1
MINISTRY OF HELTHCARE OF THE REPUBLIC OF UZBEKISTAN
TASKENT MEDICAL ACADEMY
APPROVED
Vice-rector for studying process
Senior Prof.
Teshaev O.R.
«_________» __________2011y
Uniform tutorial
Theme: ACUTE ABDOMEN
(Lesson 19)
Prepared by: assistent Murodov AS
Tashkent - 2011
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APPROVED
On conference in department of surgical diseases for general practitioners
Head of department___________________senior prof Teshaev O.R.
Text of lecture accepted by CMC for GP of Tashkent Medical Academy
Report №___________from____________2011 y
Moderator
senior professor Rustamova M.T.
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PRACTICAL SESSION № 19
Syndrome: acute abdomen
Subject: Open and closed injuries of abdominal organs. Concept. The etiology, pathogenesis,
diagnosis and differential diagnosis, methods of investigation and treatment strategy. The task of
the SPM. Rehabilitation, prevention.
Foreign bodies of the gastrointestinal tract and respiratory tract. Classification, clinical features,
diagnosis and differential diagnosis. Emergency medical care. Tactics in the treatment of GPs.
Rehabilitation and prevention.
1. Venue activities and equipment: clinic, emergency room, emergency surgery department,
office ultrasound and X-ray analysis results, handouts, quizzes.
2. Length classes 327 minutes.
3. Session Purpose:
3.1.Uchebnye objectives:
, Form an overall concept and idea of the trauma abdomen.
-To know clinic internal injuries of the abdomen.
-Teach students to diagnose abdominal trauma.
-To develop the students' clinical myschlenie.
-Be able to provide emergency medical care at the time of doctors and GPs admitted to hospital
of patients with injuries of the abdominal cavity and gastrointestinal foreign bodies, and
respiratory tract.
3.2.Student should know:
-Anatomy and physiology of the abdominal cavity and respiratory tract.
- Types of abdominal trauma
- Etiopathogenesis and clinic of injuries of the abdominal cavity and in contact with foreign
bodies in the respiratory tract.
Methods of diagnostics research.
- Length of stay.
-Complications and deaths in injuries of the abdominal cavity and gastrointestinal foreign bodies,
and respiratory tract.
-Postoperative rehabilitation of patients.
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3.3Student should be able to:
- To conduct a clinical examination of patients with damage to the abdominal cavity and
gastrointestinal foreign bodies, and respiratory tract.
-Early and correct recognition of symptoms in injuries of the abdominal cavity and
gastrointestinal foreign bodies, and respiratory tract.
-Correct and timely referral for all necessary procedures and investigations
-Formulate and substantiate the clinical diagnosis
, To provide urgent assistance in emergency surgery
-Debridement.
- Provide the primary surgery.
3.4Student must fulfill:
-Formulate and substantiate the clinical diagnosis
, To provide urgent assistance in emergency medicine
-Debridement.
- To provide primary medical care.
4. Motivation:
Abdominal trauma yavlyutsya a formidable surgical pathology requiring medical attention and a
large knowledge of surgical navykov.S to reduce mortality and provide emergency medical care
to patients with injuries of the abdominal cavity and gastrointestinal foreign bodies and
respiratory patients should be promptly diagnosed and hospitalized in a specialized hospital for
emergency surgery.
5. Interdisciplinary and inter-subject relations:
Top-anatomy, pathophysiology, physiology, and instrumental diagnosis, resuscitation,
anesthesiology, pharmacology, ENT.
Among the most important and still unsolved problems of modern surgery is one of the leaders is
diagnosis and treatment of traumatic abdominal injuries. According to many authors still high
rate of diagnostic errors, needless laparotomy and organ-which carry operations. He goes into the
history of the postulate of "blood in the stomach - an absolute indication for laparotomy."
To provide timely and competent care to patients is very important knowledge of
topographic anatomy, the location of bodies in the abdomen, in relation to the peritoneum. You
must know the physiology and pathophysiology of organs and systems, enabling improved
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clinical diagnosis and Interpretation of laboratory data. In a blood test can detect the fall of
hemoglobin, red blood cells, impaired coagulation krovi.Dlya topical diagnosis of lesions used
laboratory methods of research, radiation methods of diagnosis (polipozitsionnaya radiography,
ultrasonography, computed tomography) and endoscopic. The radiograph (spectroscopy) can
reveal free gas, or a raised dome of the diaphragm. X-ray examination is the diagnostic value by
ingestion of foreign bodies in the upper airways and gastrointestinal tract, where an X-ray image
revealed various kinds of metal and other objects, the level at which they are located.
