 8on 8u/;u0"r t0%o d" 0nt"r6"n80$n ;u0rr408

T%&ax Ope&a#o: E#to# %80"nt"# %r"#"ntn tu3o# d" dr"n" 8on"8tdo#  #0#t"m# 0rr"6"r#03/"# o #"//o# d" 4u. En otr# o8#0on"# "#t>n 8on"8tdo#  #0#t"m# d" #%0r80$n tor>808 8omo "/ d" O6"r9o/t . Todo# 8on / 70n/0dd d" mnt"n"r / "=%n#0$n %u/monr ! %r"#0$n n"4t06 %/"ur/1 #5 8omo "=tr"r 0r"1 #"8r"80on"# ! #n4r". S" mu"#tr un dr"n" d"/ t$r= ;u" %u"d" d"t"rm0nr un #%0r80$n "n / 860dd %/"ur/ 8on %r"#0$n n"4t06 8ontro/d. E# un dr"n" d" O6"r9o/t. Con#t d" un 7r#8o 8o/"8tor ;u" #" 8om%ort 8omo un #"//o 3o d" 4u ! otro 7r#8o 8on un tu3o d" %";u"o 8/03r"1 0ntrodu80do 3o d"/ 4u uno# 2-8m#. ! "n 8omun0880$n 8on / tm$#7"r. D" 8u"rdo  / /on40tud d" "#t" tu3o ;u" #" 0ntrodu&8 d"3o d"/ 4u d"/ r"80%0"nt"1 #"r> / %r"#0$n n"4t06 d"ntro d"/ t$r=.

In!pecc"%n 5e&"#a .("&0&4"ca: Pu"d" #"r norm/ ! #0 #" "=m0n  /o# tr"# o 8utro d5# %u"d" %r"#"ntr #04no# d" 0n7/m80$n /o8/ 8omo 8o/or ro#do  roo ! um"nto d" 6o/um"n1 /o ;u" %unt 980 un 0n7"880$n d" / 9"r0d.

C"ano!"!: Pu"d" #"r d"30d  un t"/"8t#0 m#06 d" un %u/m$n %or  o3#tru880$n d" un 3ron;u0o %r0n80%/. En otr# o8#0on"# #" %u"d" d"3"r  un "m3o/0#mo %u/monr d" 4ru"# rm1 "n 8u!o 8#o "/ %80"nt" r"70"r" / #"n#80$n d" mu"rt" 0nm0n"nt".

&ec(enc"a &e!p"&ato&"a: L r"#%0r80$n r>%0d ! #u%"r7080/ "# /o m># 7r"8u"nt" ! #" %u"d" 6"r "n /o# do# 8#o# nt"r0or"#. S0 #" o3#"r6 / d5 #04u0"nt" o  /o# do# d5#1 "#t" #04no %u"d" d"notr tm30
D&ena1e!: L 0n#%"880$n 0n8/u!" / o3#"r680$n d" /o# dr"n"# ! #0#t"m d" #%0r80$n. S" d"3" 8om%ro3r ;u" /o# dr"n"# d"/ t$r= "#t
! "# "n /# %r0m"r# +) 9or# d" / o%"r80$n1 %u"d" "#tr o3#tru0do "/ dr"n"1 "n 8u!o 8#o #" d"3" trtr d" %"rm"30/0&r1  6"8"# 8om%r0m0# %odmo# 6"r0708r /# 603r80on"# 6o8/"# ;u" "#tr>n d0#m0nu0d# "n /o# 8#o# m"n80ondo# d" t"/"8t#0 m#06 ! 8o/"880$n 0nt"r%/"ur/. En / t"/"8t#0 / tr>;u" #" "n8u"ntr d"#60d 980 "/ /do 7"8to1 /o ;u" #" %u"d" 6"r0708r / %/%r / m0#m  n06"/ d"/ 8u"//o.

A(!c($tac"%n A(!enc"a #e m(&m($$o +e!"c($a&: A%r"8" "n /o# m0#mo# 8#o# m"n80ondo#1 ;u" #on /# 8om%/0880on"# m># 7r"8u"nt"# d"/ t$r= o%"rdo. E# 0m%ortnt" 8orro3orr "#to# d04n$#t08o# 8on R!o# X d" t$r=1 %r %ro8"d"r d" 0nm"d0to. En "/ 8#o d" t"/"8t#01  6"8"# 8on "/ 9"89o d" / mo60/0&80$n %r r"/0&r "/ "=m"n 75#08o1 #" d"#%r"nd"n /o# t%on"# mu8o#o# ;u" o3#tru!"n "/ 3ron;u0o ! #" r"#u"/6" "/ %ro3/"m1 d" /o 8ontrr0o1 o3/04  un "ndo#8o%0 d" ur4"n80.

