Emergency surgical aid is resorted to when a life-threatening condition occurs, and the time counts literally by hours, and sometimes by minutes. It is easy to imagine that the responsibility on the surgeons who provide emergency care is colossal, and therefore the most competent and at the same time the most skillful specialists work in this specialty. But the salvation of a person depends not only on how qualified the doctor is. It is important that emergency surgical care is provided in a timely manner - as soon as possible after establishing the fact of a threat to life.
Life-threatening conditions
Conditions in which emergency surgical care is required can be divided into two large groups:
- Arising under the influence of exogenous factors, or trauma;
- Arising under the influence of endogenous factors, or acute complications of existing diseases.
Injuries that carry an immediate threat to life include not only those terrible wounds when large blood loss and traumatic shock are obvious. Often, injuries with a blunt object, without violating the integrity of the skin, are no less dangerous, and are also subject to surgical treatment. Examples include blunt abdominal trauma, which ruptures the spleen or other organs, resulting in massive internal bleeding, or cerebral contusions, in which the destruction of the brain tissue can be severe, although the first symptoms may be mild.
In pediatric practice, another type of condition is often found, when urgent surgical intervention is likely to be required, this is the presence of a foreign object in the body. Small children, playing with small objects, often stick them in the nose, ear, swallow or inhale. This situation requires immediate medical attention, and if the object cannot be removed by conservative methods, they resort to emergency surgery.
Acute complications of chronic diseases that require urgent surgical care are abscess or empyema (suppuration of an inflamed organ or tissue with the threat of rupture and outpouring of pus into the surrounding space), phlegmon (acute purulent inflammation of tissue), appendicitis, peritonitis, intestinal obstruction, internal bleeding, perforation or perforation of any organ.
How do you know if you need emergency surgery?
Emergency surgical care for injuries is necessary when there is externally visible serious damage to organs or tissues, and not necessarily with bleeding (burns and frostbite, for example). If there are no visible dangerous injuries after the injury, but the person feels worse and worse, turns pale, the pain intensifies or he loses consciousness, this is a direct indication that urgent surgical care is most likely necessary for him. In this case, it is unacceptable to self-medicate, you must immediately call an ambulance. It is especially undesirable to give any medications, in particular, analgesics. Medicines in this state are unable to solve the problem, and they can completely confuse the symptoms or even cause a deterioration in the patient's condition. All medications, without exception, should be prescribed by a doctor after an initial examination. In a similar state, the patient should also not be allowed to eat or drink until a medical examination has been carried out.
As for the complications of inflammatory diseases, there are also some signs that urgent surgery is required, and it is very important not to miss them, especially when the patient is at home and not in hospital.
How to determine that the disease has entered a dangerous phase? First, it is a prolonged painful attack. It is believed that if a painful attack during biliary or renal colic lasts more than six hours and does not lend itself to relief with analgesics, then this should alert to the appearance of one of the serious complications - either organ perforation or its suppuration with rupture. In such a situation, home treatment is extremely dangerous to continue, immediate assistance is required in an inpatient setting, since it is very likely that emergency surgery will be required.
Increasing pallor, worsening of the condition, acute abdominal pain in combination with the tension of the abdominal wall (acute abdominal syndrome), confusion or loss of consciousness, weak voice, forced position of the body - all these are symptoms of probable surgical pathology.
The first thing that doctors focus on when detecting a life-threatening condition is to deal with shock. For this purpose, anti-shock therapy is urgently carried out: electrolyte solutions are injected intravenously, designed to replenish the fluid balance of the body, and drugs whose action is aimed at maintaining cardiac activity. When the condition is more or less stabilized, they begin surgical intervention.
If we are talking about an open injury, the stages of emergency surgical care are as follows: anesthesia, revision (examination) of the wound, removal of tissue scraps and bone fragments, layer-by-layer suturing of tissues, establishment of drainage.
