Types of surgical operations presentation. Surgery, pre- and postoperative periods lecture for students of the Faculty of Dentistry. Changes in the body in the postoperative period
SURGICALOPERATION
Lecture for 3rd year students.
Assistant, Ph.D. Tikhomirova G.I.
Surgery
The operation is called mechanicaleffects on tissues and organs with therapeutic or
diagnostic purpose.
Diagnostic operations include:
Biopsies, punctures (abdominal,
pleural, articular, spinal, etc.)
Endoscopic examinations (cystoscopy,
bronchoscopy, esophagoscopy, gastroscopy,
thoracoscopy, laparoscopy, etc.)
Angiography and cardiac catheterization Medical operations can be:
radical
Palliative
Radical operations are called
those in which the affected organs or
tissues are cut or removed (incisions with
abscess, appendectomy, gastrectomy,
ligation of the patent ductus arteriosus and
etc.). Radical operations can be
expanded and combined.
Palliative operations do not eliminate
cause of the disease, but only alleviate
patient status. 1.
2.
3.
According to urgency they are distinguished:
urgent or emergency
urgent (urgent)
planned.
Emergency operations are performed
immediately, within the first two hours after
hospitalization and clarification of the diagnosis (acute
inflammation of the appendix caecum
intestines, perforation of stomach ulcer, strangulated
hernia, intestinal obstruction). IN
in some cases - acute bleeding or
blockage of the larynx by a foreign body -
surgery (stopping bleeding,
tracheostomy) should be performed according to
vital signs in the near future
A couple of minutes. Urgent operations are performed as soon as possible
days after admission to the hospital due to
with the fact that with the rapid development
process, patients can become
inoperable (malignant
tumors, external intestinal fistulas,
severe congenital heart defects).
Planned operations are performed at any time
time, and preparation for operational
the intervention may last one to two days,
and, if necessary, within
several weeks. Operations can be performed
one-stage, two- and multi-stage.
According to the degree of potential
contamination operations are distributed
into 4 groups:
1. clean
2. conditionally pure
3. contaminated
4. dirty or primary infected. Indications for surgery are absolute,
relative and vital.
With absolute readings it is established
that treatment of this disease is only possible
operationally.
Relative readings are established in those
cases where other methods can be used
therapies, although less effective.
The surgeon should not perform those operations with
which he cannot successfully cope with,
because surgery is not a sport, and a person is not
is the subject of experiments. The preoperative epicrisis notes:
1. justification for diagnosis
2. indications for surgery
3. operation plan
4. type of pain relief.
Surgery is a complex act,
in which there are three main stages:
1. preoperative period and preparation
patient for surgery
2. actual surgical operation
3. intensive observation and care of the patient in
postoperative period. PREOPERATIVE PERIOD AND
PREPARING THE PATIENT FOR
OPERATIONS
The preoperative period includes
period of time from the moment of receipt
patient to the hospital or treatment
clinic before the operation.
The preoperative period can be divided into
two stages: clarification of the diagnosis and preparation for
surgical intervention. At the first stage
the diagnosis is clarified, the condition is checked
various organs and systems are determined
indications for surgery, and on the second - the patient
prepare for surgery. Local preparation. In the preoperative
period it is necessary to conduct a thorough
examination of the skin of the body. The day before
It is advisable to prescribe a water bath for the operation,
change clothes. On the morning of the operation you should
prepare the surgical field - repeat
washing with soapy water and shaving hair
with a sharp razor. Often in surgical
branches expected field
additionally washed with chlorhexidine
solution, cover with a sterile bandage.
CARRYING OUT SURGICAL OPERATION
The surgical operation itself is divided intoseveral stages:
1. placing the patient on the operating table
2. preparation of the surgical field
3. pain relief
4. quick access
5. implementation of the operation (operative procedure)
6. completion of the operation.
POSTOPERATIVE PERIOD
This period includes the time from the endoperations until the moment when the patient
ability to work is restored or
his condition becomes stable and
permanent after the intervention.
The postoperative period is divided into three
phases:
1. early phase – the first 3-5 days after surgery
2. late phase – 2-3 weeks after surgery,
often until discharge from the hospital
3. long-term phase – before recovery
ability to work (or other specified 1.
2.
There are:
smooth or normal
postoperative period
postoperative period with
complications (complicated).
Changes in the body in the postoperative period
In 90% of cases, shifts in carbohydrate levels are observedmetabolism: possible hyperglycemia and glycosuria,
which arise regardless of the type
pain relief and disappear within 3-4 days.