An ultrasound revealed free fluid in the abdominal cavity, gap or subcapsular hematoma
parenchymal organ. Damage, combined with craniocerebral trauma of varying severity, skeletal
fractures, closed chest trauma, and Multiple injuries account for about 50% of all patients with
injuries of the abdominal cavity.
Grosser body changes and the level of fluid in the pelvis is an indication for therapeutic and
diagnostic laparoscopy Laparoscopy for abdominal trauma has its own characteristics and
phasing. Initial revision allows us to establish the stability of the situation and / or to determine
the indications for conversion of access. Performed a thorough eksfuziya blood from the
abdominal cavity. Next, the examination of the abdominal cavity to determine the direct signs of
damage in the form of availability of space gap, which often fail due to delimiting the gap seal or
sufficiently dense clot. But revealed indirect signs of damage to parenchymal organs: the large
amount of blood with clots around the body or in the place of the alleged gap imbibitsiya blood
mezhorgannyh surrounding ligaments. The absence of intra-abdominal bleeding continued to
completion is an indication of laparoscopy, drainage of the abdominal cavity. The reverse
situation is an indication for conversion of access, the question of which is important to decide in
a timely manner.
Introduced in the diagnostic algorithm of closed abdominal trauma CT highly competing with
other techniques, especially in the retroperitoneal space, is the only method reliable verification
of degree gap parenchymal organ in the conservative tactics and endosurgical diagnostic
laparoscopy. This tactic allowed to exclude from the arsenal of urgent surgery and celiocentesis
futile laparotomy.
Surgery,
Communication with anestiziologiey directly in patient care, which is defined in the
preoperative period and the preparation of the patient during surgery and the depth of anesthesia
tactics. After operating rehabilitation of patients with injuries of abdominal surgery is closely
correlated with the Critical Care Medicine.
After contact with foreign bodies in the lumen of the upper respiratory tract and
gastrointestinal tract is very valuable knowledge of ENT pathology and anatomy of the digestive
tract.
6.Soderzhanie classes:
6.1. The theoretical part.
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1. Classification of abdominal trauma.
Closed:
1. With organ damage:
- Hollow;
- Parenchymatous;
- The large vessels;
- Genitourinary.
2. No organ damage: Bruising and hematoma anterior abdominal wall.
Open:
1.Pronikayuschie:
- Puncture wounds;
- Kolotov incised wounds;
- Cut the wound;
- Gunshot wounds;
- Open wounds may be through;
- With the damage of internal organs and without damage.
2.Nepronikayuschie:
Tangents and blind.
2. The etiology of indoor and outdoor plants of the abdominal cavity
Closed abdominal injuries usually occur when strong shocks or a blunt object after the auto
injury when falling from heights, severe bruises.
Open wounds in peacetime are the result of impact with knives or other sharp objects. In
wartime, as a result of gunshot wounds, which differ in severe and multiple injuries of the
abdominal cavity.
3. Clinic and diagnosis:
Depends on the type of injury and because a body is damaged. Since in a hollow organ damage
(this may be the stomach or intestines, bladder, gall bladder) patient, along with signs of
bleeding within the peritoneal predominant symptoms of peritonitis, resulting in release of
contents in the free abdominal cavity.
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If the damage parenchymal organs (liver, spleen, pancreas) in patients with predominant
symptoms in the clinic inside the abdominal bleeding. Injury of these organs may one and twogap torque. In the one-stage rupture time of injury there is a rupture of the parenchyma authority
and integrity of the capsule body with simultaneous hemorrhage in the abdominal cavity. At the
moment the two breaks the integrity of the capsule is not broken, there is a rupture of the
parenchyma and organ formation subcapsular hematoma, which after a certain time with a sharp
movement breaks into the abdominal cavity. Therefore, you must be very careful and cautious in
the diagnosis of abdominal injuries that would not miss this pathology has not been a moment of
discontinuity in two non-stationary conditions.