ABDOMEN Examen í!"co #e$ A,#omen De*"n"c"%n: E/ 3dom"n "# un 4rn 860dd "n 8u!o 0nt"r0or ! "n d0#t0nto# %/no#1 #" u308n un 4rn nm"ro d" 65#8"r# d" d"#04u/ 8on#0#t"n80 ! 8u!# %r"d"# "#t>n 8on#t0tu0d#1 8on "=8"%80$n d"/ r;u0#1 %or m#8u/o#1 %on"uro#0# ! un r"6"#t0m0"nto 8"/u/r ! 8ut>n"o. Como / %r"d 3dom0n/ nt"r0or "# 7>80/m"nt" d"%r"803/" ! d" %o8o "#%"#or1 / mno ;u" %/% no

#o/o / "=%/or #0n d0708u/td1 #0no ;u"  #u tr6<#1 "// %u"d" /8n&r /# 65#8"r# #u3!8"nt"#. E/ %"r70/ d" / %r"d nt"r0or d"/ 3dom"n #" 9 8om%rdo 8on un S 0t>/08 d"%r0m0d "n "/ "%04#tr0o ! /04"rm"nt" #/0"nt" "n 90%o4#tr0o.

 De!c&","&emo! como acc"#ente! #e "mpo&tanc"a: 2ro@ "/ om3/04o1 /o8/0&do "n / %rt" m"d01 ;u" "# un d"%r"#0$n m># o m"no# %ro7und1 #"4n #" m!or o m"nor / 0n70/tr80$n d0%o# d"/ t"0do 8"/u/r #u38ut>n"o  +do@  m3o# /do# d" / /5n" m"d0 6"rt08/ #" 6" / %rom0n"n80 d" m3o# m#8u/o# r"8to# d"/ 3dom"n Hro@ 980 3o1 #0r60"ndo d" /5m0t" 0n7"r0or  "#t %r"d nt"r0or1 /# r8d# 0n4u0n/"#1 ;u" #" "=t0"nd"n d" un  otr "#%0n 0/58 >nt"ro' #u%"r0or1 %"ro ;u" #04u"n un tr!"8to d"#8"nd"nt" %r "n8ontrr#" un 8on otr "n "/ 3ord" #u%"r0or d"/ %u30#. Por d"ntro1 / 860dd 3dom0n/ "#t> /0m0td 980 rr03 %or m3# 8%u/# d07r4m>t08#1 ;u" / #"%rn d"/ t$r= ! 980 3o %or "/ "#tr"89o #u%"r0or d" / %"/60#1 ;u" / 8ont0n 8on / 860dd %"/60n. Lo# /5m0t"# 0nt"rno# no #" 8orr"#%ond"n 8on /o# "=t"rno#1 %u"# %or rr03 #04u"n "/ r"3ord" 8o#t/1 d"#d" / 3#" d"/ %# "=8tm"nt" 860dd 3d$m0no'%"/60n. A#5 8om%r"nd0d "#t 860dd "# d" 7orm o6o0d"1 8on un %o/o #u%"r0or m!or d07r4m>t08o ! "/ m"nor 0n7"r0or o %708o1 / #u%"r7080" d" / %r"d nt"r0or d"/ 3dom"n #" d060d" d" / #04u0"nt" mn"r:' S" tr&n do# /5n"# #8"nd"nt"#1 ;u" %rt0"ndo d"/ "=tr"mo "=t"rno d" /# rm# 9or0&ont/"# d"/ %u30#1 /8n&n /# "=tr"m0dd"#

nt"r0or"# d" /# d<80m# 8o#t0//# #" tr& otr /5n" ;u" un" / d<80m 8o#t0// d"r"89 8on #u 9om$n0m d"/ /do 0&;u0"rdo ! otr /5n" %r/"/  / nt"r0or ;u" un" m3# "#%0n# 0/58# nt"ro'#u%"r0or"#. A#5 ;u"d d060d0d / #u%"r7080" nt"r0or d"/ 3dom"n "n  r"40on"# ;u" r"803"n /o# #04u0"nt"# nom3r"#: un m"d0 #u%"r0or1 r"40$n "%04>#tr08 do# #u%"r0or"# /t"r/"#1 90%o8ondr0o d"r"89o " 0&;u0"rdo un m"d0 8"ntr/1 r"40$n um30/08/ ! do# m"d0# /t"r/"#1 7/n8o d"r"89o " 0&;u0"rdo ! un &on m"d0 " 0n7"r0or1 "/ 90%o4#tr0o ! do# r"40on"# /t"r/"# 0n7"r0or"#1 7o## 0/58#1 d"r"89 " 0&;u0"rd1 r"#%"8t06m"nt" / rt"r0 9"%>t081 6"n %ort1 8ondu8to# 8o/n8r"#1 rt"r0 m"#"nt808o.