It is believed that changes in carbohydrate metabolism
occur due to insufficient oxidation
sugars due to irritation of the central nervous system and
endocrine system disorders. Disturbance of acid-base balance - in
blood alkaline reserve decreases and
signs of acidosis. Initially, acidosis is
compensated nature, however, as
decreases in alkaline reserves may appear
vomiting, flatulence, headaches,
anxiety, insomnia. Changes in protein metabolism
accompanied by an increase in residual
nitrogen in the blood, hypoproteinemia,
increase in globulin fractions, etc.
The development of hypoproteinemia is promoted by
bleeding during surgery. Important in
also in the postoperative period
changes in water-electrolyte metabolism.
There is a decrease in chloride levels
blood, especially in patients with the syndrome
intestinal obstruction. Change is also important
blood composition in the postoperative
period. Leukocytosis in this case
is a normal reaction of the body
on the absorption of protein breakdown products and
possible penetration of microbes into
organism. At the same time it is observed
decrease in the number of red blood cells; quantity
hemoglobin drops by about 0.5-2 g%
(0.31-1.35 mol/l).
Postoperative complications, their prevention and treatment
Postoperative complications are possibleboth at an early and late stage.
In the early postoperative period, often
there is shock or collapse, disorders
nervous system, pulmonary complications
(atelectasis, pulmonary edema, bronchopneumonia),
acute liver and kidney failure
(jaundice, oliguria, severe intoxication),
phenomena of anoxia associated with cardiac or
pulmonary insufficiency syndrome
postoperative hyperthermia (more often in
children). At a late stage there are
disorders mainly related to
malnutrition (hypoproteinemia,
hypo- and vitamin deficiency, acidosis), with changes
blood clotting (phlebothrombosis,
thrombophlebitis, pulmonary embolism and
heart attack-pneumonia), with intoxication and
autonomic depression (intestinal paresis,
urinary retention), as well as
development of surgical infection
(complications during wound healing,
eventeration, surgical sepsis). Neurotic postoperative
disorders most often manifest as pain,
insomnia, psychosis, paresthesia,
paralysis.
Pain to varying degrees is observed after
any operation. If observed
sleep disorders, barbiturates are prescribed and
other means.
Postoperative psychosis most often
develop in weakened patients at the stage
intoxication. There are also reactive states, such
patients require careful monitoring
(individual post) and ensuring personal
security.
Cardiovascular complications
systems – acute cardiac and vascular
failure, thrombosis, embolism, heart attack
observed as a result of primary cardiac
insufficiency, or may be secondary to
cases of shock and anemia. In the pathogenesis of acute vascular
insufficiency plays an important role
vasomotor paralysis, which causes
atony of capillaries and decrease in blood volume.
For the treatment of acute cardiac
heart failure is used
glycosides (strophanthin, corglycon, digoxin,
Celanide), tonics
peripheral blood flow (strychnine, caffeine,
ephedrine, dopamine), are used
coronary lytic (nitroglycerin) agents
and diuretics (Lasix, etc.), oxygen therapy. Thrombosis usually develops in the veins of the legs and pelvis,
more often in obese and sedentary patients. IN
embolism may occur as a result of thrombosis
main arteries, including embolism
pulmonary artery, which is extremely dangerous.
Respiratory complications include acute
respiratory failure, bronchitis, tracheitis,
pneumonia, pleurisy, atelectasis, lung abscess.
The most common symptoms are bronchitis and
bronchopneumonia. Postoperative pleurisy and atelectasis
are more often detected after thoracic operations,
and pulmonary abscesses and gangrene develop
mainly against the background of septic
pneumonia.
Digestive complications
systems are more often observed after transection. Disorders of motor and secretory function
organs of the digestive system are manifested
belching, hiccups, vomiting, flatulence,
diarrhea and other disorders.
Postoperative peritonitis may
be observed after any abdominal surgery
cavities, but most often they develop
due to the divergence of the sutures placed on
stomach or intestines, generalization
limited abscesses, etc. Intestinal obstruction occurs
mechanical (inflammatory edema,
infiltration or scar process in
areas of anastomosis; compression,
formation of a spur at the anastomotic angle
or volvulus) and
dynamic origin (atony
stomach, reflex spasm
intestines). Organ complications
urination manifests itself
urinary retention (ischuria),
decreased urine output
kidneys (oliguria, anuria),
inflammatory processes of the kidney
pelvis (pyelitis) or bladder
(cystitis).
