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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5302_Библиотеки_им_академика_М_И_Перельмана
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Esophageal Varices
Definition: Dilated and swollen veins in the lower esophagus, often due to
portal hypertension.
Pathophysiology: Increased pressure in the portal vein, leading to the
development of collateral vessels in the esophagus.
Signs and Symptoms: Vomiting blood, black, tarry stools (melena),
abdominal pain, signs of liver disease.
Causes/Risk Factors: Cirrhosis, portal vein thrombosis, alcoholic liver
disease.
Medical Management: Medications to reduce portal pressure, endoscopic
interventions (band ligation, sclerotherapy).
Surgical Management: Transjugular intrahepatic portosystemic shunt
(TIPS), surgical shunting procedures in severe cases.
Prognosis: Guarded; risk of bleeding and mortality are high, especially
with advanced liver disease.
Interesting Fact: Esophageal varices are a potentially life-threatening
complication of liver disease and require close monitoring and
intervention to prevent bleeding.
Fecal Incontinence
Definition: Inability to control bowel movements, leading to involuntary
passage of stool.
Pathophysiology: Damage to the anal sphincter muscles or nerves.
Signs and Symptoms: Involuntary bowel movements, inability to control
gas, social withdrawal.
Causes/Risk Factors: Childbirth trauma, anal surgery, nerve damage,
aging.
Medical Management: Dietary modifications, medications, physical
therapy.
Surgical Management: Sphincter repair, sacral nerve stimulation,
colostomy in severe cases.
Prognosis: Variable, depending on the underlying cause and severity.
Interesting Fact: Fecal incontinence significantly impacts the quality of
life and often goes unreported due to embarrassment.
Femoral Hernia
Definition: Hernia that protrudes through the femoral canal into the upper
thigh.
Pathophysiology: Weakness in the femoral canal allows abdominal
contents to herniate.
Signs and Symptoms: Groin bulge, discomfort, pain, especially during
bending or lifting.
Causes/Risk Factors: Weakness in the femoral canal, obesity, pregnancy.
Medical Management: Supportive garments, lifestyle modifications,
avoiding heavy lifting.
Surgical Management: Hernia repair through open or laparoscopic
surgery.
Prognosis: Excellent with surgical intervention; risk of complications if
left untreated.
Interesting Fact: Femoral hernias are more common in women and have a
higher risk of incarceration compared to inguinal hernias.
Foreign Body Ingestion
Definition: Swallowing of objects or substances that are not intended for
ingestion.
Pathophysiology: Ingested foreign bodies can cause obstruction,
perforation, or other complications.
Signs and Symptoms: Throat discomfort, difficulty swallowing,
abdominal pain, vomiting, bloody stools.
Causes/Risk Factors: Accidental ingestion, psychiatric conditions (pica),
young children.
Medical Management: Observation, endoscopic removal.
Surgical Management: Surgery for complications such as perforation or
severe obstruction.
Prognosis: Generally good with prompt removal; can be serious if
complications occur.
Interesting Fact: Foreign body ingestion is common in children but can
also occur in adults, especially those with psychiatric disorders.
Fournier’s Gangrene
Definition: Rapidly progressing, life-threatening infection of the genital
and perineal area.
Pathophysiology: Bacterial infection often originating from the skin or
urinary tract, leading to necrotizing fasciitis.
Signs and Symptoms: Severe pain, swelling, crepitus (gas under the skin),
fever, systemic toxicity.
Causes/Risk Factors: Diabetes, immunosuppression, local trauma,
urogenital infections.
Medical Management: Intravenous antibiotics, aggressive fluid
resuscitation, wound care.
Surgical Management: Surgical debridement of necrotic tissue, often
requiring multiple procedures.
Prognosis: Poor without aggressive surgical intervention; high mortality
rate.
Interesting Fact: Fournier’s gangrene requires urgent and extensive
surgical debridement to prevent the systemic spread of infection.
Gallbladder Cancer
Definition: Malignant tumor originating from the cells of the gallbladder.
Pathophysiology: Uncontrolled cell growth in the gallbladder lining, often
associated with gallstones.
Signs and Symptoms: Jaundice, abdominal pain, unexplained weight loss,
bloating.
Causes/Risk Factors: Gallstones, chronic inflammation of the gallbladder,
porcelain gallbladder.
Medical Management: Chemotherapy, radiation therapy, targeted therapy.
Surgical Management: Cholecystectomy (removal of the gallbladder) with
or without additional resection of nearby tissues.
Prognosis: Poor; often diagnosed at an advanced stage, leading to limited
treatment options.
Interesting Fact: Gallbladder cancer is relatively rare but can be
aggressive, often requiring a multidisciplinary approach for treatment.
Gallbladder Polyps
Definition: Small growths or lesions in the gallbladder wall.
Pathophysiology: Precise cause unknown; some polyps can progress to
cancer.
Signs and Symptoms: Usually asymptomatic; discovered during imaging
studies for other conditions.
Causes/Risk Factors: Genetic factors, inflammation, gallstones.
Medical Management: Monitoring with regular ultrasounds, and surgical
removal if polyps are large or suspicious.
Surgical Management: Cholecystectomy (removal of the gallbladder) for
large or suspicious polyps.
Prognosis: Generally good if detected early; risk of malignancy is low.
Interesting Fact: Most gallbladder polyps are benign, but surveillance is
necessary due to the risk of cancerous transformation.
Gallstone Ileus
Definition: Bowel obstruction caused by the passage of a large gallstone
into the small intestine.
Pathophysiology: Gallstone migrates from the gallbladder to the intestine,
causing obstruction.
Signs and Symptoms: Abdominal pain, vomiting, distension, visible lump
in the abdomen.
Causes/Risk Factors: Gallstones, gallbladder inflammation.
Medical Management: Intravenous fluids, pain management,
decompression.
Surgical Management: Enterolithotomy (surgical removal of the gallstone)
and possible cholecystectomy.
Prognosis: Good with surgical intervention; can lead to complications like
bowel perforation if untreated.
Interesting Fact: Gallstone ileus is a rare cause of small bowel obstruction
and requires a careful approach to management.
Gallstone Pancreatitis
Definition: Inflammation of the pancreas caused by gallstones obstructing
the pancreatic duct.
Pathophysiology: Gallstones block the pancreatic duct, leading to
autodigestion of the pancreas.
Signs and Symptoms: Severe upper abdominal pain, nausea, vomiting,
and fever.
Causes/Risk Factors: Gallstones, obesity, rapid weight loss.
Medical Management: NPO (nothing by mouth), intravenous fluids, pain
management, addressing underlying gallstones.
Surgical Management: ERCP (Endoscopic Retrograde
Cholangiopancreatography) with sphincterotomy to remove stones, and
cholecystectomy for recurrent cases.
Prognosis: Excellent with prompt medical or surgical intervention.
Interesting Fact: Gallstone pancreatitis is a common cause of acute
pancreatitis.
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