 5"pocon#&"o #e&ec6o7 L$3u/o d"r"89o d"/ 954do 7ondo d" / 6"#58u/ 30/0r >n4u/o 9"%>t08o ! %rt" d"/ 8o/on trn#6"r#o "=tr"m0dd #u%"r0or d"/ r0$n d"r"89o ! 8>%#u/ #u%rrr"n/ 8orr"#%ond0"nt".

5"pocon#&"o "3.("e&#o7 L$3u/o 0&;u0"rdo d"/ 954do tu3"ro#0dd m!or 4>#tr08 8rd0#1 "%0%/$n 4#tro"#%/%#u/ #u%rrr"n/ %";u" %or80$n d"/ 8o/on d"#8"nd"nt" ! >n4u/o "#%/n8r"#.

Re4"%n (m,"$"ca$ o me!o4a!t&"o7 E%0%/$n m!or1 8o/on trn#6"r#o1 %or80$n 3 d"/ "#t$m4o ## d"/4d# 8on #u m"#"nt"r0o1 ort ! 86.

$anco "3.("e&#o7 Prt" d"/ 0nt"#t0no d"/4do ! 8o/on 0&;u0"rdo.

 $anco #e&ec6o7 Prt" d"/ 0nt"#t0no d"/4do ! 8o/on d"r"89o.

 5"po4a!t&"o7 E%0%/$n m!or %rt" d"/ 0nt"#t0no d"/4do 6"04 ! %or80$n t"rm0n/ d" m3o# ur
o!a "$íaca #e&ec6a7 C0"4o ! %
o!a "$íaca "3.("e&#a7 S04mo0d"#1 %or80$n 3 d"/ 8o/on d"#8"nd"nt" ## d"/4d#1 6#o# 0/58o#1 m#8u/o %#o# ! 4"n0t/"# 0nt"rno# "n / mu"r.  L t<8n08 d"/ "=m"n 75#08o d"/ 3dom"n "#t> "n r"/80$n 8on /o# #5ntom# ;u" ;u"" ! d" / #o#%"89 d"/ %ro8"#o %to/$408o ;u" #" #u%on" t"n4 "/ %80"nt" ! %r "//o 8um%/0r"mo# / #"m0ot"8n01 "# d"80r1 /o# m# 8on#0d"r80on"# #o3r" "/ "=m"n 75#08o d"/ 3dom"n 4udo1 tn 0m%ortnt" "n 80ru45 d" ur4"n80.

Examen *í!"co E/ o3"t06o %r0n80%/ 8on#0#t" "n d"70n0r #0 "/ "n7"rmo "# %ortdor d" un tumor 3dom0n/ ! #0 un 65#8"r "#t> um"ntd d" tmo o 8o/o8d "n %o#080$n norm/. E# 0m%ortnt" ;u" "/ "n7"rmo "#t< r"/do ! 8on7ort3/" "n %o#080$n 9or0&ont/ un;u" 9! utor"# ;u" %r"70"r"n ;u" / 83"& ! m3# rod0//# "#t
In!pecc"%n D"3" "7"8tur#" 8on 3u"n 0/um0n80$n / 7u"nt"1 d" /u& ntur/ d" %r"7"r"n801 rt07080/ o d07u# #0 "# %o#03/"1 "n 8#o 8ontrr0o1 9 d" "#tr  8o/o8d  "#%/d# d"/ "=m0ndor. E/ %80"nt" #" "=m0nr> %r0m"ro "nd" 830to #u%0no1 d"#%u<# %u"#to d" %0" ! "n /4un ;u" otr o%ortun0dd "n %o#080$n #"ntd o %o#080on"# "#%"80/"#. L 0n#%"880$n #" 9r> no #o/o m0"ntr# ;u" "/ %80"nt" 4urd un 8t0tud %#061 #0no tm30 /04"rm"nt" r"tr5do1 #u "6"r#0$n %u"d" #"r #04no d" #80t0#1 d0#t"n#0$n 3dom0n/ o d" un 9"rn0  "#" n06"/. E# 0m%ortnt" d"t"rm0nr / %r"#"n80 d" 6"n# d0/td# o d0#t"nd0d# ! d" /o# mo60m0"nto# r"#%0rtor0o# d" / %r"d 3dom0n/1 #5 8omo tm308t"r ! /o8/0&80$n d" /# 808tr08"# 3dom0n/"#. L 9"rn0 0n80#0on/ ! / d0#t#0# d" /o# m#8u/o# r"8to# #" 98"n o#t"n#03/"# 8undo #" /" 0n60t / %80"nt"  /"6ntr / 83"& o 0n8r"m"ntr / %r"#0$n 0ntr'3dom0n/ ?%ur@.