Postoperative oliguria or
anuria have a neuroreflex
origin or related to
damage to the renal parenchyma.
Ishuria is more often observed after
operations on the pelvic organs. Bladder catheterization
produced in compliance with asepsis.
Complications of surgical wounds
include bleeding from wounds,
hematomas, infiltrates, wound suppuration,
wound dehiscence and eventeration.
Bleeding from a surgical wound
stopped in a dressing room or in
operating room. In the operating room
the wound may develop limited
hematoma. Much more common is wound
infiltrate that can be felt in
in the area of the wound in the form of a dense
painful lump, with
redness of the skin around.
Wound infiltrate is caused
penetration of infection into tissues.
Sometimes infiltrate over time
resolves, but more often it
is festering.
The material was prepared by Tatyana Vladimirovna Yapparova, biology teacher at Municipal Educational Institution “Secondary School No. 198”
Slide 2
Stages of surgical treatment: preparing the patient for surgery, pain relief (anesthesia), surgery. Stages of the operation: surgical access (incision of the skin or mucous membrane), surgical treatment of the organ, restoration of the integrity of tissues damaged during the operation.
Slide 3
Classification of operations by nature and purpose:
Diagnostic operations allow the surgeon to make a more accurate diagnosis and are, in some cases, the only diagnostically reliable method. Radical operations completely eliminate the pathological process. Palliative operations alleviate the general condition of the patient for a short time. Classification of operations by nature and purpose: Emergency operations require immediate execution (stopping bleeding, tracheotomy, peritonitis, etc.). Urgent operations may be postponed while the diagnosis is clarified and the patient is prepared for surgery. Planned operations are performed after a detailed examination of the patient and the necessary preparation for the operation.
Slide 4
Features of modern surgery
becomes reconstructive surgery, that is, aimed at restoring or replacing the affected organ: vascular prosthesis, artificial heart valve, strengthening the hernial orifice with a synthetic mesh, etc.; becomes minimally invasive, that is, aimed at minimizing the area of intervention in the body - mini-accesses, laparoscopic techniques, x-ray endovascular surgery. Surgery is associated with such areas as neurosurgery, cardiac surgery, endocrine surgery, traumatology, orthopedics, plastic surgery, transplantology, ophthalmic surgery, maxillofacial surgery, urology, andrology, gynecology, etc.
Slide 5
Historical information
Renaissance Ambroise Pare (1517-1590) - a French surgeon replaced the technique of amputation and ligation of large vessels. Paracelsus (1493-1541) - a Swiss doctor developed a technique for using astringents to improve the general condition of the wounded. Harvey (1578-1657) - discovered the laws of blood circulation, determined the role of the heart as a pump. In 1667, the French scientist Jean Denis performed the first human blood transfusion. The 19th century is the century of major discoveries in surgery. Topographic anatomy and operative surgery have developed. Pirogov N.I. performed a high section of the bladder in 2 minutes, and amputation of the lower leg in 8 minutes. The surgeon of the army of Napoleon I Larrey performed 200 amputations in one day.
Slide 6
Mastering the technology of pain relief In 1846, the American chemist Jackson and dentist W. Morton used inhalation of ether vapor when removing a tooth. Surgeon Warren removed a neck tumor under ether anesthesia in 1846. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved loss of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus could contain “sticky infection” and used antiseptic substances. In 1885, the Russian surgeon M. S. Subbotin sterilized dressing material to perform surgical interventions, which marked the beginning of the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907, J. Jansky developed a blood transfusion technique.
Slide 7
Russian surgery
Surgery in Russia began to develop in 1654, when a decree was issued on the opening of chiropractic schools. In 1704, pharmacy business appeared and in the same year the construction of a surgical instruments factory was completed. Until the 18th century, there were practically no surgeons in Russia, and there were no hospitals. The first hospital in Moscow was opened in 1707. In 1716 and 1719 two hospitals are being commissioned in St. Petersburg.
View all slides
Slide 1
Slide description:
Slide 2
Slide description:
Slide 3
Slide description:
Slide 4
Slide description:
Slide 5
Slide description:
Slide 6
Slide description:
Mastering the technology of pain relief Mastering the technology of pain relief In 1846, the American chemist Jackson and the dentist W. Morton used inhalation of ether vapor when removing a tooth. Surgeon Warren removed a neck tumor under ether anesthesia in 1846. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved loss of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus could contain “sticky infection” and used antiseptic substances. In 1885, the Russian surgeon M. S. Subbotin sterilized dressing material to perform surgical interventions, which marked the beginning of the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907, J. Jansky developed a blood transfusion technique.
