Patricio Paute V. MD.

Cirugía General, digestiva y Laparoscópica, cirugía HPB. Hospital General Alfredo Noboa Montenegro, Guaranda. Clinica “El Batán”.

[Dr. Mateo Avila @drteoa]

📌 Sonda nasogástrica: indicaciones, colocación y manejo
Nasogastric Tubes—Indications, Placement, and Management: A Review — JAMA Surgery, 2026

La SNG sigue siendo fundamental en cirugía, pero el mensaje del artículo es claro: no debe colocarse ni mantenerse “por rutina”.

🔹 Obstrucción intestinal: es su principal indicación. En obstrucción adhesiva sin isquemia, estrangulación ni peritonitis, la descompresión con SNG forma parte del manejo conservador, que resuelve aproximadamente 75% de los casos. Habitualmente se observa respuesta durante 48–72 h.

🔹 Contraste hidrosoluble: tras 2–6 h de descompresión puede administrarse por la SNG, pinzarla unas 2 h y realizar radiografía a las 12–24 h. Que el contraste llegue al colon ayuda a predecir resolución; su beneficio terapéutico, en cambio, sigue siendo discutido.

🔹 Después de cirugía abdominal: aquí está uno de los mensajes más importantes. La SNG profiláctica rutinaria debe evitarse. En cirugía colorrectal, gástrica, pancreática, hepatobiliar y ginecológica no disminuye la fuga anastomótica y puede retrasar alimentación, movilidad y recuperación. ERAS favorece retirarla precozmente o usarla solo de forma selectiva.

🔹 Colocación segura: paciente sentado 60–90°, avanzar suavemente por el piso nasal y nunca forzar ante resistencia. Si se utilizará para alimentación o administrar sustancias, debe confirmarse radiológicamente; la auscultación tras insuflar aire no es un método fiable.

🔹 Manejo: la succión suele mantenerse en 40–80 mmHg. Las pruebas de pinzamiento o gravedad no deberían hacerse rutinariamente; si se utilizan, deben ser cortas (2–4 h) y con cabecera ≥30°.

⚠️ Vigilar diariamente aspiración, lesiones nasales, migración, pérdidas de volumen, hipopotasemia y alcalosis metabólica. Si la nutrición enteral será necesaria por más de 4–6 semanas, debe considerarse una gastrostomía.

💡 Para recordar: la mejor SNG no es la que permanece “por si acaso”, sino la que tiene una indicación clara, se coloca correctamente y se retira tan pronto deja de ser necesaria.

[Dr.Marlon Villanueva™ 🩺 𝕏 @MarlonVFZR]

💩𝗗𝗶𝗮𝗿𝗿𝗲𝗮 𝗰𝗿𝗼́𝗻𝗶𝗰𝗮 (>𝟰 𝘀𝗲𝗺𝗮𝗻𝗮𝘀) — 𝗲𝗻𝗳𝗼𝗾𝘂𝗲 𝗱𝗶𝗮𝗴𝗻𝗼́𝘀𝘁𝗶𝗰𝗼🧪
⬇️⬇️⬇️⬇️

🔎 𝙃𝙞𝙨𝙩𝙤𝙧𝙞𝙖 𝙘𝙡𝙞́𝙣𝙞𝙘𝙖 𝙘𝙡𝙖𝙫𝙚

Buscar:
💊𝙛𝙖́𝙧𝙢𝙖𝙘𝙤𝙨 (metformina, colchicina, Mg)
🥙𝙖𝙡𝙞𝙢𝙚𝙣𝙩𝙤𝙨 (lactosa, gluten)
🔪𝙘𝙞𝙧𝙪𝙜𝙞́𝙖 𝙞𝙣𝙩𝙚𝙨𝙩𝙞𝙣𝙖𝙡
🧬𝙚𝙣𝙛𝙚𝙧𝙢𝙚𝙙𝙖𝙙𝙚𝙨 𝙖𝙪𝙩𝙤𝙞𝙣𝙢𝙪𝙣𝙚𝙨