In all cases, the patient complained of abdominal pain, severe weakness, with massive
bleeding in patients with predominant symptoms of hemorrhagic shock.
The patient was pale, in hemodynamics observed drop in blood pressure, heart rate dramatically
speeded the patient, a symptom of scissors. His facial features are sharp. If the damage is a
hollow organ abdomen tense, there is pain in the injured organ, percussion liver dullness may be
absent due to release of free gas in the abdomen. If the damage parenchymal organ patient lies in
a forced situation, stomach disease, but not tense, symptom-Vanka vstanka. Subcapsular
hematoma palpable when enlarged organ.
4. Methods for evaluating patients with abdominal trauma.
In the open wounds of the abdomen diagnosis presents no great difficulties, and if the patient
revealed a penetrating wound to the abdomen, regardless of the suspected damage to internal
organs or not, it is necessary to perform the operation laparotomy, in order to audit the
abdominal cavity. On rentgenagramme (spectroscopy) can reveal free gas, or a raised dome of
the diaphragm. An ultrasound revealed free fluid in the abdominal cavity, gap or subcapsular
hematoma parenchymal organ. In a blood test can detect the fall of hemoglobin, red blood cells,
impaired coagulation of blood.
5.Taktika treatment and the problem of the SPM. Clinical management of patients with
injuries of the abdominal cavity is reduced to the fact that the patient is first emergency in place.
Struggle with shock, bandaging wounds, if they are open injuries, and immediate transportation
of the patient to a specialized medical facility for rehabilitation and BCC specialized care.
6. The concept of foreign bodies gastrointestinal and respiratory tracts.
Ingested foreign bodies are often mentally ill, accidentally children and adults as a result of
bad habits to keep the mouth are different things. During the meal ingested fish meat bones,
dentures. In the lower divisions of the large intestine foreign bodies may get an injury or put it in
force. Also in the stomach and intestines can develop different kinds of bezoar.
Foreign bodies in upper respiratory tract due to accidental fall or heavy breathing when
frightened, an unexpected incident, when a person holds an object in his mouth. This is usually
coins and other items. As a result, patients who started a sudden shortness of breath.
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7. Clinic and diagnosis in contact with foreign bodies in the gastrointestinal tract or respiratory
tract.
Clinic of the disease depends on what department in the gastrointestinal tract is a foreign body.
When injected into the patient's esophagus, marked difficulty and pain when swallowing. Pain in
the chest and giving back, corresponds to the place where the object is stuck. If an item does not
votknetsya sharp end and perforates the wall, the body can migrate. Passes into the stomach and
intestines. Walking through the bowels of a foreign body can perforate and cause symptoms as a
result of peritonitis. Or plug into the wall and around to form painful infiltrate.
After contact with a foreign body in the upper airway in a patient suddenly has a feeling of
suffocation, the patient becomes cyanotic, begins to stick to the throat. The sharp foreign body in
the mucosa of the larynx causes the pain. At the site of entry of a foreign body in the lining of
the larynx edema, cough and feeling sore and suffocation.
Diagnostic value represents the X-ray examination in which an X-ray image revealed various
types of metal and other objects, the level at which they are located.
8. Emergency and tactics of GPs in the treatment of gastrointestinal inorodnygo body and
respiratory tract.
After contact with a foreign body in the digestive tract must send the patient to a hospital,
surgical department. Since the foreign body can migrate, the patients used conservative treatment
is to appoint a high-fiber vegetarian diet, for coating of foreign bodies and to facilitate the
passage of food foreign bodies in the digestive tract. Surgical treatment is applied in the presence
of large foreign bodies, which are long in these bodies, the threat of perforation of the stomach
and intestines, and in the presence of rebound tenderness.
After contact with a foreign body in the upper airway is necessary. Holding the victim's face
rotated upward, open mouth, holding the tongue with the lower jaw between your thumb and
other fingers, and pull the lower jaw (pulling the tongue and lower jaw).
Enter the index finger of your other hand along the inside surface of the cheeks, deep in the
throat to the base language (digital manipulation). Hook the finger object, try to bring it into the
mouth and then removed.