Emergency surgical care for closed wounds, as well as for complications of internal diseases, is complicated by the fact that it is not always clear what exactly happened. Therefore, it is necessary to carry out emergency diagnostics. If we are talking about a traumatic brain injury with suspected brain contusion, computed tomography is performed. In the case of diseases of the abdominal organs, the approach consists in diagnostic surgical intervention, as a rule, it is diagnostic laparoscopy. This saves time and, if pathology is detected, immediately begin to provide assistance. Sometimes this happens by means of laparoscopy, which goes from diagnostic to therapeutic, in some cases, laparoscopic intervention is transferred to abdominal surgery. The essence of the actions is similar to those in surgical intervention for trauma: revision, washing the operating area with an aseptic solution to remove pus, blood or other foreign substances (for example, intestinal contents during intestinal perforation), restoration of the integrity of organs with subsequent suturing of tissues, if an abdominal operation was performed ... With laparoscopic surgery, the incision is not made, so this step is omitted. Then the wound is drained.
This completes the emergency surgical care, the patient is transferred to the surgical intensive care unit, where he stays until his condition stabilizes.
genre: Surgery
Format: PDF
Quality: OCR
Description: The manual reflects the issues of organizing emergency surgical care for diseases and injuries of the abdominal organs, outlines the principles of their diagnosis, methods of surgical and conservative treatment. The main tasks that the surgeon must solve in this or that pathology of the abdominal organs are formulated, modern therapeutic and diagnostic algorithms are given, key points are highlighted that the doctor must take into account when providing assistance to this difficult contingent of patients and victims.
For doctors undergoing retraining in abdominal surgery, resident surgeons and 4-6 year students of medical universities in the specialty "surgery".
Present and future of emergency abdominal surgery
Emergency abdominal surgery combines a wide range of diseases and injuries of the abdominal and retroperitoneal organs with a high risk of mortality. Despite the different etiology, hemorrhage, surgical infection, organ ischemia, intra-abdominal hypertension, and organ dysfunction are the underlying causes of acute surgical diseases and visceral trauma.
The prognosis for these pathological conditions deteriorates significantly with a deviation from the developed algorithms for their diagnosis and treatment, as well as with improper organization of medical and, in particular, surgical care. Good results of treatment of emergency surgical diseases indicate a high level of development of public health services in the state and its regions, since morbidity and mortality from this pathology currently remain extremely high. For example, of the 51 million people who died worldwide in 2012, 17 million suffered from diseases requiring surgical treatment.
The main trend of modern surgery is to reduce the invasiveness of surgical interventions ... The use of a step-by-step approach, consisting in differentiated tactics of using conservative therapeutic measures, minimally invasive interventions and, finally, laparotomy, allows for an individualized approach to surgical patients, avoiding unnecessary, extremely traumatic and sometimes mutilating operations. An important role is played by minimally invasive methods of intervention: laparoscopic, intra-luminal endoscopic, X-ray endovascular, percutaneous (under X-ray, ultrasound or CT navigation).
Undoubtedly, the most severe category of emergency patients is patients with peritonitis, septic shock, syndrome of intra-abdominal abdominal hypertension, and severe blood loss. The treatment of these dangerous conditions requires impeccable mastery of general surgical manipulations, blood preservation technologies, methods of staged management of an open abdomen, decompression of the abdominal cavity and methods of its closure. At the same time, the proportion of such severe patients in the structure of urgent surgical pathology is relatively small. In this regard, it is extremely important to use technologies aimed at reducing the aggression of surgical intervention. Modernization of surgical equipment and consistent training of surgeons in the skills of endovideosurgery over the past decade have led to a significant increase in the number of laparoscopic interventions.
Laparoscopic surgery has become the treatment of choice in the treatment of acute appendicitis, acute cholecystitis and perforated ulcers. We can say that they have entered the routine surgical practice.
During this time, the methods of typical operations using endovideoscopic technology have been standardized, exact conversion criteria have been adopted, and methods for such interventions have been developed for complicated forms of diseases. Surgeons have reached a learning plateau. One of the important achievements of the introduction of laparoscopy in the surgery of acute appendicitis was the reduction in the number of unnecessary appendectomies from 25-30% to 1-2%, since the detection of an unchanged appendix with an open access in most cases prompted the surgeon to perform an appendectomy in order to justify his actions.