🧠 𝙋𝙞𝙨𝙩𝙖𝙨 𝙘𝙡𝙞́𝙣𝙞𝙘𝙖𝙨

𝙈𝙚𝙟𝙤𝙧𝙖 𝙘𝙤𝙣 𝙖𝙮𝙪𝙣𝙤 → 𝙢𝙖𝙡𝙖𝙗𝙨𝙤𝙧𝙘𝙞𝙤́𝙣
→ celiaquía / insuficiencia pancreática

𝙋𝙤𝙨𝙩 𝙖𝙡𝙞𝙢𝙚𝙣𝙩𝙤𝙨 𝙚𝙨𝙥𝙚𝙘𝙞́𝙛𝙞𝙘𝙤𝙨 → 𝙞𝙣𝙩𝙤𝙡𝙚𝙧𝙖𝙣𝙘𝙞𝙖
→ lactosa / fructosa

𝙉𝙤 𝙢𝙚𝙟𝙤𝙧𝙖 𝙘𝙤𝙣 𝙖𝙮𝙪𝙣𝙤 + 𝙣𝙤𝙘𝙩𝙪𝙧𝙣𝙖 → 𝙨𝙚𝙘𝙧𝙚𝙩𝙤𝙧𝙖
→ colitis microscópica / ácidos biliares

𝙄𝙣𝙞𝙘𝙞𝙤 𝙩𝙧𝙖𝙨 𝙛𝙖́𝙧𝙢𝙖𝙘𝙤 → 𝙘𝙤𝙡𝙞𝙩𝙞𝙨 𝙢𝙞𝙘𝙧𝙤𝙨𝙘𝙤́𝙥𝙞𝙘𝙖

🧪 𝙀𝙨𝙩𝙪𝙙𝙞𝙤𝙨 𝙞𝙣𝙞𝙘𝙞𝙖𝙡𝙚𝙨
🩸BH
💉electrolitos
💩calprotectina fecal
🧬anti-transglutaminasa IgA
🧩TSH

🚨 𝙎𝙞𝙜𝙣𝙤𝙨 𝙙𝙚 𝙖𝙡𝙖𝙧𝙢𝙖
🩸sangrado GI
🧟‍♂️pérdida de peso
💊anemia ferropénica
👨🏽‍💼inicio >45 años
🌖diarrea nocturna

➡ 𝙘𝙤𝙡𝙤𝙣𝙤𝙨𝙘𝙤𝙥𝙞𝙖 / 𝙚𝙣𝙙𝙤𝙨𝙘𝙤𝙥𝙞𝙖

🩺 𝙎𝙞 𝙚𝙨𝙩𝙪𝙙𝙞𝙤𝙨 𝙣𝙤𝙧𝙢𝙖𝙡𝙚𝙨

→ 𝙄𝘽𝙎-𝘿 / 𝙙𝙞𝙖𝙧𝙧𝙚𝙖 𝙛𝙪𝙣𝙘𝙞𝙤𝙣𝙖𝙡

Tratamiento inicial:
𝙙𝙞𝙚𝙩𝙖 𝙡𝙤𝙬-𝙁𝙊𝘿𝙈𝘼𝙋 + 𝙖𝙣𝙩𝙞𝙙𝙞𝙖𝙧𝙧𝙚𝙞𝙘𝙤𝙨.

‼️Si te sirve: ❤️ Me gusta | 🔁 Repost | ➕ Follow para más #MedED en #ClubCrit 😄🧠🫶

👇🏼👇🏼👇🏼👇🏼
📚📖#ClubCrit

#Diarrea #Diarrhea #CritCare #UCI #ICU #CriticalCare #Diagnóstico #icu #intensivecare #diagnosis #management #POCUS #VExUS #MedicinaBasadaEnEvidencia #Terapia #MedEd #Medicina #FOAMed #FOAMcc #CuidadoCrítico #MedX #EducaciónMédica #MedIntensiva #MedXCommunity #MedicinaCrítica #MedED #CritCare #ICUManagement #MustRead #LecturaRecomendada

[Julio @JulioFdez79]

TRAMADOL

[Estudiando pal ENARM 2026 @ParaelENARM]

Apendicitis

Triada Clásica 3️⃣
1.-Dolor periumbilical irradiado hacia Fosa Iliaca Derecha
2.-Náusea
3.-Fiebre

#ENARM #ENARM2026

[Julio @JulioFdez79]

GLP-1

[HerniaDude @RicardoRGlz]

Post surgical seroma https://t.co/pPQz1lV8Bl

[Springer Health+ IME @SpringerIME]

Are you confident in your ability to effectively recognise and diagnose late-onset genetic cholestasis?

Explore this free expert-led program and discover resources providing education on the latest developments in disease presentation, the importance of genetic testing, and more

[Patricio Paute V. MD. @PPautevMD]

@teffpalacioss What???

[Japanese Society of HBP Surgery @JSHBPS]

📊✨ Groundbreaking study reveals the impact of conversion surgery after FOLFIRINOX or GnP chemotherapy on initially unresectable pancreatic cancer. 🚀 Significant boost in overall survival!
Read more: https://t.co/9tWrWHFkvX
#JSHBPS @IHPBA @AHPBA

[Aerosmith @Aerosmith]

It was 1970 when a spark of inspiration became Aerosmith. Thanks to you, our Blue Army, that spark caught flame and has been burning for over five decades. Some of you have been with us since the beginning and all of you are the reason we made rock ‘n’ roll history.