If the victim is choked foreign body stuck in your throat, you should perform subdiaphragmatic
abdominal thrusts,. (These events are called shocks or manual reception Heymlika). If your
manipulation has no effect, it is necessary to urgently hospitalize or call an ambulance. The
patient will make bronchoscopy and removal of foreign body. Asphyxia - tracheostomy.
6.2.Analiticheskaya part:
Innovative technology used in class:
- Interactive game.
- Discussion.
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-Work in small groups.
Solution of case problems.
Interactive game, "questioning" the ball.
Write questions about the little pieces of paper and stick on the ball with a ribbon molding so
that it is possible to read the questions. Completely and remove them after the response.
Throws the ball to one of the students. A student who receives the ball detaches one of the
questions and answers the question written on a piece of paper. If the answer is correct, then the
game goes on and answered the question throws the ball to another student. Thus, the game
continues until you have answered all the questions.
Situational problem:
Card 1.
Patient 40 years old enrolled in the clinic through the emergency room after avtotravmy. The
patient complains of severe pain in right hypochondrium region, weakness, heart palpitations.
The general condition of the patient of average weight, clear consciousness, the patient was pale,
and A / D - 80/50 mm. Hg Pulse -100 beats. in minutes. Abdomen painful to palpation in the
right hypochondrium region, intense. The right half of lags in the act of breathing. The patient
has pain in the horizontal (s-m "Vanka - vstanka").
1. Your tentative diagnosis.
2. What methods of research should be undertaken.
3. Tactics and treatment.
4. Arterial blood supply to the liver.
Response.
To clarify the diagnosis should be performed.
1. Total blood and urine. Ultrasound. X-ray study.
In general, the blood test will be marked decrease in hemoglobin, red blood cells. Signs inside
the abdominal bleeding and hemorrhagic shock.
On ultrasound examination can detect free fluid, blood in the abdominal cavity. On examination
can reveal part of the gap or injury of the liver or gall bladder.
Your diagnosis.
Closed abdominal trauma with liver damage. Hemoperitoneum. Hemorrhagic shock, 2 tbsp.
Tactics: The patient, after surveys and confirm the diagnosis of liver trauma it brought to the
operating room, the patient performed an urgent infusion therapy, blood transfusion and
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plazmotransfuziya. And we need to make an emergency laparotomy surgery, suturing the injured
area of the liver, sanitation and drainage of the abdominal cavity. Adequate after surgical
treatment.
Card 2.
Objective: The patient was 35 years brought to the admissions. To file a complaint at the
puncture incised wounds of the abdomen, weakness, dizziness, pain in the wounds. History of 2
hours before admission, was stabbed by unknown assailants. On examination the general
condition of patients with severe, consciousness clear, pale skin. A/D-90/50 mm Hg. Art. Pulse
110 beats. in minutes. In the abdomen in the epigastric region, and the area has left
hypochondrium puncture incised wounds anterior abdominal wall. The patient is restless.
Diagnosis. Your diagnosis. Tactics. Treatment.
Response. Given the severity of the patient must spend the next survey. Complete blood count,
which revealed decrease in hemoglobin, red blood cells, red blood part. Ultrasonic study to
determined the free fluid in the abdominal cavity and spleen injury. On the x-ray can reveal free
gas under the dome of the diaphragm. But in cases where the diagnosis is in doubt, the patient's
severe, the patient should be transported to the operating room without the work of radiological
and ultrasound study.
Patient survey: patients with severe general condition, consciousness clear, pale skin. In the
epigastrium and left hypochondrium region 1 cm below the costal arch has stab wounds cut with
smooth edges and sharp corners, in which revealed traces of soreness and bleeding. Abdomen
tense. Symptom U - Bljumberga positive. C-m Spizharskogo the disappearance of liver dullness
on percussion trauma of hollow organs. The absolute sign of penetrating abdominal injuries is
loss of viscera through a wound.
Diagnosis. Multiple stab wounds cut the anterior abdominal wall, penetrating into the
abdominal cavity with damage to the hollow and parenchymatous organ. 2st hemorrhagic shock.
Tactics and treatment.
Patient needs emergency surgery, restoring blood volume, plazmotransfuzii, in-fusion therapy.
Patient passing department must be brought to the operating room. Under endotracheal
anesthesia, laparotomy conduct the operation, revision of the abdominal cavity. Restoring the
integrity of the hollow body, in the event of damage to the spleen - splenectomy. Sanitation and
drainage of the abdominal cavity. Postoperatively, maintenance of adequate treatment.