D"#%u<# d" un 8u0ddo# 0n#%"880$n d"/ 3dom"n1 d"3"n "=m0nr#" / r"40$n 5n4u0no'7"mor/ ! /o# 4"n0t/"# "=t"rno# "n "/ 9om3r"1 8on 60#t  no d"r %#r 0nd6"rt0do un t"#t58u/o no d"#8"nd0do o un 9"rn0 0n4u0n/ o 7"mor/ #0m%/" o "#trn4u/d.

'a$pac"%n Durnt" / %/%80$n #" n"8"#0t / 8oo%"r80$n d"/ %80"nt"1 d"m># d" un d"8ud r"/80$n. E/ "n7"rmo do%tr> "/ d"830to dor#/1 un;u" "n o8#0on"# #"r> n"8"#r0o "=m0nr/o "n otr# %o#080on"#1 8omo "/ d" 830to /t"r/1 6"ntr/1 d" %0" ! otr# "#%"80/"# #0 7u"r n"8"#r0o. E/ mn4u/o o3tu#o. L# mno# d"/ "=m0ndor  d"3"n t"n"r un t"m%"rtur %ro%0d ! 8tur 8on d"/08d"& %r 4nr  / 8on70n& d"/ %80"nt". Pr0m"ro #" %ru"3 "/ tono d" /o# m#8u/o# r"8to# m"d0nt" un %r"#0$n 4"nt0/ 8on / %/m d" / mno d"#8n#ndo #o3r" / %r"d 3dom0n/. S0 /o# m#8u/o# r"8to# "#t>n r"#0#t"nt"# ! 9! dud #o3r" #u 8ontr880$n 6o/untr01 / %/m d" / mno #" %r"#0on #u6"m"nt" m0"ntr# "/ %80"nt" r"/0& un r"#%0r80$n %ro7und 8on / 3o8 30"rt 8on /o ;u" "/ "#%#mo 6o/untr0o ! / r040d"& d" / %r"d 3dom0n/ d"#%r"8"n durnt" / "#%0r80$n. A 8ont0nu80$n #" %/% / %r"d 3dom0n/ "n 3u#8 d" 3om3m0"nto ! m## tumor/"#1 ;u" #" 98"n m># "60d"nt"# 8undo "/ %80"nt" 98" un "#7u"r&o / /"6ntr /o# %0"# o / 83"& ?mn0o3r d"

Bou898our@. S" "=%/orn d"m>#1 / %0"/1 "/ t"0do 8"/u/r #u38ut>n"o ! /o# m#8u/o#1 "n 3u#8 d" /"#0on"# tumor/"# "n "#t# "#tru8tur#. S" "=m0nn 04u/m"nt" /o# or07080o# ntur/"# ! /# %o#03/"# 808tr08"#1 "n 3u#8 d" #o/u80on"# d" 8ont0nu0dd d" / %r"d 3dom0n/1 "#%"80/m"nt" d"3" %/%r#" "/ om3/04o1 /o# or07080o# 0n4u0n/"#1 8rur/"# ! / /5n" m"d0 3dom0n/. S" %/%n /o# or07080o# r"8o40"ndo #u# 8r8t"r"# ! #" 0n60t  to#"r o %ur / %80"nt" %r "60d"n80r / %o#03/" #/0d d" 65#8"r#  tr6<# d" /o# or07080o# 9"rn0r0o#.

'e&c(!"%n L %"r8u#0$n d"/ 3dom"n #" r"/0& 8on "/ "n7"rmo 8o#tdo "n d" 830to #u%0no ! %or "=8"%80$n "n otr# %o#080on"# 8on "// #" trt d" 0d"nt0708r /o# d0#t0nto# #on0do# 3dom0n/"#1 /o# ;u" d"%"nd"n norm/m"nt" d" / ntur/"& m># o m"no# #$/0d d" /# 65#8"r# 0ntr3dom0n/"#. E/ m80/m"nt" "n todo "/ 3dom"n. S" r"/0& / %"r8u#0$n r"8orr0"ndo tod / %r"d 3dom0n/ ! #" o3t"ndr> /

0n7orm80$n d" /# /t"r80on"#

"n8ontrd# 8omo #on: mt0d"& d"8/06"1 ;u" "=%r"# / %r"#"n80 d" /5;u0do /03r" "n / 860dd1 8omo #80t0# o #n4r" ! t0m%n0#mo #u3d07r4m>t08o1 ;u" "=%r"# n"umo%"r0ton"o %or %"r7or80$n d" un 65#8"r 9u"81 o

mt0d"& "n "/ 90%o8ondr0o d"r"89o1 ;u" #" 8orr"#%ond" 8on "/ tmo d"/ 954do.

