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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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Abdominal or Retroperitoneal Sarcoma
Definition: Abdominal or retroperitoneal sarcomas are rare tumors that
arise from soft tissues in the abdominal cavity or retroperitoneal space.
Pathophysiology: Genetic mutations in mesenchymal cells lead to
uncontrolled growth, forming sarcomas.
Signs and Symptoms: Abdominal pain, a palpable mass, changes in bowel
habits, and in advanced cases, symptoms due to compression of nearby
structures.
Causes/Risk Factors: Genetic predisposition, certain inherited syndromes,
and exposure to radiation might increase the risk.
Medical Management: Chemotherapy, radiation therapy, and targeted
therapy to shrink the tumor before surgery. Surgical resection of the
tumor, often involving surrounding tissues.
Surgical Management: Wide surgical excision to remove the tumor along
with surrounding tissues to achieve clear margins.
Prognosis: Prognosis varies based on the tumor type, size, location, and
stage at diagnosis. Complete surgical removal offers the best chance of
cure.
Interesting Fact: Sarcomas can develop in various soft tissues, making
their diagnosis and treatment complex.
Abdominal Trauma
Definition: Abdominal trauma refers to injuries to the abdomen and its
contents, often resulting from accidents, falls, or assaults.
Pathophysiology: Blunt or penetrating force causes damage to internal
organs, blood vessels, or abdominal wall structures.
Signs and Symptoms: Abdominal pain, tenderness, distension, bruising,
signs of shock, and in severe cases, evisceration.
Causes/Risk Factors: Accidents, falls, sports injuries, or physical assaults.
Medical Management: Stabilization, pain control, and diagnostic imaging
(CT scans) to assess internal injuries.
Surgical Management: Surgical exploration to assess and repair internal
injuries, control bleeding, and prevent infection.
Prognosis: Prognosis varies widely based on the nature and extent of the
injury. Prompt medical and surgical intervention can improve outcomes.
Interesting Fact: Abdominal trauma can involve injuries to multiple
organs, requiring a multidisciplinary approach for effective treatment.
Abdominal Wall Hernia
Definition: Protrusion of abdominal organs through a weak spot in the
abdominal wall muscles.
Pathophysiology: Weakness in the abdominal wall, allowing abdominal
contents to herniate.
Signs and Symptoms: Visible bulge, pain, discomfort, especially during
lifting or straining.
Causes/Risk Factors: Weak abdominal muscles, previous surgery, 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 recurrence if not
repaired.
Interesting Fact: Abdominal wall hernias can occur in various locations,
including inguinal, femoral, umbilical, and incisional hernias.
Accessory Spleen Removal
Definition: Accessory spleens are small, additional spleen tissue masses
that may cause discomfort or complications, necessitating their removal.
Pathophysiology: Accessory spleens result from embryonic remnants and
are usually harmless. However, if they cause symptoms or complications,
surgical removal may be required.
Signs and Symptoms: Pain or discomfort in the left upper abdomen,
especially if the accessory spleen compresses nearby organs or
experiences torsion.
Causes/Risk Factors: Congenital factors lead to the presence of accessory
spleens. Most are asymptomatic, but complications can arise in some
cases.
Medical Management: Symptomatic management, imaging studies, and
evaluation to confirm the presence and location of the accessory spleen.
Surgical Management: Accessory spleen removal (splenectomy) is
performed to excise the additional spleen tissue, relieving symptoms and
preventing complications.
Prognosis: Removal of accessory spleens typically resolves symptoms,
providing relief to affected individuals.
Interesting Fact: Accessory spleens are a normal variation in human
anatomy, occurring in approximately 10-30% of individuals. Surgical
removal is only necessary if they cause problems.
Achalasia
Definition: Neurological disorder affecting the esophagus, leading to
difficulty swallowing and impaired esophageal motility.
Pathophysiology: Loss of nerve cells in the esophagus, leading to
decreased peristalsis and impaired lower esophageal sphincter relaxation.
Signs and Symptoms: Dysphagia (difficulty swallowing), regurgitation,
chest pain, weight loss.
Causes/Risk Factors: Unknown; possibly autoimmune or genetic factors.
Medical Management: Calcium channel blockers, nitrates, botulinum
toxin injections, pneumatic dilation.
Surgical Management: Heller myotomy (a surgical division of the
esophageal muscle), fundoplication if reflux is present.
Prognosis: Generally good with appropriate interventions; symptoms can
be managed effectively.
Interesting Fact: Achalasia is a rare disorder and can be challenging to
diagnose due to its similarity to other esophageal conditions.
Acute Cholecystitis
Definition: Inflammation of the gallbladder, often due to gallstones
blocking the cystic duct.
Pathophysiology: Blockage of the cystic duct, leading to gallbladder
inflammation and sometimes infection.
Signs and Symptoms: Severe right upper abdominal pain, fever, nausea,
vomiting, positive Murphy’s sign.
Causes/Risk Factors: Gallstones, obesity, rapid weight loss, pregnancy.
Medical Management: Fasting, intravenous fluids, antibiotics, pain
management.
Surgical Management: Cholecystectomy (removal of the gallbladder)
during the acute phase or after resolution.
Prognosis: Good with timely intervention; can lead to complications like
gangrene or perforation if untreated.
Interesting Fact: Acute cholecystitis is a common reason for
hospitalization and surgery, often occurring due to gallstone obstruction.
Acute Perforated Peptic Ulcer
Definition: A peptic ulcer that has eroded through the wall of the stomach
or duodenum, leading to leakage of digestive juices into the abdominal
cavity.
Pathophysiology: Chronic inflammation weakens the ulcer site, which can
perforate due to increased pressure from gastric acids.
Signs and Symptoms: Sudden, severe abdominal pain, guarding, rigidity,
rebound tenderness, and signs of shock.
Causes/Risk Factors: Helicobacter pylori infection, NSAID use, smoking,
and alcohol consumption.
Medical Management: Intravenous fluids, antibiotics, and acid-
suppressing medications.
Surgical Management: Emergency laparotomy to repair the perforation
and, in some cases, remove part of the ulcer.
Prognosis: Prognosis depends on the extent of the perforation and timely
surgical intervention. Mortality rates are higher in older adults.
Interesting Fact: Perforated peptic ulcers are surgical emergencies with a
high risk of complications if not promptly treated.
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