80 SURGICAL TRAINING Ministry of Health in Portugal - Kolej By surgery km medical association - Project for the structure of training: Fixiran... in laparoscopy catho standard in the basic course for specialization By root surgery. PROTECT SELF-EDUCATION IN SURGERY IS NOT TRYABVA YES...
Student scientific circle of the department of...
The work of the regional scientific surgical society O Participation in student competitions By surgery(university, Russian) Format of the circle O Since 2008 ... Participation in scientific student conferences of SSMU O Participation in olympiads By surgery(SSMU, zonal, all-Russian) O Scientific publications in...
Professor at Saratov University for years. Author of a number of research papers By surgery. The famous Saratov Medical Institute is named after the scientist. ... professor at Saratov University. Author of a number of research papers By surgery. The following Saratov Medical Institute is named after the scientist. ...
Hours Postoperative ultrasound and X-ray examination Stay in the department surgery after surgery – 7 days Laparoscopic gastric banding Preoperative... composed of a surgeon, anesthesiologist and bariatric therapist who have undergone specialization By bariatric medicine (in June 2009 - ...
Surgery destructive cholecystitis M.I. Prudkov, A... gallbladder with a thickened wall, double circuit By ultrasound data). Peritoneal syndrome (muscle tension in... Navigation punctures and, especially, cholecystostomy should be used By strict indications 16 Tactics for complicated cholecystitis (with...
University questionnaires 2010 – Questionnaire...
Ology Anatomy Highly rated lectureship for teacher By “Surgery” (obstetrics) and “Infectious diseases.” Page 10 Are you ready? Take a concrete example from the internship. Page 25 Presentation on the teacher By “Surgery”(obstetrics) and “Infectious diseases” are not understandable and clear for...
Employees of the RSC - Yaroslavl region...
At the National Center for Agricultural Agricultural Sciences named after. A.N.Bakuleva By surgery BCA Master class in Maastricht (Holland) By surgery aorta and peripheral arteries within... medical institute 1994 Since 1994 By 1995 internship By surgery, then clinical residency By surgery on the basis of the Yaroslavl Regional Clinical Hospital, ...
Surgical operation By urgency Emergency Urgent Planned Open Closed Repeated Microsurgical Endoscopic Endovascular One-stage (Single-stage) Multi-stage Simultaneous Trial Explorative Typical Atypical Stages of the operation Surgical access Main stage of the operation (surgical technique) Wound suturing (primary and secondary sutures) BY VOLUME and RESULT U Radical Palliative
By urgency: Emergency - operations performed immediately or within the next few hours from the moment the patient is admitted to the surgical department. (The goal is to save the patient’s life) Urgent – operations performed within the next few days after admission. Planned – operations performed as planned (their execution time is unlimited)
There are radical operations (in which, by removing a pathological formation, part or entire organ, the return of the disease is excluded) and palliative operations (performed to eliminate an immediate danger to the patient’s life or alleviate his condition). Diagnostic operations - to clarify the diagnosis, biopsy; trial; endoscopic; endovascular; microsurgical. Typical and atypical operations.
Preoperative period - - The time from the patient’s admission to the hospital to the start of the operation. Its duration varies and depends on the nature of the disease, the severity of the patient’s condition, and the urgency of the operation. The timing of the operation is determined by indications, which can be vital (vital), absolute and relative.
Vital indications for surgery arise in diseases in which the slightest delay in surgery threatens the patient’s life. - ongoing bleeding due to rupture of an internal organ (liver, spleen, rupture of the fallopian tube during the development of pregnancy in it) - acute diseases of the abdominal organs of an inflammatory nature (appendicitis, strangulated hernia, acute intestinal obstruction - these diseases are fraught with the development of purulent peritonitis). - purulent-inflammatory diseases (abscess, phlegmon - delaying surgery can lead to the development of sepsis).
Absolute indications for surgery arise in diseases in which a long delay or failure to perform the operation can lead to a life-threatening condition for the patient. - malignant neoplasms, pyloric stenosis, obstructive jaundice, chronic lung abscess. A long delay can lead to tumor metastases, general exhaustion, and liver failure. Operations for absolute indications are performed urgently, several days or weeks after the patient’s admission to the surgical department.