Currently, experience is being accumulated and the possibilities of laparoscopic operations are being studied in the treatment of acute intestinal obstruction, strangulated hernia, generalized peritonitis, and abdominal trauma. The training period for this pathology is much longer, which is associated with more complex techniques. In addition, due to the lack of proven benefits of laparoscopic access, many surgeons are ambivalent about them.
Intraluminal diagnostic and therapeutic techniques nowadays play an important role in the diagnosis and treatment of urgent diseases. Endoscopic hemostasis has become the leading method for stopping gastrointestinal bleeding. Now it is possible to perform surgical interventions under the control of endosonography: sanitation of cavities and removal of sequesters in pancreatic necrosis through the posterior wall of the stomach, a wide range of transpapillary interventions in obstruction of the biliary tree, creation of anastomosis between the gallbladder and duodenum in acute cholecystitis in case of impossibility to perform radical surgery. A relatively new method is the use of self-expanding stents to eliminate obstructions in various parts of the gastrointestinal tract, and when using covered stents (stentgrafts) - and to seal the lumen of hollow organs.
Percutaneous radiation-guided interventions in the treatment of many urgent diseases play no less important role than laparoscopy. Thus, the use of percutaneous puncture and drainage has become the leading method of treating fluid accumulations in pancreatic necrosis, appendicular abscesses, postoperative complications, and trauma. Puncture and drainage of the gallbladder are the leading methods of treating acute cholecystitis in patients with severe concomitant pathology and preparing them for radical surgery.
Endovascular interventions allow to carry out hemostasis due to selective embolization of extravasation sites from the vessels supplying the pathological focus with ulcers, tumors and trauma, changing the usual treatment algorithms, making it possible to abandon laparotomy. Along with ultrasound, X-ray methods have become the navigation for access to the biliary tree for unloading in hypertension.
Improvement of minimally invasive approaches and methods of conservative treatment forms algorithms in which the concept of a “nonoperative” approach to the treatment of many urgent surgical diseases is of increasing importance: ulcerative bleeding, trauma to parenchymal organs, pancreatic necrosis, intestinal obstruction, and a number of postoperative complications.
Currently, the issues of replacing operations with conservative therapy, for example, in acute appendicitis, are being considered. However, no convincing data have yet been obtained to demonstrate the unconditional efficacy of conservative therapy. Conservative treatment of appendicitis can be considered at an extremely high risk of surgery, pregnancy, and the patient's categorical refusal. It is necessary to understand that an increase in the number of cases of non-surgical treatment of surgical diseases requires close supervision of a surgeon and became possible due to the round-the-clock availability of highly effective diagnostic methods - ultrasound, endoscopy, computed and magnetic resonance imaging. Obviously, a patient with non-operative treatment of a surgical disease should be in a surgical hospital, since surgical treatment may be required at any time, the line of indications between operative and non-operative treatment is often blurred, which often leads to delays in operations and conceals a potential increase in diagnostic mistakes.
Application of accelerated rehabilitation protocols in emergency surgery to date, little has been studied, but surgeons' interest in this problem is growing. It is known that many options of the multimodal approach to accelerated rehabilitation are quite applicable for urgent surgery. Moreover, the introduction of laparoscopic operations in emergency surgery makes it possible to classify a number of patients in the category of those who can be treated in short-term hospitals.
Prospects for the development of emergency abdominal surgery are in the formation of knowledge and skills of a surgeon focused on providing assistance to the most severe category of patients. Adherence to algorithms based on evidence-based recommendations is an important, but not the only factor in improving the results of treatment of urgent surgical diseases. The foundation for the quality work of the "emergency surgeon" should be laid at the stages of proper training and modern organization of emergency surgical care.
The training of a general surgeon presupposes his clear orientation in endoscopy and interventional radiology, mastery of traditional and laparoscopic skills of hemostasis, and intestinal suture. He should be trained in basic surgical techniques, the use of staplers, methods of staged management of an open abdomen.