Card 3.
Problem. The patient was delivered to the admissions office complaining of sharp pains in the
left hypochondrium, weakness, dizziness. Of history in a few hours before admission, the patient
fell down the stairs and hit his left side on a chair. In connection with the intensification of
complaints addressed to the ambulance. The general condition of the patient of average weight,
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pale skin. The abdomen is soft, the left iliac region on palpation of a painful left hypochondrium
serves approximately 1 cm seal Symptoms of irritation of the peritoneum is not detected.
Research methods. Diagnosis. Types of damage to parenchymal organov.Opredelnie a-maVanka vstanka. Tactics and treatment.
Response.
The patient must make a blood test. Which would be identified reduction of hemoglobin, red
blood cells, red blood part.
Hemodynamic disturbances occur fall in blood pressure, increased heart rate.
On ultrasound, we reveal an enlarged spleen in size.
Where there is accumulation of blood subcapsular injections, hematoma, and rupture area of the
parenchyma of spleen. On the X-ray was normal to find.
Based on these data, patient diagnosis.
Diagnosis: Closed abdominal trauma. Subcapsular hematoma of the spleen.
Tactics, such patients should be urgently taken to the surgical department. Patients in the
department carried out emergency surgery, laparotomy, splenectomy. At the moment the two
breaks the integrity of the capsule is not broken, there is a rupture of the parenchyma and organ
formation subcapsular hematoma, which after a certain time with a sharp movement breaks into
the abdominal cavity. Therefore, you must be very careful and cautious in the diagnosis of
abdominal injuries that would not miss this pathology has not been a moment of discontinuity in
two non-stationary conditions.
In the operating period after adequate treatment.
Card 4. Patient 30 was delivered to the hospital emergency department with complaints of stab
wound to cutting in the abdomen. History of the patient at home dropped by a sharp iron object.
The general condition of the patient relatively satisfactory. Hemodynamics stable A/D-110/70,
pulse 84 beats. Abdomen soft, involved in the act of breathing, palpation painless. The right half
of the abdomen in mid clavicular line at the navel is a stab wound about 2h1sm. Peritoneal
phenomena is not defined.
Q: What steps need to conduct surveys. Your diagnosis. Tactics and lnechenie.
Responses: Blood tests are carried out to determine the amount of hemoglobin in the blood,
changes which may indicate blood loss. On the X-ray can reveal the presence of free air in the
peritoneal cavity, which is determined by damage to hollow organs. An ultrasound revealed the
presence or absence of fluid (hemoperitoneum) in the abdominal cavity. Revision of the wound
is performed under local anesthesia, the wound and expands along the bottom of the wound
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channel is determined wounds. If it does not penetrate into the abdominal cavity, held PECVD
wounds.
Stages of CVD wounds: wedge excision and bottom edges of the wound at the level of healthy
tissue, hemostasis, and suturing the wound layer by layer.
Anatomy of the anterior abdominal wall.
Card 5. The patient complained of difficulty or pain on swallowing, sore and pain behind the
breastbone. History of the previous night the patient ate fish, after which came the above
complaints.
Q: What research methods should be undertaken. Tactics and treatment. First aid in emergency
situations when foreign body vdyhatelnye path and clearance gastrointestinal tract. Anatomy of
the esophagus.
Diagnostic value represents the X-ray examination in which an X-ray image reveals foreign
bodies, the level at which they are located. When injected into the patient's esophagus, marked
difficulty and pain when swallowing. Pain in the chest and giving back, corresponds to the place
where the object is stuck. If an item does not votknetsya sharp end and perforates the wall, the
body can migrate. Passes into the stomach and intestines. Or plug into the wall and around to
form painful infiltration, which can lead to mediastinitis.
After contact with a foreign body in the digestive tract must send the patient to a hospital,
surgical department. Since the foreign body can migrate, the patients used conservative treatment
is to appoint a high-fiber vegetarian diet, for coating of foreign bodies and to facilitate the
passage of food foreign bodies in the esophagus. Surgical treatment is applied in the presence of
large foreign bodies, long located in the esophagus, the risk of perforating the wall of the
esophagus.