It has been the honor of our lives to have our music become part of yours. In every club, on every massive tour and at moments grand and private you have given us a place in the soundtrack of your lives.

We’ve always wanted to blow your mind when performing. As you know, Steven’s voice is an instrument like no other. He has spent months tirelessly working on getting his voice to where it was before his injury. We’ve seen him struggling despite having the best medical team by his side. Sadly, it is clear, that a full recovery from his vocal injury is not possible. We have made a heartbreaking and difficult, but necessary, decision - as a band of brothers - to retire from the touring stage.

We are grateful beyond words for everyone who was pumped to get on the road with us one last time. Grateful to our expert crew, our incredible team and the thousands of talented people who’ve made our historic runs possible. A final thank you to you - the best fans on planet Earth. Play our music loud, now and always. Dream On. You’ve made our dreams come true.

*For those who purchased their tickets through Ticketmaster, you will automatically be refunded – there is nothing further you need to do. For those who purchased via third-party resale sites such as SeatGeek, StubHub, VividSeats, etc. – please reach out to your point of purchase for more details.*

[BJS @BJSurgery]

Read @young_bjs 'Acute threat of Life' series!
2���Management of blunt abdominal trauma
https://t.co/NtlvUfDkl6

- Blunt abdominal trauma is a significant cause of morbidity and mortality
- Timely intervention and individualized treatment strategies are required to optimize patient outcomes
- Most patients with significant blunt abdominal trauma have multi-organ injuries
- Blunt abdominal trauma should be managed through a combination of operative intervention, angiographic techniques, and non-operative management
- In patients who are operated on, the primary operative decision point is determining whether a definitive or damage control operation is required

Great work by Janet R Ashley, Keith W Burczak, Bryan A Cotton, Thomas W Clements

#SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @ksoreide @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol #SoMe4Trauma #emgensurg @WSESurgery @NELANews #EmLap @ASGBI_MA #some4peds

[DCRjournal @DCRjournal]

How to create a tension-free anastomosis: how much length in cm does each of 3 colon lengthening maneuvers provide? Find out in this month's #DCRjournal: https://t.co/sVJbrDvbmM

@JohnRTMonsonMD @jendavidsmd @ScottRSteeleMD @Swexner @me4_so @ACPGBI @drtracyhull @ASCRS_1

[Esteban Ortiz @EstebanOrtizMD]

En un capítulo más de #leyesCojudas
Hoy , un ciudadano está preso por ir a 64 km/h seguramente yendo a trabajar y en la misma ciudad dejan libres a vacunadores y extorsionadores que seguirán delinquiendo “por falta de pruebas”

[Patricio Paute V. MD. @PPautevMD]

@EstebanOrtizMD Exacto… la ley aplica sólo para quienes la cumplen! La hipotenusa 🤷‍♂️

[amcgmx @amcgmx]

Se parte de la Sesión Mensual "Manejo Seguro del Abdomen difícil" que El Colegio de Especialistas en Cirugía General de la Ciudad de México y Área Metropolitana estará impartiendo el día 11 de Enero en punto de las 19:45 hrs

Link: https://t.co/1hSuAc6ojn

[AmJSurgery @AmJSurgery]

Evaluating mesh fixation techniques for ventral hernia repair: A systematic review and network meta-analysis 🔑🪡 🧶#SoMe4Surgery @pferrada1 @ericpaulimd @PipeCabreraV @TomVargheseJr @SWexner @juliomayol @herbchen @Cirbosque Link: https://t.co/ANGhWcwvHW

[Ville Sallinen @villesallinen]

Our PERFECT trial finally out in @TheLancet !

Pragmatic Nordic 🇫🇮🇳🇴 multicenter RCT comparing appendectomy within 24h versus 8h.

1803 patients!

No difference in rate of perforated appendicitis (9% vs 8%).

👉 Allows to postpone appendectomy to daytime.

https://t.co/AK77BsrTtG

[Steven D Wexner MD, PhD @SWexner]

Mesh versus suture repair of incisional hernias 2 cm or less: Is mesh necessary? A propensity score–matched analysis of the abdominal core health quality collaborative @CCFSurgery @ClevelandClinic @CleClinicMD in @SurgJournal by @ChaseWehrle @BeffaLukeMD https://t.co/IwUGNmb368

[Patricio Paute V. MD. @PPautevMD]

@SuerodlaVerdad1 😡🤬🤬