A(!c($tac"%n Con "/ %80"nt" "n d"830to #u%0no #" %ro8"d"  r"/0&r / u#8u/t80$n d"/ 3dom"n %r 0d"nt0708r /o# ru0do# 90dro
Ba3o E/ 3&o d" tmo norm/ no "# %/%3/". Con "/ "=%/ordor #0tudo  / 0&;u0"rd d"/ %80"nt"1 8o/o8do "n d"830to #u%0no1 "/ 3&o #" "=%/or 0n#0nundo / mno 0&;u0"rd %or d"3o d"/ r"3ord" 8o#t/ 0&;u0"rdo "n / /5n" =0/r m"d01 m0"ntr# "/ "n7"rmo r"/0& un 0n#%0r80$n %ro7und. E#t

mn0o3r #" r"%0t" "n 6r0# o%ortun0dd"# ! #0 no #" %"r803" nd1 %ro33/"m"nt" "/ 3&o no "#t> um"ntdo d" tmo. L mn0o3r d" S9u/t&" %u"d" #"r t0/: #" 8o/o8 / %80"nt" "n d"830to /t"r/ d"r"89o 8on "/ 3r&o 0&;u0"rdo 8o/o8do #o3r" / 83"& ! / %0"rn 9omo/t"r/ 7/"=0ond #o3r" "/ mu#/o ! <#t" #o3r" "/ 3dom"n "/ m
'a$pac"%n #e$ ,a3o me#"ante $a po!"c"%n - man"o,&a #e Sc6($t3e Tm30r" "#%/
R"8one! L 0n#%"880$n d"/ 3dom"n %u"d" d"#8u3r0r / %r"#"n80 d" tumor80on"# "n uno o m3o# /do# d"/ 3dom"n "n r"/80$n  un um"nto

d" tmo r"n/ un0/t"r/ o 30/t"r/. En / 7o# /um3r %r"8"n #04no# 0n7/mtor0o# 4udo# 8omo tumor1 ru3or o do/or "n r"/80$n 8on un 3#8"#o %"r0 n"7r5t08o ! d"m>#1 ";u0mo#0# "n r"/80$n  un trum r"n/. En /o ;u" r"#%"8t  / %/%80$n1 /o# r0on"# norm/"# no #on %/%3/"#1 "=8"%to "/ r0$n d"r"89o ;u"1 "n %80"nt"# d"/4do#1 %u"d" %/%r#" "n %o#080$n d" %0" 8omo un m# o6o0d" ! /0#.

'&oce#"m"ento ,"man(a$ #e pa$pac"%n E/ %80"nt" 8o/o8do "n d"830to #u%0no1 r"/do ! "/ m
98" %r"#0$n 8on /

!"m d" /o# m0#mo#. L mno d"r"89 d"3" 0r %ro7und0&ndo 980 / %r"d %o#t"r0or 9#t //"4r  %/%r "/ r0$n d" "#" /do 8undo "#t> d"#8"nd0do o um"ntdo d" tmo.  E=%/or80$n %or %/%80$n 30mnu/ d"/ r0$n d"r"89o

Man"o,&a #e 9pe$oteo &ena$7 E#t mn0o3r 8on#0#t" "n %rodu80r 8on /o# d"do# d" / mno 0&;u0"rd ?%o#t"r0or@ 0m%u/#o# 3ru#8o# ! r"%"t0do# "n / 7o# /um3r1 mnt"n0"ndo / mno d"r"89 ?nt"r0or@ "n "/ #0t0o d"#8r0to. Cundo "=0#t" un r0$n %/%3/" u otro tumor ;u" 98" 8ont8to /um3r1 / mno d"r"89 ?nt"r0or@ %"r803" un #"n#80$n d" 4o/%". Cundo / mn0o3r "=%o#0t061 / mno d"r"89 %"r803" "n "/ 3dom"n un 89o;u" #u6" " 0nt"rm0t"nt" ;u" 8orr"#%ond" / r0$n ;u" K%"/ot" %or "/ 0m%u/#o 0m%r"#o %or / mno #0tud "n / r"40$n /um3r.

2e1"4a L 6"04 ur0nr0 no #" %/% #0 "#t> 6851 #0n "m3r4o #0 "#t> //"n #" %/% %or "n80m d" / #5n70#0# d"/ %u30# 8omo un m# o6o0d" /0# ! 8on mt0d"& "60d"nt"  / %"r8u#0$n. L 6"04 d0#t"nd0d #" d"nom0n "n 8/5n08 4/o3o 6"#08/.