7. The method of controlling the knowledge, skills and abilities.
-Oral response.
-Written response.
Demonstration of performance skills.
Decision-situational problems
№
1
%
96-100
evaluation
Criteria
Excellent "5"
The full presentation is on the edematous limb
pain syndrome, classification, diagnosis, and
treatment methods dif.diagnostike. The
questions gives a correct and comprehensive
answer. To think independently and draw
conclusions. Self-supervised patients and
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skillfully applies the practical skills. Interprets
the data of clinical and instrumental studies.
Independently, with knowledge of the facts
involved in the choice of treatment. Actively
involved in conducting intraktivnyh games. In
solving the situational problems applies
unconventional approaches grounded in the
responses.
2
91-95
Excellent "5"
In full view of a syndrome of limb ischemia,
classification, diagnosis, and treatment methods
dif.diagnostike. The questions gives a correct
and comprehensive answer. To think
independently and draw conclusions. Selfsupervised patients and skillfully applies the
practical skills. Interprets the data of clinical
and instrumental studies. Independently, with
knowledge of the facts involved in the choice of
treatment. Actively involved in conducting
intraktivnyh games. In solving the situational
problems applies unconventional approaches
grounded in the responses. When interpreting
the data biochemistry made one mistake
3
86-94
Excellent "5"
The full presentation is on the edematous limb
pain syndrome, classification, diagnosis, and
treatment methods dif.diagnostike. The
questions gives a correct and comprehensive
answer. To think independently and draw
conclusions. Self-supervised patients and
skillfully applies the practical skills. Interprets
the data of clinical and instrumental studies.
Independently, with knowledge of the facts
involved in the choice of treatment. Actively
involved in conducting intraktivnyh games. In
solving the situational tasks made some errors
4
81-85%
"Good"
A student has full understanding of edematous
limb pain syndrome, classification, diagnosis,
and treatment methods dif.diagnostike. The
questions gives the correct answer. Selfsupervised patients and skillfully applies the
practical skills. Interprets the data of clinical
and instrumental studies, but not fully aware of
14
the value of individual data. Knowingly
involved in the choice of treatment. Actively
involved in conducting intraktivnyh games. In
solving the situational tasks made some errors
5
6
7
76-80%
"Good"
A student has full understanding of edematous
limb pain syndrome, classification, diagnosis,
and treatment methods dif.diagnostike. The
questions gives the correct answer. To think
independently. Self-supervised patients and
skillfully applies the practical skills. Interprets
the data of clinical and instrumental studies, but
not fully aware of the value of individual data.
Knowingly involved in the choice of treatment.
Actively involved in conducting intraktivnyh
games. In solving the situational tasks and skills
made a few inaccuracies
Good "4"
A student has full understanding of edematous
limb pain syndrome, classification, diagnosis,
and treatment methods dif.diagnostike. The
questions gives the correct answer. To think
independently and draw conclusions. Selfsupervised patients and skillfully applies the
practical skills. Independently, with knowledge
of the facts involved in the choice of treatment
tactics, but admits mistakes. In carrying out the
practical skills makes a grave error. Situational
problems decides not to complete.
Satisfactory "3"
The student is aware of the edematous limb pain
syndrome, classification, diagnosis, and
treatment methods dif.diagnostike. The
questions do not give a complete answer. Make
mistakes in presenting the classification and
dif.diagnostike. The answers are not confident.
Practical skills and case studies serves correctly.
71-75%
66-70%
8
61-65%
9
55-60%
Satisfactory "3"
At half the questions gives the correct answer.
Answers are not confident. Poor knowledge of
the classification of ischemia. To individual
questions knows the answers, but to present
their idea can not.
Satisfactory "3"
Half the questions asked gave the correct
66-
15
answer. In presenting the essence of the
syndrome, diagnosis, diff. Diagnostic algorithm
for the interpretation of medical mistakes.
Uncertain poses a problem. Practical skills are
difficult to perform. Situational tasks executes
correctly.
Unsatisfactory "2"
10
under
54%
The student has no idea about the syndrome,
classification, diagnosis of the disease, does not
know diff.diagnostike treatment policy and is
not able to perform practical skills.
stages of training
form class
№
Duration
of activity
(327min)
1
Introductory speech teacher, study subjects
5
2
Discussion of homework. Interactive game "lottery"
The survey, discussion
(Annex № 1)
30
3
Admission of patients in the clinic, dispensary
work. Study dispensary cards.
