chapter 1 Flashcards
What is surgery?
It is a field of medicine studying diseases and traumas of all regions and organs of the patients body and applying special methods of treatments which are accompanied by damage of continuity of covering tissues of Organism
what are the features of surgical methods?
- Invasion into the internal environment of the Organism
- damage of barriers separating patients Organism from the surrounding environment
what are the stages of assisting a patient with surgical disease?
- Pre-physician or first aid
- Aid administered by surgeons at outpatient clinics or hospitals or general surgery departments
- aid administered at the specialized surgical department
what types of surgeries are implemented on the outpatient clinics?
- Removal of atheroma
- incision of felon
- surgical debridement of small wounds
- incision of abscesses and phlegmons of subcutaneous fatty tissue
- removal of an ingrown nail
- placement of secondary researchers of granulating wound
what are the indications for emergency hospitalization?
- Acute surgical diseases of the abdomen
- closed and open traumas of the thorax, abdomen or damages of major bones of extremities, pelvis, and vertebral column
- thromboembolism of major vessels
- grave purulent inflammatory diseases requiring large volume surgeries and detoxifying therapy
- condition after resuscitation
what are the purposes of preoperative diagnostic workup?
- To define the affected organ
- to find out the etiology and pathogenesis of the disease
- to identify the complications of the condition if any exist
what are the stages of investigating the patients?
- Clarification of the patients complaints
- gathering medical history
- detailed examination of local manifestations of the disease
what are the mainstays of the patients medical record?
- Chief complaints
- history of present illness or anamnesis morbi
- physical examination of affected organs or status localis
Why is history taking important?
It helps furnishing clues for diagnosis by considering relevant data only
what is past medical history or anamnesis vitae?
It is a short biographical narrative of the patient that consists of many different parts.
What are the components of past medical history?
- Hospitalizations
- Operations
- childhood illnesses
- injuries
- family history
- social history
- allergies
what are some diseases that should be considered when looking at the family history?
- Tuberculosis
- Hypertension
- coronary heart disease
- anemia
- diabetes
- blood dyscrasia
- cancer
- migraine
what are the methods for physical examination?
- Inspection
- Thermometry
- Palpation
- Percussion
- Auscultation
What are some skin changes that might be seen on patients?
- Yellow skin discoloration
- skin pallor
- cyanosis
- scarring
- transparency
what does a generalized yellow skin discoloration and a patient with malignant tumor indicate?
It indicates advanced stage of condition leading to severe intoxication and cachexia
what does a localized skin discoloration indicate?
It indicates circulatory disorder or disturbance and pigmentation
what does a localized skin pallor indicate?
It indicates a severe defect in arterial blood circulation
why is palpation important?
- It allows us to find out the existence of disease
- it allows to find out the degree of muscle tension in the region of the pathological focus
- it allows to find out the local temperature
- it allows us to find out the existence of pathological mass
- it allows to find out the location, size, shape, consistency of the discovered mass, its relation to the surrounding organs, motility, and its movement during breathing
How is abdominal tenderness assessed?
By reflective resistant of the abdominal muscles during palpation
why is percussion important?
It is important for diagnosing the disease and injuries of the internal organs as well As for determining the location of fluid or gas accumulation in the cavities
what is percussion?
Is the method of examination in which the surface of the body is struck to emit sounds that vary in quality according to the destiny of the underlying tissues
what is auscultation?
It is the method of listening to and interpreting the meaning of sounds produced within the body
what are some sounds that we can hear during auscultation?
- Heart sounds
- Murmurs
- breathing sounds
- crackles
- bowel sounds
What are special investigations?
- Diagnostic punctures
- Thoracoscopy
- Laparoscopy
- Biopsy
what is an operation?
It is a special mechanical influence upon organs or tissues with treating or diagnosing aim
what are the types of operations?
- Emergency
- Urgent
- Elective
- Radical
- Palliative
- single stage
- staged
- simultaneous
- trial
- Diagnostic
- Microsurgical
- endovascular
what is an emergency operation?
It is an operation performed immediately or soon after the patient’s admission to the surgical department at which indications appear when the slightest postponement threatens the patient’s life
what is an urgent operation?
It is an operation performed on the nearest days after the patient’s admission to the hospital at which absolute indications appear in diseases like malignant neoplasms, pyloric stenosis, obstructive jaundice, and chronic lung Abscess
what is an elective operation?
