CÁTEDRA DE MEDICINA INTERNA

UNIVERSIDAD CENTRAL DEL ECUADOR

CARRERA DE MEDICINA

CÁTEDRA DE MEDICINA INTERNA

GASTROENTEROLOGÍA

Fajardo Cabrera Natalia Elizabeth

CASO CLÍNICO

DATOS DE FILIACIÓN

NOMBRE:______________________________

EDAD: ________________________________

SEXO: ________________________________

ETNIA: _______________________________

ESTADO CIVIL: _________________________

PROFESIÓN: ___________________________

FECHA DE NACIMIENTO: _________________

LUGAR DE NACIMIENTO: ____________________

RESIDENCIA OCASIONAL: ___________________

RESIDENCIA ACTUAL: _______________________

RELIGIÓN: ________________________________

GRUPO SANGUÍNEO: _______________________

LATERALIDAD: ____________________________

INSTRUCCIÓN: ____________________________

MOTIVO DE CONSULTA:_____________________________________________________________________

ENFERMEDAD ACTUAL:

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REVISIÓN DE SISTEMAS

APARATO RESPIRATORIO: __________________________________________________________________

APARATO CARDIOCIRCULATORIO: ___________________________________________________________

APARATO DIGESTIVO: _____________________________________________________________________

APARATO GENITO-URINARIO: _______________________________________________________________

APARATO ENDOCRINO_____________________________________________________________________

APARATO NERVIOSO: _____________________________________________________________________

APARATO LOCOMOTOR: _ __________________________________________________________________

ÓRGANOS DE LOS SENTIDOS: ________________________________________________________________

ANTECEDENTES NO PATOLÓGICO (HÁBITOS):

• Alimentación:____________________________________________________
• Miccional: _______________________________________________________
• Defecatorio : _____________________________________________________
• Alcohol: _________________________________________________________
• Drogas: _________________________________________________________
• Tabaco: _________________________________________________________
• Sueño: __________________________________________________________

• Exposición a carburantes de biomasa: _________________________________
• Alergias: _________________________________________________________

• Ejercicio: _________________________________________________________
• Medicamentos: ___________________________________________________

ANTECEDENTES PATOLOGICOS PERSONALES:

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ANTECEDENTES GINECOOBSTÉTRICOS

• Menarquía: _________________________
• Inicio de vida Sexual: __________________
• ETS: ________________________________
• Gestas: _____________________________
• Cesáreas: ___________________________
• Abortos: ____________________________
• Hijos vivos: __________________________
• FUM: _______________________________

ANTECEDENTES QUIRÚRGICOS

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ANTECENDENTES PATOLOGICOS FAMILIARES:

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