Reception questioning,
examination of patients.
Primary surgical treatment
of wounds.
60
4
Improvement of practical skills, interpretation of
laboratory data, radiographs.
The algorithm of
60
break
30
5
Discussion of the practical lessons with the teacher.
A poll debate
35
6
Hearing the abstract of the report the student,
followed by discussion as a group
Abstract messages,
discussion threads
32
7
Group discussion as interactive games. The solution
of case problems on the wound, securing the
students' knowledge
Working in small groups,
interactive game
65
8
Conclusion lecturer on the topic. Evaluation of each
student on a 100 ballnoy system and announces it.
Distributes tasks for self-training.
(Annex № 2,3)
10
9
Independent work in the library
Magazine, the work
program, questions for
16
self-training.
10. Control ontrolnye questions:
1 The concept of open and closed injuries of abdominal organs
2 .. The classification of injuries of the abdominal cavity.
3.Etiologiya open and closed injuries of abdominal organs.
4. Clinic and diagnosis of trauma of the abdominal cavity.
5.Metody examination of patients with abdominal trauma
6.Taktika treatment. The task of the SPM.
7.Ponyatie of foreign bodies gastrointestinal tract.
8.Ponyatie of foreign bodies airways.
9.Klinika and diagnostics.
10.Neotlozhnaya medical care and tactics in the treatment of GPs.
11. Tests with a single correct answer.
1. What kinds of damage to parenchymal organs by a mechanism exist?
A. Open, zaktrytye.
B. Co.
B. Multiple.
G. overnight, dvuhmomentnye .*
2. For what diseases are most characteristic of m-Vanka-vstanka:
A gastric rupture.
B. Acute pancreatitis.
In acute appendicitis.
G. Damage to the spleen.
D. Damage to the kidneys.
3. For any damage to the organs characterized by the presence of X-ray free gas in the abdomen:
A. Damage to parenchymal organs.
B. Damage to hollow organs *
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B. Acute intestinal obstruction.
G. Acute appendicitis.
4. The most reliable method of examination of parenchymal organs in trauma:
A. Complete blood and urine.
B. measure the A / D and pulse.
B. Ultrasound .*
G. X-ray examination.
D. EGDFS
5. Your tactics for identifying the patient subcapsular splenic injury:
A. The patient should be treated in medical departments.
B. The patient is hospitalized in a surgical ward for observation over time.
B. The patient is hospitalized in the surgical department for emergency surgery .*
G. The patient is treated as outpatients.
6. When a disease is defined by symptom-Kulen Campha:
A. Damage to hollow organs.
B. Acute appendicitis.
B. NUC.
G. Apoplexy ovary.
D. Crohn's disease.
7.Pri damage to any body cavity brshnoy test conducted by Zel'dovich.
A. Damage to the spleen.
B. Damage to the kidneys.
B. Damage to the bladder.
G. If the damage of the uterus.
D. Damage Reports intestine.
8. The absolute figure for emergency surgery in the abdomen injury.
A. Fall of A / D
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B. Severe abdominal pain.
B. Availability of stab wounds to the anterior abdominal wall.
G. eventration strand packing of the wound channel .*
D. X-ray data.
Problem 2: The patient was 35 years brought to the admissions. To file a complaint at the
puncture incised wounds of the abdomen, weakness, dizziness, pain in the wounds. History of 2
hours before admission, was stabbed by unknown assailants. On examination the general
condition of patients with severe, consciousness clear, pale skin. A/D-90/50 mm Hg. Art. Pulse
110 beats. in minutes. In the abdomen in the epigastric region, and the area has left
hypochondrium puncture incised wounds anterior abdominal wall. The patient is restless.
1. What research methods should be undertaken.
A. Complete blood *
B. Ultrasound .*
B. EGDFS
G. Fluoroscopy.
D. Biochemical analysis of blood.
2.Vash preliminary diagnosis.