Co$on E/ 8o/on #8"nd"nt" ! "/ 80"4o #5 8omo "/ 8o/on d"#8"nd"nt" ! "/ #04mo0d"#1 mu89# 6"8"# %u"d"n %/%r#". E/ 80"4o ! 8o/on d"r"89o #" %"r803"n "n "/ 9"m03dom"n d"r"89o 8omo un m# r"dond"d ! 3/nd d0#8r"tm"nt" #"n#03/". En /4un# o8#0on"# #" %r"80 "/ %"r0#t/t0#mo ud03/" ! / m# %/%3/" d"#%r"8". E/ 8o/on #04mo0d"# "n num"ro## o8#0on"# #" %"r803" 8omo un m# tu3u/r1 "/>#t081 "#tr"89 ;u" #" "=t0"nd" 980 3o d"#d" / 7o# 0/58 0&;u0"rd 980 "/ %u30#. A/ 70n/ d"/ "=m"n "/"8t06o d"/ 3dom"n d"3"n "=%/orr#" /# /t"r80on"# d" / #"n#030/0dd %r0"t/ un %"//0&8m0"nto #u6" "n / %0"/ o "/ %0n89&o 8on un 4u "n 8d uno d" /o# 8utro 8udrnt"# %ro6o8 un "#t5mu/o ;u" #"

mn070"#t %or "/ 3ru#8o d"#%/&m0"nto d"/ om3/04o 980 / &on "#t0mu/d.

2a$o&ac"%n #e $a Ma!a A,#om"na$ E/ "=m0ndor 9 d" t"n"r / #"4ur0dd d" ;u" /o ;u" %r"8" un m# 3dom0n/1 no "# un "#tru8tur norm/. Fr"nt"  / %r"#"n80 d" un tumor  "n 90%o4#tr0o "n un mu"r 7 n"8"#r0o "68ur/. E/ %romontor0o /um3o#8ro %rom0n"nt"1 "n un %80"nt" d"/4do1 %u"d" 8on#0d"rr#" "rr$n"m"nt" un m# d" / /5n" m"d0 0n7rum30/08/1 #o3r" todo 8undo "# #"n#03/"  / %/%80$n un "=m"n 8u0ddo#o d"mu"#tr /# %u/#80on"# d" / ort 0nm"d0tm"nt" %or "n80m d" / #u%u"#t m#. En %80"nt"# o3"#o# "# %o#03/" %/%r un m# "n "%04#tr0o d"30do  un m#8u/o r"8to 8ontr5do 6o/untr0m"nt". Un nu"6o "=m"n 8u0ddo#o 8on "/ %80"nt" r"/do1 /o4r d"#8rtr "#t %o#030/0dd. L %/%80$n d" / ort / n06"/ d" "%04#tr0o %u"d" dr / 0m%r"#0$n d" un tumor %u/#>t0/. Un n"ur0#m 3dom0n/ no #o/o %u/# 8o/o8ndo un d"do  8d /do d"/ tumor #" %u"d" %"r8030r n"tm"nt" #u 8r>8t"r "=%n#03/". Un tumor "ndur"80do "n /o# #04mo0d"# %u"d" #"r un 7"8/om ! #0mu/r un

tumor 3dom0n/ "n 8#o d" dud 9! ;u" "=m0nr / %80"nt" d"#%u<# d" un "n"m "68unt".