It is an operation performed in routine order at which in terms of performing isn’t limited at which relative indicators can be a disease which doesn’t start in a patient’s life like hernia, varix dilation of superficial veins of lower extremities, and innocent tumors
what is a radical operation?
There’s an operation at which ablation of pathogenic formation, or part or the whole of an Organism performed which excludes the we turn off the disease
what are examples of radical operations?
- Excision of fibroma
- excision of lipoma
- appendectomy
- cholecystectomy
What are palliative operations?
Our operations performed with the aim of elimination of immediate hazard for the patients life or relief of patients status
what is a single stage operation?
It is an operation at which all its phases are performed immediately one after another without delay
what is a staged operation?
It is an operation that consists of definite stages of surgical treatment which are time spaced
what is an endovascular operation?
It is a closed intravascular operative intervention performed under X-ray control
what are the stages of surgical operations?
- Surgical access
- surgical method or mainstage
- wound closure
What are the different factors that define the type of wound closing?
- Character of operation
- treatment of patient at post operative.
- Condition of tissues
- presence of inflammatory changes
What are the different types of wound closing?
- Tight closing of wounds
- Drainage of cavity or wound
- temporary suturing with a glance of reinterventions leaving the wound open
what is a preoperative period?
It is the time from patients admission to therapy department till the beginning of operation
what is the aim of preoperative preparation?
To minimize the risk of coming operation and possibility of the development of post operative complications
what are the contraindication of a surgical intervention?
- Cardiac decompensation
- respiratory failure
- circulatory collapse or shock
- myocardial infarction
- stroke
- hepatorenal collapse
- recurrent thromboembolism
- acute metabolic imbalance
- acute anemia
- hyper cachexia
what are the factors that help choose the type and volume of anesthesia?
- General well-being of the patient
- volume and character of operation
- type of Anesthesia needed
what are the characteristics of post operative preparation?
- Short termed
- Quick
- Effective
- decreasing the level of hypervolemia and dehydration of tissues in extreme situations
what is the treatment of hypervolemia or water electrolyte acid base balance in post operative preparation?
Infusion therapy of transfusing Polyglukin, albumin, protein, and sodium bicarbonate solution
What is the aim of premedication?
Lessening the frequency of intra and post operational complications
What are non specific measures?
They are methods and measures aimed at rising general reactivity of Organism, its durability to any unfavorable influences which risen susceptibility of Organism to infection, improvement of operative conditions, & technique of operative intervention.
What are the tasks of non specific measures during preoperative preparation?
- Normalization of hemostasis and metabolism
- Blood replacement
- Anti shock activities
- Normalization of protein and electrolyte balance
- improvement of operative technique
- good care of tissues
- meticulous hemostasis
- shortening the duration of operation
what are specific measures during preoperative periods?
There are different types and forms of influence on the possible causes of bacterial complications that is applying methods and measures of influence on micro flora.
What are examples of specific measures?
- Sanitation of niduses off infection
- using antibacterial agents on infection transferring ways such as IV, IM , and endolymphatic introduction of antibiotics
- immunocorrection and immune stimulation
What are the post operative infective complications?
- Wound abscesses
- Pneumonia
- inflammatory diseases of urinary tracts
- intra cavity complications like abdominal pleural abscesses and empyemas
- sepsis
what is a post operative period?
It is an interval from finishing the operation to recovery of the patient or his or her transfer on invalidity
what is an early post operative period?
It is the interval from finishing surgical operation till discharge from hospital
what is late post operative.?
It is the interval from the moment of discharge to the recovery and transfer of patient on invalidity
what are the phases of post operative period?
- Catabolic face
- clinical presentation
- phase of involution
- anabolic phase
what is the duration of catabolic phase?
Three to five days
what is the duration of phase of involution?
Four to six days
what is the duration of anabolic phase?
Two to five weeks
what are some post operative complications?
- Hemorrhage
- development of hematoma
- water electrolyte balance disorder
- atelectasis
- pneumonia
- bronchitis
- Episodes of acute cardiovascular collapse like tachycardia, rhythm disorder, rise and CVP
- Enteroparesis
- Urine passage disorder
- Thromboembolism
- wound infection
- decubitus ulcers