A penetrating wound of the abdominal cavity with damage to internal organs .*
B. Acute pancreatitis.
B. nonpenetrating wound anterior abdominal wall.
G. Damage to the right kidney.
3. Your tactics, treatment.
A. Hospitalization in the therapeutic department.
B. Admission to the surgical department for emergency surgery .*
B. Admission to the surgical department for observation over time.
G. Outpatient observation.
Zadacha3. The patient was delivered to the admissions office complaining of sharp pains in the
left hypochondrium, weakness, dizziness. Of history in a few hours before admission, the patient
fell down the stairs and hit his left side on a chair. In connection with the intensification of
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complaints addressed to the ambulance. The general condition of the patient of average weight,
pale skin. The abdomen is soft, the left iliac region on palpation of a painful left hypochondrium
serves approximately 1 cm seal Symptoms of irritation of the peritoneum is not detected.
Response.
Card 4. Patient 30 was delivered to the hospital emergency department with complaints of stab
wound to cutting in the abdomen. History of the patient at home dropped by a sharp iron object.
The general condition of the patient relatively satisfactory. Hemodynamics stable A/D-110/70,
pulse 84 beats. Abdomen soft, involved in the act of breathing, palpation painless. The right half
of the abdomen in mid clavicular line at the navel is a stab wound about 2h1sm. Peritoneal
phenomena is not defined.
1. What diagnostic measures should be undertaken.
A. Complete blood and urine.
B. Ultrasonography of the abdomen .*
B. Fluoroscopy abdomen .*
G. CT.
D. All the answers are correct.
2. Further tactics.
A. Hospitalization in the therapeutic department.
B. Implementation of CVD and audit wounds. Further observation of the dynamics .*
B. Admission to the surgical department, emergency laparotomy operation ..
G. Outpatient observation.
3. Your diagnosis.
A penetrating stab wound of the abdominal wall with damage to internal organs.
B. Penetrating stab wound of the abdominal wall without damaging the internal organs.
B. Do not penetrating stab wound to the anterior abdominal wall .*
G. Injury abdominal wall.
Card 5. The patient complained of difficulty or pain on swallowing, sore and pain behind the
breastbone. History of the previous night the patient ate fish, after which came the above
complaints.
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Q: What research methods should be undertaken. Tactics and treatment. First aid in emergency
situations when foreign body vdyhatelnye ways and gastrointestinal tract.
1. What research methods should first spend.
A. X-ray study .*
B. ultrasound.
B. EGDFS *
D. Bronchoscopy.
D. CT.
2. Where should I treat the patient.
A. Hospitalization in the therapeutic department.
B. Admission to the surgical department conservative treatment. Observation of the dynamics .*
B. Admission to the surgical department, emergency surgery.
G. Outpatient observation.
3. Your diagnosis.
A. Contact with a foreign body in the respiratory tract.
B. CHD. Angina.
B. Contact with a foreign body in the esophagus .*
G. chest injuries.
Task 6. Patient 35 delivered to the clinic with complaints of pain in lower abdomen, weakness.
History of the patient at home fell and hit his stomach on a chair. The general condition of the
patient of moderate severity. The heart tones are clear, A/D-100/70, Pulse 90 beats. Abdomen
tense and painful in the lower abdomen especially above the vagina.
1. Methods:
A. Complete blood count.
B Urinalysis.
B. ultrasound.
G. Conduct a test of Zeldovich.
D. All the answers are correct .*
2. The preliminary diagnosis.
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A. Bruising anterior abdominal wall.
B. abdominal trauma with injury of a hollow organ.
B. abdominal trauma with damage to parenchymal organ.
G. abdominal trauma with injury of the bladder .*
3. Treatment.
A. Out-patient observation.
B. Admission to medical departments.
B. Admission to the surgical department, observation over time.
G. Hospitalization for emergency surgery .*
D. antispasmodics. Release the patient's home.
11. References:
Main
1. Emergency surgery of the abdominal cavity. DF Skripnichenko. Kiev. Health. 1986.
2.SavelevV.S.Rukovodstvo for emergency abdominal surgery. M.2004g.
3.Kuzin MI Surgical diseases. M.1987g.
5. . Shalimov VD digestive tract surgery. M.1984g.
6.Karimov SH.I. Surgical diseases. T. 2005
7.Dzh. Murtagh. Directory of GP praktiki.M1998.
8.Ataliev AE Study Guide for the practical skills of surgical. T .2003
9. Electronic versions of the Internet.