For this, it is necessary to create curricula that combine the acquisition of theoretical knowledge with the possibility of practicing practical skills in conditions close to real ones. This is possible thanks to the introduction of cadaver courses and work in operating rooms with laboratory animals on living tissues.
Organization of surgical care patients and victims should be to reduce the time of delivery of patients to the hospital, their minimum presence in the emergency departments, quick triage and subsequent correct decision-making on diagnosis and treatment. The creation of specialized centers that provide assistance to patients with trauma and urgent diseases shows their high efficiency. Meanwhile, today in Russia, due to difficult geographic and climatic conditions, it is not always possible to deliver a patient to a specialized hospital. That is why it is extremely important to adhere to the stages of surgical care based on the elimination of life-threatening conditions and the subsequent transfer of the patient to a specialized stage (damage contlrol tactics).
We hope that the Guide offered to readers will serve as a kind of alphabet for novice surgeons, and that experienced surgeons will allow them to abandon a number of familiar, but obsolete dogmas, to some extent changing their views on emergency surgery.
"Emergency abdominal surgery"
ORGANIZATION QUESTIONS
- Organization of emergency surgical care
- Features of the organization of assistance in case of abdominal injuries during terrorist attacks and hostilities
- Accelerated Rehabilitation in Emergency Abdominal Surgery
BLEEDING
- Upper gastrointestinal bleeding
- Bleeding from the small and large intestine
- Intra-abdominal bleeding
- Rupture of an aneurysm of the abdominal aorta and its visceral branches
- Modern principles of blood loss replacement
ABDOMINAL SURGICAL SEPSIS
- Acute appendicitis
- Perforated stomach and duodenal ulcer
- Strangulated hernia
- Spilled purulent peritonitis
- Principles of treatment for abdominal surgical sepsis
ACUTE INTESTINAL DISEASES
- Non-neoplastic mechanical intestinal obstruction
- Tumor obstruction of the colon
- Acute disorders of mesenteric circulation
- Complicated diverticular disease of the colon
- Non-neoplastic bowel disease in the practice of a surgeon
DISEASES OF THE ORGANS OF THE HEPATOPANCREATOBILIARY ZONE
- Acute cholecystitis
- Obstructive jaundice
- Cholangitis and liver abscesses
- Acute pancreatitis
ABDOMINAL INJURY
- Hollow organ damage
- Rectal injury
- Damage to parenchymal organs
- Pelvic hematomas: causes, consequences, surgical tactics
- Features of gunshot and mine-explosive trauma of the abdomen
POSTOPERATIVE COMPLICATIONS
- General issues of prevention of postoperative complications
- Treatment of surgical site infections
- Modern tactics of treatment of postoperative purulent intra-abdominal complications
- Principles of treatment for non-infectious intra-abdominal complications
SURGICAL PROBLEMS OF RELATED SPECIALTIES
- Acute gynecological diseases in the practice of a surgeon
- Acute abdomen in pregnant women and postpartum women
- Sharp abdomen in childhood
- Acute urological pathology in emergency surgical practice
Discipline: "Emergency surgery" in the direction of "Surgical diseases"
Emergency surgery_rus
For the initial period of acute appendicitis, it is typical:
A) diffuse soreness in the presence of signs of diffuse peritonitis
B) the appearance of pain in the upper abdomen with displacement within 6 hours in the right iliac region
C) the presence of girdle pain with repeated pain
D) the presence of cramping abdominal pain in combination with diarrhea
E) hectic body temperature
(Correct answer) = B
(Difficulty) = 1
(Semester) = 14
The most common causes of gastrointestinal bleeding are:
A) gastric ulcer and 12p. intestines
B) erosive esophagitis
C) stomach swelling
D) Mallory-Weiss syndrome
E) colon diverticulosis
(Correct answer) = A
(Difficulty) = 1
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by V.S. Saveliev, M., Triada, 2004)
(Semester) = 14
A 30-year-old patient, 5 days after appendectomy, for acute gangrenous appendicitis, developed a high fever, chills, pain in the right hypochondrium, hepatomegaly, jaundice of the sclera, fever, chills. On ultrasound in the 8th segment of the liver, a hyponegative formation 4x3 cm. Select the surgical tactics for treating this complication:
A) Laparotomy, lancing and drainage of liver abscess
B) Puncture of the liver cyst
C) Drainage of the liver cyst under ultrasound control
D) Antibacterial and resorption therapy
E) Liver resection with abscess
(Correct answer) = A
(Difficulty) = 2
(Semester) = 14
For intestinal obstruction, a laparotomy was performed, during which the presence of a tumor of the transverse colon was established, spreading to the hepatic angle and sprouting into the antrum of the stomach, the leading part of the intestine was significantly expanded, in the lumen of feces, the ileum was not dilated. What operation should be performed?
