- •Methodical pointing for work of students on the practical lesson
- •Distribution of the marks appropriated to the students:
- •IV. Table of contents of teaching Structurally logical scheme of the theme
- •V. Reference basis of an action
- •2. Local:
- •Varieties of ulcers:
- •Phases of course:
- •In relation to an external environment:
- •Foreign bodies
- •VI. System of teaching tasks for verification of final knowledge
- •Vіі. Method of leadthrough of the lesson and organizational structure of the lesson Distribution of the marks appropriated to the students:
Foreign bodies
Foreign bodies is bodies of abiological origin, which are in tissues, organs.
Circumstances of hit of foreign bodies:
A trauma is fragments of object which damages.
Operation
permanent implants (artificial organs): prosthetic appliances of cardiac valves, vessels, ligature
temporal implants (drainages, vascular catheters)
imprudent abandonment of serviettes, instruments
Conscious or irresponsible actions of patient (foreign bodies of gastroenteric highway, respiratory tracts, urethra and urinary bladder).
Classification
On the circumstances of hit: traumatic, iatrogenic, autogenic.
Contrasting and uncontrasting.
Pathologic anatomy. Inflammation. Encapsulation. Migration. Thrombosis.
Clinic. Pain. Symptoms of inflammation. Disorders of function of organs and systems (violation of circulation of blood, peritonitis).
Diagnostics. Account of complaints, circumstances of damage, anamnesis of disease and life. Roentgenologic inspection. Endoscopy.
Treatment. Basic method - operative.
Looking after advancement of foreign bodes on a gastroenteric highway.
Deleting (endoscopic) from a gastroenteric highway, respiratory and urinary tracts.
VI. System of teaching tasks for verification of final knowledge
Situational tasks:
Patient, 81 years old, appealed with complaints about tormina. Pain arose up suddenly in 2 hours after meal. Washing of stomach and the enema of facilitation did not bring. The patient has IDC, 5 months ago was carried the heart attack of myocardium. The condition of the patient is heavy, pale, mucous membranes are cyanochroic, acrocyanosis. Shortness of breath. A pulse is 100 shots in 1 minute, arrhythmia. The abdomen is evenly swollen, soft, at deep palpation – sickly. Percussion – high tympanitis, a peristalsis is sharply hyposthenic. Peritoneal symptoms are not determined. Per rectum – are tailings of excrement with mucus and dark blood. What is credible diagnosis and what will be tactic of treatment?
Answer. At patient thrombosis of mesenteric vessels. The resection of necrotic loop of intestine is indicated.
Patient, 72 years old, delivered in an induction centre in a grave condition with complaints about swelling of abdomen, pain without clear localization during three days. The general condition is heavy, a skin and visible mucous membranes is pale. The tongue is dry. A pulse is 98 shots in 1 minute, AP – 100/60 mm Hg. The abdomen is swollen, sickly in all of regions, the unclear signs of irritation of peritoneum are determined. At auscultation - not hearkened to peristaltic noises. Рer rectum - the ampula of rectum is empty, on a glove are tracks of with-mucous excretions. What will your preliminary diagnosis? What will optimal method of treatment?
Answer. Thrombosis of mesenteric vessels is diagnosis. The resection of necrotic loop of intestine is indicated.
A patient, 76 years old, is entered surgical separation with complaints about pain in a counter-clockwise foot and shin. During 12 years he is ill atherosclerosis. About 2 weeks ago suddenly there was great pain in a counter-clockwise foot. For medical help did not apply. An edema grows. A skin at the beginning was pale, then – marble, by touch of cold. The bubbles of the removed a layer by a layer epidermis appeared gap-filling an ichor. A pulse on a popliteal artery and arteries of foot is not determined. Motions are absent. Temperature of body – 37,8o C, Pulls – 100 in 1 mines, AP is 90/50 mm Hg. What will your diagnosis and tactic of treatment?.
Answer. Diagnosis is moist gangrene of foot on soil of thrombosis of arteries. High amputation of lower is indicated.
A patient, 65 years old, 4 yeas ago carried appendectomy. In the area of postoperated scar the defect of covers (opening) registers by a diameter 1,5-2 mm, through which about 2 ml of rather yellow content is selected for days. A skin round this defect is not changed. Palpation is not sickly. Edema, infiltrate of surrounding tissues is not present.To define the necessary methods of additional inspection.
Answer. A patient needs to investigation – fistulography.
5. A patient, 68 years old, marks a sensitiveness to the cold feet, origin of pain in gastrocnemius muscles at walking on distance to 50 meters. A pulse on popliteal arteries and arteries of foot is absent. There is a defect of skin of the rounded form in the area of outward ankle, largenesses, by a diameter to 3 cm, in 2 mm depth Bottom of defect is gap-filling languid| granulations, covered a fibrin. Define reason| of origin and character of the described defect. Specify tactic of inspection and subsequent of this patient.
Answer. Diagnosis is chronic ischemia of lower| on soil of atherosclerosis. The defect is a trophic ulcer which arose up on a background the chronic ischemia of lower extremities. A patient needs additional inspection (arteriography, ULTRASONIC of arteries) and operation on the arteries| of lower extremities|.
6. The patient, 77 years old, 1 day ago was operated. It was amputation of counter-clockwise lower concerning a moist gangrene. The condition of the patient is heavy. Independently to move he does not can. At examination found out a dermahemia in the areas of corners of both shoulder-blades. What complication can develop for this patient? What must be done in such situation?
Answer: bedsores can develop for a patient; it is necessary to wipe the indicated areas 40% by solution of ethyl spirit, to conduct the complex of measure on the prophylaxis of bedsores.