Relative indications for surgery may be for diseases that do not pose a threat to the patient’s life - hernias (not strangulated), varicose veins of the lower extremities. These operations are performed as planned. The underlying disease, which requires planned surgical intervention, should be studied at the outpatient stage of treatment (tests, instrumental studies and specialist consultations). In the preoperative period, the doctor needs to examine the condition of the patient’s vital organ systems and assess the surgical risk.
Preoperative preparation should be short-term and quickly effective - in patients with hypovolemia, water-electrolyte imbalance, infusion therapy is started (polyglucin, albumin, protein are transfused) - in case of acute blood loss - blood, plasma, albumin transfusion - when a patient is admitted in a state of shock - anti-shock therapy , aimed at eliminating the shockogenic factor (elimination of pain - traumatic shock, stopping bleeding - hemorrhagic shock, detoxification therapy - toxic shock), restoration of blood volume and vascular tone. Immediate preparation before surgery: cleanse. enema, fasting for 8 hours, removing stomatol. Prostheses, preparation of the surgical field (shaving). Premedication - minutes before surgery (sedative, antibiotic...) A nasogastric tube and urinary catheter are usually installed during the operation.
Main tasks 1. Establish a diagnosis. 2. Determine the indications for the operation, its possible nature and degree of risk. 3. Prepare the patient for surgery. Indications for surgery 1. Vital (Vital) 2. Absolute 3. Relative 1. Selection of surgical treatment method 2. Premedication 3. Postoperative management plan 4. Possible complications and their prevention Additional studies 1. Medical history 2. Laboratory studies (cytological and histological study) 3. Functional 4. X-ray 5. Endoscopic 6. Radioisotope 7. Ultrasound 8. CT 9. MRI (NMR) Preoperative period
The postoperative period is the period of time from the end of the operation until the patient recovers or is transferred to disability. The early postoperative period is the time from the completion of surgery to the patient’s discharge from the hospital. The late postoperative period is the time from the moment the patient is discharged from the hospital until his recovery or transfer to disability.
Surgical operations and anesthesia lead to certain pathophysiological changes in the body, which are a response to surgical trauma. The body mobilizes a system of protective factors and compensatory reactions. Under the influence of the operation, a new metabolism does not arise, but the intensity of individual processes changes - the ratio of catabolism and anabolism is disrupted.
The catabolic phase - 3 - 7 days - is a protective reaction of the body, the purpose of which is to increase its resistance through the rapid delivery of necessary energy and plastic materials. Clinical manifestations: on the 1st day, patients are lethargic and drowsy (due to the residual effect of narcotic and sedative substances). Starting from the 2nd day, manifestations of instability of mental activity are possible (restless behavior, agitation or, conversely, depression. Cardiovascular system: pallor, increased heart rate by 20 - 30%, moderate increase in blood pressure. Respiratory system: increased breathing when it decreases depth, vital capacity (vital capacity of the lungs) decreases by 30 - 50%
Transitional phase or phase of reverse development – 4 – 6 days. Signs: disappearance of pain, normalization of body temperature, appearance of appetite. Patients become active. The heart rate approaches the initial preoperative level, and the activity of the gastrointestinal tract is restored.
Anabolic phase: - increased synthesis of protein, glycogen, fats consumed during surgery and in the catabolic phase of the postoperative period. Clinical signs characterize this phase as a period of recovery, restoration of impaired functions of the cardiovascular, respiratory, excretory systems, digestive organs, and nervous system. In this phase, the patient’s well-being and condition improves.
Incision is an incision of soft tissue for an abscess. Trepanation - creating a hole in the bone (skull, tubular bones) Tomia - section - opening the cavity: Laparotomy - opening the abdominal cavity; Thoracotomy – opening of the chest; Craniotomy – opening of the cranial cavity; Herniotomy – hernia repair; Tracheotomy – opening of the trachea; Ectomy – excision of an organ; Appendectomy - removal of the appendix; Nephrectomy – removal of a kidney; An equivalent concept is extirpation. Amputation is the cutting off of a limb or part thereof. Disarticulation is the removal of a limb at the joint level. Resection is the removal of part of an organ. Ostomy – operation to create an artificial fistula: Gastrostomy – gastric fistula; Cystostomy is a fistula of the bladder. Anastomosis - creation of an anastomosis between two organs (gastroenteroanastomosis) Plastic surgery - restoration of the shape of an organ or creation of a new organ (nose) Prosthetics - reconstructive operations using endoprostheses, autologous tissues. Pexia – binding, suturing.
Loading...