A) Resection of the transverse colon
B) Bypass ileotransverse anastomosis
C) Resection of the transverse colon with anastomosis and resection of the stomach
D) Right-sided hemicolectomy with gastric resection
E) Cecostomy
(Correct answer) = D
(Difficulty) = 2
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
At the time of surgery for cholecystitis, a dramatically altered gallbladder with multiple cords in the infundibular zone was found, the choledoch is hidden by inflammation. In such circumstances, it is recommended:
A) Cholecystectomy from the bottom
B) Cholecystectomy from the cervix
C) Cholecystostomy
D) Atypical cholecystectomy
E) Combined cholecystectomy
(Correct answer) = A
(Difficulty) = 2
(Semester) = 14
0explain the reason for the appearance of muscle tension in the right ileal region, which occurs with a perforated duodenal ulcer
A) Reflex connections through the spinal nerves;
B) The accumulation of air in the abdominal cavity;
C) Leakage of acidic gastric contents along the right lateral canal;
D) Developing diffuse peritonitis;
E) Viscero-visceral connections with the appendix.
(Correct answer) = C
(Difficulty) = 2
(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)
(Semester) = 14
For what purpose is the gastric stump fixed in the mesocolon window during the Billroth-2 gastric resection:
A) delimiting possible inflammatory complications in the upper abdominal floor
B) prevention of the development of small bowel obstruction
C) prevention of insolvency of the gastrointestinal anastomosis
D) prevent reflux
E) normal passage of food
(Correct answer) = B
(Difficulty) = 2
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
Patient D., 47 years old, was admitted to the emergency department with complaints of repeated bloody vomiting and black stools, loss of consciousness, severe weakness and dizziness. Ulcerative history for 5 years. On admission, the condition was serious, the pulse was 100 beats per minute, the blood pressure was 80/40 mm Hg. Art., pale. In the analysis of blood Er. 2.2x1012, Hb 80, hematocrit 30. In case of emergency EFGDS, a chronic callous ulcer of the stomach body up to 3 cm in diameter, covered with a friable red thrombus, was found. Your tactics?
A) transfer to the intensive care unit for further treatment
B) probe the stomach, followed by lavage and administration of aminocaproic acid and norepinephrine
C) operate immediately without preparation
D) conduct hemostatic and replacement therapy with follow-up
E) emergency surgery after preoperative preparation
(Correct answer) = E
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
On the roentgenogram of the stomach and duodenum, the patient has the following data: What operation should the patient perform?
A) Resection of 2/3 stomach according to Billroth-I
B) Resection of 2/3 stomach according to Billroth-II
C) Selective vagotomy, ulcer excision
D) Proximal gastric resection
E) Gastrectomy
(Correct answer) = A
(Difficulty) = 2
(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)
(Semester) = 14
On the roentgenogram of the patient's stomach, there is the following data: What operation is indicated for the patient?