Ca(!a! .(e !"m($an (n t(mo& a,#om"na$: Contr8tur d"/ m#8u/o r"8to nt"r0or d"/ 3dom"n1 6"04 norm/ d0#t"nd0d1 7"8/om d"/ #04mo0d"#. En / 6/or80$n d" un tumor 3dom0n/ "# mu! 0m%ortnt" %r"80#r / mo60/0dd d"/ m0#mo. Lo# tumor"# ;u" #" d"#%/&n 980 3o 8on / r"#%0r80$n "# %ro33/" ;u" 4urd"n r"/80$n 8on "/ 954do o 3&o ! d"m>#1 #0 #" d"#%/& 8on / %/%80$n %ro33/"m"nt" #" 6"80no / 954do o 3&o1 o "#t< un0do  un d" <#t# "#tru8tur#. Lo# 3u/tom# 4>#tr08o# #u"/"n t"n"r 80"rt mo60/0dd1 /o# d" 8o/on #8"nd"nt" ! d"#8"nd"nt" #on %o8o mo603/"#. Un tumor 70o  / %/%80$n 98" #o#%"89r / %r"#"n80 d" un m# %n8r">t08 o r"tro%"r0ton"/ !o tumor m/04no 6n&do. Lo# tumor"# d" 0nt"#t0no d"/4do ! /4uno# tumor"# d"/ o6r0o1 #u"/"n d"#%/&r#" /03r"m"nt". L# m## /o8/0&d# "n "/ m"#"nt"r0o #" mu"6"n trn6"r#/m"nt"  / %/%80$n1 8omo "/ %
A(mento #e +o$(men #e$ p/nc&ea! So/m"nt" "n %80"nt"# "n ;u" "/ %>n8r"# "#t< mu! um"ntdo d" tmo ! 94 8ont8to 8on / %r"d 3dom0n/ nt"r0or1 #" %u"d"n o3t"n"r  #04no# 0m%ortnt"# / "=m"n 75#08o. L 0n#%"880$n d"/ 3dom"n %u"d" mo#trr 3om3m0"nto "n / r"40$n "%04>#tr081 %rodu80do %or tumor"#1 ;u0#t"# ! #"udo;u0#t"# ;u" #0"nt"n "n / 83"& d" "#t 65#8"r #0 / tumor80$n #" u308 "n 8u"r%o o 8o/1 "/ 4rndm0"nto "# 60#03/" #o3r" "/ 8udrnt" #u%"r0or 0&;u0"rdo. A / %/%80$n #" 8on#tt / 8on#0#t"n80 70rm"1 dur1 o "n o8#0on"# %n8r"# %or "n80m d"/ "#t$m4o d"#%/&do  / d"r"89

M;to#o #e Ma$$et< G(- %r / "=%/or80$n d"/ %unto do/oro#o %n8r">t08o "n 90%o8ondr0o 0&;u0"rdo. Otro %unto 0m%ortnt" ;u" #" "=%/or "n / %n8r"t0t0# 4ud "# "/ #04no d" M!o'Ro3#on. S" d"#8r03" 8omo "/ %unto do/oro#o  / %/%80$n 8on "/ d"do 5nd08" "n "/ %unto m"d0o d" / 30#"8tr0& d"/ >n4u/o r"8to d"/ 8udrnt" #u%"r0or 0&;u0"rdo ;u" un" "/ om3/04o 8on "/ r"3ord" 8o#t/ 0&;u0"rdo. L %"r8u#0$n ! u#8u/t80$n d"/ %>n8r"# no 3r0ndn dto# d" 0nt"r<#.

A(mento #e +o$(men #e$ Ba3o L %r"#"n80 d" "#%/"nom"4/0 /04"r o mod"rd %u"d" %/%r#" 8omo un 0m%u/#o %"r8030do "n / %unt d" /o# d"do# d"/ ;u" "=%/or "n "/ 90%o8ondr0o 0&;u0"rdo1 8undo "/ %80"nt" 0n#%0r %ro7undm"nt". Uno d" /o# m# nt"r0or1 d" 3ord" m># 4udo ! "/ r0$n "# %o#t"r0or1 r"tro%"r0ton"/ ! 98" 8ont8to /um3r. Cundo 9! "#%/"nom"4/01 "/ m
A(mento #e +o$(men #e$ R"8%n Un r0$n um"ntdo d" tmo #" %/% 7>80/m"nt" "m%/"ndo / mn0o3r d" Gu!$n. En %80"nt"# d"/4do#1 "/ r0$n d"r"89o %u"d" %/%r#" "n %o#080$n d" %0"1 ! ;u" "n o8#0on"# d"#80"nd" 9#t / 7o# 0/58 d"r"891 o3t"n0
L mn0o3r d"/ K%"/ot"o %"rm0t" %"r8030r "/ r0$n "n / mno 8o/o8d "n / %r"d nt"r0or d"/ 3dom"n "#t" %ro8"d0m0"nto "# mu! 0m%ortnt"1 ! ;u" 98" %o#03/" d07"r"n80r un r0$n um"ntdo d" 6o/um"n d" un 6"#58u/ 30/0r 4rndd o d0/td. Un um"nto d" tmo d" m3o# r0on"# 0ndu8"  %"n#r "n "n7"rm"dd %o/0;u5#t08. E/ r0$n 8on#"r6 #u %o#080$n %o#t"r0or   %"#r d" "#tr um"ntdo 4rnd"m"nt" d" tmo1 8omo #" %r"80 "n / 90dron"7ro#0#. En "/ "=m"n %or %"r8u#0$n d"/ 3dom"n %r"8" t0m%n0#mo %or d"/nt" d" un tumor r"n/ d"30do  / %r"#"n80 d"/ 8o/on.

