- •Practical skills From module a 1 «abdominal surgery»
- •11) An estimation of weight of sharp pancreatitis is after a scale Ranson.
- •12) Determination of index of Alhover is at the different degrees of blood loss.
- •13) Establishment of bleeding source is by the nature of the vomitive and excrement masses.
- •14) Raising of nasogastric probe.
- •15) Realization of cleansing enema.
- •16) Realization of siphon enema.
Practical skills From module a 1 «abdominal surgery»
Demonstration of symptom of Shchotkina-Blumberg.
During palpation of front abdominal wall, slowly press fingers on an abdominal wall, then take away suddenly, appearance or strengthening of pain specifies on inflammation of peritoneum in this place.
Demonstration of symptom of Voskresensky.
By a left arm on a bottom edge by the tags of ІІ, ІІІ, IV set the fingers of right arm in a epigastric area and during exhalation sick at the relaxed abdominal wall with a moderate onslaught on a stomach execute sliding motion finger-tips in a right iliac area and there stop a hand, not tearing away her from a stomach.
Demonstration of symptom of Bartom'ye-Michelson.
A patient is in position on a back. He is asked to return on left under the corner of 45º. If at palpation of right iliac area strengthening is marked pains, a symptom is considered positive.
Determination of protective tension of muscles of front abdominal wall.
During deep palpation in a right iliac area marked resistance of fabrics at passing deep into. It can be limited or widespread.
Demonstration of symptom of Grekov - Ortner.
A patient is in position, lying on a back, at pattering of palm a rib on a right costal arc pain appears in the area of gall-bladder.
Demonstration of symptom of Georgievsky – Mussi.
Pain at palpation in a supraclavicular area in the point placed between legs to the sterno clavicular mastoid muscle on the right.
7) Demonstration of symptom of Кеr.
1 stage. To find the place of crossing of external edge of direct to the muscle stomach with a right costal arc (point of projection of gall bladder).
2 stage. Arcuated ІІ and ІІІ by the fingers of right arm to conduct palpation in the found point.
3 stage. Pain at palpation testifies to pathology of gall bladder.
8) Demonstration of symptom of Val.
Thin patients have visible through a front abdominal wall, and for other patients - at palpation is balloon shaped blow of transversal-by-pass bowel.
9) Demonstration of symptom of Sklyarov.
Symptom of Sklyarov - «capotement» - it belong to the symptoms of bowel obstruction. A patient is in horizontal position on a back, at the easy shaking off of abdominal wall, with the simultaneous auscultation of stomach, a doctor hearkens to the splash of liquid in bowel that testifies for a positive symptom.
10) Demonstration of symptom of Spizharnoho.
Symptom of Spizharnoho - «disappearance of hepatic dullness» - it belong to the symptoms of perforation of hollow organ of abdominal region, mostly at a perforative gastric or duodenum ulcer. A patient is in horizontal position on left, a doctor conducts percussion on right middling axillary lines in the projection of liver. Disappearance of dulling in the projection of liver is the sign of accumulation of gas under the right dome of diaphragm, and thus by the presence of this symptom.