A) Resection of 2/3 stomach according to Billroth I
B) Resection of 2/3 stomach according to Billroth II
C) Selective vagotomy, ulcer excision, Finney pyloroplasty
D) Stem vagotomy, excision of the ulcer, pyloroplasty according to Heineck-Mikulich
E) Selective proximal vagotomy, ulcer excision, duodenoplasty
(Correct answer) = B
(Difficulty) = 2
(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)
(Semester) = 14
Patient V., 30 years old, complains of constant abdominal pain, which appeared 3 days ago in the epigastric region. One day back, single vomiting, independent stool. Tongue dry, coated. The abdomen is tense, painful in all parts, but more along the right lateral canal. Percussion tympanitis in all parts of the abdomen. Hepatic dullness is preserved. Shchetkin-Blumberg's symptom is positive. Peristalsis is not heard. Blood leukocytes 18 thousand / ml, fallen - 10%. On a survey X-ray of free gas, there are no "Kloyber cups", the loops of the small intestine are pneumatized. What is your preliminary diagnosis?
A) Peritonitis of unknown etiology.
B) Acute appendicitis. Peritonitis.
C) Acute cholecystitis? Peritonitis.
D) Perforated gastric ulcer.
E) Acute pancreatitis? Peritonitis.
(Correct answer) = B
(Difficulty) = 2
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
During the operation in a patient with phlegmonous cholecystitis, it was found that there is a vitreous edema on the hepatoduodenal ligament and retroperitoneal space. With intraoperative cholangiography - common bile duct up to 10 mm, the contrast enters the duodenum, there is contrast reflux into the pancreatic duct. What should the surgeon take in this situation and why?
A) Cholecystectomy, choledochotomy, choledochoduodenostomy, because it is necessary to remove the inflamed organ and ensure constant drainage of bile, to prevent destruction in the pancreas
B) Cholecystectomy, choledochotomy, drainage of the choledoch according to Vishnevsky, because it is necessary to remove the inflamed organ, revise the common bile duct and create a condition for decompression of the biliary tract in order to prevent destructive pancreatitis
C) Cholecystectomy, drainage of the common bile duct through the cystic duct stump, because it is necessary to remove the inflamed organ and relieve tension in the biliary tract and pancreatic duct caused by edematous pancreatitis
D) Cholecystectomy, drainage of the retroperitoneal space, because it is necessary to remove the inflamed organ and eliminate tension in the retroperitoneal space
E) Cholecystectomy, choledochotomy, choledochojejunostomy, because it is necessary to remove the inflamed organ and create a roundabout way for the flow of bile into the intestine in order to prevent obstructive jaundice
(Correct answer) C
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
During cholecystectomy, the surgeon found that the hepaticocholedochus was enlarged to 2.5 cm, cholangiography. How should the operation be completed?
A) Choledocholithotomy and drainage of the common bile duct according to Abbe
B) Choledocholithotomy and percutaneous transhepatic biliary drainage
C) Choledocholithotomy and external drainage of the common bile duct with T-shaped drainage, because while not only decompression of the biliary tract occurs
D) Choledocholithotomy and blind suture of the choledoch
E) Choledocholithotomy and formation of choledochoduodenoanastomosis
(Correct answer) = E
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
The patient is worried about: chills with fever, jaundice and pain in the right hypochondrium. What method of drainage of the common bile duct is shown to the patient and why?
A) According to Pikovsky, since makes it possible to carry out external drainage of the biliary tract without choledochotomy
B) According to Vishnevsky, because ensures the removal of infected bile and at the same time creates conditions for the outflow of bile into the intestines
C) According to Felker, because gives rapid decompression of the biliary tract and prevents suture insufficiency
D) Along Lane, because allows you to completely drain infected bile outside
E) Choledochoduodenostomy, because there is no loss of bile to the outside
(Correct answer) = B
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
Patient S., 48 years old, was admitted on an emergency basis 12 hours after the illness with complaints of severe weakness, dizziness, nausea and tarry stools. From the anamnesis: for 10 years suffering from chronic gastritis. The last 3 years have not been examined, with an objective examination: the skin is pale, the pulse is 90 beats per minute, the blood pressure is 100/70 mm Hg. Art. BH 20 per minute, temperature -37.0 ° C. On the part of the blood test Er. 2.9x10 12, ESR-12 mm / h. What are the primary tasks you need to solve in this case?
A) establish the fact of gastrointestinal bleeding, determine the degree of blood loss.
B) establish the fact of gastrointestinal bleeding, conduct a naso-gastric tube, establish the source of the bleeding.