E+a$(ac"%n #e $o! 6a$$a34o! pato$%4"co! A(mento #e +o$(men #e$ 5í4a#o E/ um"nto d" tmo d"/ 954do "n "%04#tr0o " 90%o8ondr0o d"r"89o %u"d" r"6"/r#" %or / 0n#%"880$n "n %80"nt"# d"/4do# ! #" 98" o#t"n#03/"  / %/%80$n 8undo "/ %80"nt" "#t> r"/do. E/ 3ord" 0n7"r0or  d"/ 954do "# romo "n "/ 80rr$t08o " 0rr"4u/r ! nodu/r "n "/ 9"%tom %r0mr0o o "n "/ 954do m"t#t>#08o. E/ um"nto d" 6o/um"n d"/ 954do %or  d"3o d"/ r"3ord" 8o#t/ d"r"89o %u"d" d"t"rm0nr#" %or %"r8u#0$n1 "/ 4rndm0"nto 9"%>t08o %u"d" %r"80r#" m0d0"ndo / d0#tn80 "ntr" "/

r"3ord" 8o#t/ ! "/ 3ord" 9"%>t08o. L %r"#"n80 d" 9"%tom"4/0 0ndu8" / mt08.

A(mento #e +o$(men #e +e!íc($a ,"$"a&7 L 6"#58u/ 30/0r um"ntd d" tmo #" %/% %or d"3o d"/ r"3ord" 8o#t/1 8omo un tumor /0#o1 %0r07orm"1 "n "/ 90%o8ondr0o d"r"89o1 ;u" #" d"#%/& 980 3o durnt" / 0n#%0r80$n %ro7und. 30tu/m"nt" %u"d" d"t"8tr#" %or 7u"r d"/ 3ord" "=t"rno d"/ m#8u/o r"8to1 %"ro "n %80"nt"# d"/4do# t0"nd"  d"#%/&r#" 980 7u"r ! "n o8#0on"# /8n& "/ 7/n8o d"r"89o. L 6"#58u/ 30/0r um"ntd d" tmo ! mu! #"n#03/" "# 8r8t"r5#t08 d" / 8o/"80#t0t0# 4ud. Un 6"#08u/om"4/0 no do/oro# #o80d  un 58t"ro o3#tru8t06o m/04no %or 8>n8"r d" / 83"& d"/ %>n8r"# o d"/ >m%u/ d" V>t"r #" 8ono8" "n 8/5n08 8on "/ nom3r" d" #04no d" Cour6o0#0"r'T"rr0"r. S0 / 6"#58u/ 30/0r "#t> 8r$n08m"nt" "n7"rm %or /0t0#0# no /" "# %o#03/" d0#t"nd"r#" %or / 703ro#0# d" #u# %r"d"#.

A(mento #e +o$(men #e$ p/nc&ea! So/m"nt" "n %80"nt"# "n ;u" "/ %>n8r"# "#t< mu! um"ntdo d" tmo ! 94 8ont8to 8on / %r"d 3dom0n/ nt"r0or1 #" %u"d"n o3t"n"r  #04no# 0m%ortnt"# / "=m"n 75#08o. L 0n#%"880$n d"/ 3dom"n %u"d" mo#trr 3om3m0"nto "n / r"40$n "%04>#tr081 %rodu80do %or tumor"#1 ;u0#t"# ! #"udo;u0#t"# ;u" #0"nt"n "n / 83"& d" "#t 65#8"r #0 /

tumor80$n #" u308 "n 8u"r%o o 8o/1 "/ 4rndm0"nto "# 60#03/" #o3r" "/ 8udrnt" #u%"r0or 0&;u0"rdo. A / %/%80$n #" 8on#tt / 8on#0#t"n80 70rm"1 dur1 o "n o8#0on"# %n8r"# %or "n80m d"/ "#t$m4o d"#%/&do  / d"r"89

CONCLUSIONES L ntom5 d"#8r0%t06 no# mu"#tr un 7orm d" 8$mo 8om%r"nd"r "/ #"r 9umno 3o un %unto d" 60#t o3#"r6dor1 80"nt5708o ! n/5t08o. En "/ #"r 9umno "=0#t"n m/t0%/"# "n/8"# d" m#8u/o# 8on n"r60o# ! "=t"n#o# m#8u/o# ;u" #" 8on"8tn  #u 6"& 8on otro# m#8u/o#. L #"m0o/o45 d"/ 8u"r%o 9umno #" "#tud0 %or %rt"#. D" 3o 980 rr03 o 608"6"r#. Pr0m"ro #" "#tud0 "/ or04"n d"/ m#8u/o1 %r /u"4o #"4u0r 8on un 0n#"r80$n1 un 0n"r680$n ! %or u/t0mo un 880$n. L rtro/o45 8omo t/1 "# / 3#" d" /o ! 60#to1 #5 8omo tm30# 8om%/"o#.