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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_848_Библиотеки_им_академика_М_И_Перельмана
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Chapter 13: Miscellaneous
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
INCENTIVE RESPIROMETER
It is a medical device used to help patients for improving function of lungs.
63
alient Features
S
It has 3 chambers
The balls in 1st, 2nd, 3rd chamber, i.e. red, yellow and blue
balls respectively register a maximum ow of 600, 900,
1200 cc/s respectively
It has a patent mouth piece with inbuilt lter.
ses
U
Used to train patients to breathe deeply to ensure good
expansion of lungs especially in atelectatic areas of lungs
in postoperative patients
Used preoperatively in patients who undergo surgery
especially thoracic and upper abdominal surgery
Used in patients recovering from respiratory ailments like
COPD, asthma.
ethod
M
Ask the patient to blow air forcefully into the mouth piece
of respirometer
Reverse the device and ask the patient to inhale forcefully.
64
Section 2: Non-Metallic Surgical Objects
PROLENE MESH
alient Features
S
Consists of knitted polypropylene monolament that
resists degradation by tissue enzyme and retains strength
indenitely
Bidirectional elastic property allows adaptation to various
stresses encountered in body
Available in various sizes (according to size of hernia
defect).
SKIN STAPLER
ses
U
Abdominal wall reinforcement in hernia repair
Used in incisional, inguinal, femoral, umbilical and ventral
hernias.
alient Features
S
Contains preloaded skin staples
Available in pre-sterilized pack.
ses
U
For approximation of dierent skin incisions
Used to x skin grafts to a raw area.
dvantages
A
Cosmetically good scar
Perfect approximation of skin
Saves time
Decrease chances of needle injuries.
isadvantages
D
Costlier
Needs separate stapler removal instrument to remove
stapler pins.
Chapter 13: Miscellaneous
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
BANDAGES AND ADHESIVE TAPES
Bandage is something which is used to cover, support, immobilize and exert pressure over a part of body.
Adhesive tapes are tapes with adhesive material used to x anything on body or to other object.
A. COTTON BANDAGE
alient Features
S
Light and woven bandage
Available in various sizes
It does not have elastic properties.
ses
U
Used to dress a wound especially for rst aid
To cover any wound and prevent infection
To provide compression over limbs to reduce swelling
Can be used for anal packing in rectoanal surgeries.
65
B. CREPE BANDAGE
alient Features
S
Has considerable elasticity and stretches to nearly double
its length and regains its original size again.
Provides rm but controlled compression.
ses
U
Used for compression dressing in cases of:
¾ Sprain
¾ Bleeding surfaces
¾ Swelling of limbs
To restrict movement of a limb or a particular joint
In postoperative cases of varicose vein surgery
To assist in correction of a deformity.
66
C. HIPORE SURGICAL TAPE
D. ELASTIC ADHESIVE BANDAGE
Section 2: Non-Metallic Surgical Objects
alient Features
S
Non-woven, non-allergic fabric
Easy to tear
Water repellent.
ses
U
Suitable for long term gauze xation, dressing xation, for
securing intravenous needles, medical devices, electrodes
and to x tubings on skin.
alient Features
S
Woven non-allergic fabric
Has elastic and adhesive properties
Has to be cut by a blade or scissors.
ses
U
Suitable for compressive dressings of postoperative area
Used to x tubings on body rmly to minimize the risk of
dislodgement.
SECTION
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x-rayS
3
CHAPTERS
Chapter 14: Introduction
Chapter 15: Gastrointestinal
Chapter 16: Hepatobiliary
Chapter 17: Genitourinary
Chapter 18: Chest
Chapter 19: Miscellaneous
INTrOduCTION
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
CHAPTER
14
Things To do BEFoRE AnALYsing
An x-RAY
Know precise history of patient
Availability of a proper view box
impoRTAnT pARTicuLARs
mEnTionEd on A digiTAL x-RAY
Name of patient
Male/Female
Age of the patient
View of X-ray
Part of body viewed
Date of X-ray
Diagnostic center name
Right and left side of X-ray
how To dEscRiBE An x-RAY
is is a plain/digital/contrast skiagram of region (chest/
abdomen etc.) view (PA/oblique/AP) showing positive
ndings suggestive of provisional diagnosis
Gastrointestinal
XRAY ABDOMEN WITH GAS UNDER BOTH DOMES DIAPHRAGM
Chapter
15
Figure 1: This is a digital skiagram of abdomen anteroposterior view with lower part of chest taken in erect posture showing free gas under both lobes
of diaphragm suggestive of pneumoperitoneum along with multiple distended gas lled bowel loops. (Put forward a dierential diagnosis)
Chapter 15: Gastrointestinal
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71
Figure 2: This is a digital skiagram of chest P-A view with upper part of abdomen taken in erect posture showing free gas under both lobes of
diaphragm suggestive of pneumoperitoneum
Figure 3: Similar X-ray with enormous amount of free gas under both lobes of diaphragm
72
Figure 4: This is a digital skiagram of abdomen AP view with lower part of chest and upper part of pelvis taken in erect posture showing free gas under
both lobes of diaphragm with classical ground glass appearance of abdomen suggestive of pneumoperitoneum most probably due to perforation in GI
tract
Section 3: X-rays
ierential Diagnosis
D
Perforation in gastrointestinal tract (gastric/duodenal/small or large gut)
Peritoneal breach (Due to external injuries like stab injury/rearm injury)
Following laparoscopic procedures (Iatrogenic pneumoperitoneum)
Infection with gas forming organism (like clostridium)
Postoperative patients of laparotomy
Following tubal insuation test (Rubin test)
Chilaiditi’s sign can mimic pneumoperitoneum due to interposition of small or large bowel loops between diaphragm and liver
Peritoneal dialysis.
ey Points
K
If patient is not able to stand, then X-ray is preferred in left lateral decubitus position.
Gas under diaphragm present in only 60-70% of peptic perforation as early omental adhesions may occur and the gas present may
get re-absorbed
In appendicular perforation (Most commonly due to obstructive pathology) generally no free GUD present as very less air is present
in appendicular lumen
The ground glass appearance is due to uid in peritoneal cavity
Stages in development of peritonitis
¾ Stage 1 – Stage of chemical peritonitis
¾ Stage 2 – Stage of peritoneal reaction
¾ Stage 3 – Stage of bacterial peritonitis
Management of these patients includes-
¾ Stabilizing the vitals
¾ Laparotomy to nd the cause.
Supine Film Signs of Pneumoperitoneum
¾ Rigler’s sign - Visibility of both the surface of bowel wall, due to gas within lumen and free gas outside the lumen which
contours the wall outline.
¾ Football sign - Collection of air in centre of abdomen over a uid collection.
¾ Cupola sign - Large amount of gas under the diaphragm.
¾ Triangle sign - Air between bowel loops.
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