C) establish the fact of gastrointestinal bleeding, establish the source of bleeding, determine the degree of blood loss, determine the degree of hemostasis.
D) establish the source of bleeding, determine the degree of blood loss.
E) establish the source of bleeding, determine the degree of blood loss, determine the degree of hemostasis.
(Correct answer) = C
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
After resection of the stomach according to Billroth II, a blood flow of about 500 ml / h was released via a nasogastric tube. Conducted hemostatic and replacement therapy without effect. What are the further tactics of conducting and why?
A) continue hemostatic therapy
B) urgently operate on the patient as conservative therapy has no effect
C) insert the probe into the stomach stump and carry out local therapy as it was not performed
D) carry out substitution therapy
E) dynamic observation
(Correct answer) = B
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
Patient K., 52 years old, suffering from atrial fibrillation, 5 hours ago developed severe abdominal pain, had two vomiting, and loose stools. On examination, the patient's condition is moderate. Tongue dry. The abdomen is soft in all parts, pronounced soreness in the mesogastric region is determined. Symptoms of peritoneal irritation are questionable. Intestinal peristalsis is weakened. The content of blood leukocytes is 22x10 9 / l. What disease does this clinical picture correspond to, what is your further tactics?
A) Hemorrhagic pancreatic necrosis, surgical treatment
C) Acute violation of mesenteric circulation, surgical treatment
C) Acute strangulated intestinal obstruction, surgical treatment
D) Budd-Chiari disease, conservative treatment
E) Dissecting aneurysm of the abdominal aorta, surgical treatment
(Correct answer) = B
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
(Semester) = 14
Patient K., 52 years old, is admitted on an emergency basis with complaints of repeated vomiting of the color of "coffee grounds", weakness, melena, epigastric pain during the day. History of severe painful osteochondrosis, uncontrolled use of diclofenac. Objectively: BP - 80/40 mm Hg, Hb - 70 g / l, er - 2.3 * 10 12 / l, Ht - 28. Define the operational tactics?
A) resection of the stomach according to B-1 in order to remove the callous ulcer of the duodenum
C) resection of the stomach according to B-2 with the aim of removing the tumor of the antrum of the stomach
C) gastrectomy to remove a tumor of the lesser curvature of the stomach
D) suturing an acute gastric ulcer for the purpose of hemostasis
E) economical resection for gastric polyps for the purpose of hemostasis
(Correct answer) = D
(Difficulty) = 3
(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by VS Saveliev, M., Triada, 2004)
Emergency surgery may be required for life-threatening conditions. Conventionally, such states can be divided into two groups:
arising under the influence of external factors or injuries: trauma of the abdomen with a blunt object with rupture of internal organs, the presence of foreign bodies in the body;
arising under the influence of internal factors and complications of diseases: abscesses, phlegmon, appendicitis, peritonitis, etc.
How is emergency surgery performed?
When a patient is admitted to the emergency department of the Best Clinic, his immediate preparation for the operation begins. The patient is immediately carried out the necessary tests, x-rays or ultrasound to reduce the risks of surgery.
Whenever possible, our specialists try to carry out not an abdominal, but a laparoscopic operation - mini-punctures in the place where surgical intervention is necessary. All operations are carried out on advanced European and American equipment - for safe surgical interventions with minimal trauma.
Only high quality drugs are used for anesthesia. The injection is done while still in the ward so that the patient is not bothered by the natural fear of the operation. And in the operating room there are monitors for measuring the depth of anesthesia.
Rehabilitation
After the operation, the patient is monitored in a hospital. The length of stay under supervision depends on the complexity of the operation and the patient's condition.
In the hospital "Best Clinic" you will be under the round-the-clock supervision of specialists and medical personnel. Each bed has a button to call staff in case you need anything.
Upon discharge, the Best Clinic doctor will give detailed recommendations on the limitations of the recovery period.
The most important thing is to determine that the person needs emergency surgical care. Even if no damage is visible, and the person turns pale, feels worse and faints, it is necessary to urgently go to a medical institution.
Food and water should not be given to the patient before being examined by a doctor.
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