Operative surgery and topographic anatomy icon

Operative surgery and topographic anatomy




НазваOperative surgery and topographic anatomy
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Дата23.08.2012
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To determine the source of knowledge, abilities to self-monitoring and self-correction propose to solve the following tests:


Test №1

When performing nephrectomy on the Kidneys located in retroperitoneum, what are the major organs except the kidneys, usually located in this space?

A. The adrenals, ureters

B. Ureter, bladder

C. The adrenal glands, urinary bladder

D. Urinary bladder, urethra

E. Sigmoid colon, ureters


Test № 2

When performing nephrectomy on patient with tumours in kidney, surgeon tied the three elements of renal legs. What is the third element, except the renal artery and vein, which was tied in this situation?

A. Pelvis

B. Ureter

C. Urethra

D. Pancreatic duct

E. Common bile duct


Test № 3

When removing the adrenal gland surgeon bandaged upper adrenal artery. This vessel which was tied up is a branch of which artery?

A. Lower diaphragmatic

B. Upper diaphragmatic

C. Renal

D. Abdominal aorta

E. Surface epigastric


Test № 4

A doctor palpated a muscle lying along the vertebral column in the lumbar region. What kind of muscle did the doctor palpate in this situation?

A. latissimus dorsi

B. external oblique (abdominal)

C. internal oblique (abdominal)

D. rectus

E. psoas

Standards of responses to tests to determine the initial level: № 1 - A; № 2 -B; № 3 - A; № 4 - D.

Information necessary for the formation of background knowledge, skills, can be found in the following sources:

1. Prives M.G., Lysenkov N.K Human Anatomy .- M.: Medicine, 1985 .- p.
2. Sinelnikov RD Atlas of Human Anatomy .- M.: Gos. Vol. med. Lt-ture, 1963 .- T. 1 .- p. 108-124.
3. Sapin M.R. Human Anatomy .- M., 1993 .- p.
4. Tests on human anatomy .- Donetsk, 1999 .- p.


^ TRAINING CONTENT

After mastering the necessary background knowledge, skills, you can go to

the study of the following materials:

LIST OF THEORETICAL ISSUES

1. Topographic anatomy of the lumbar region, and retroperitoneum.

2. Possible pathways of pathological processes in the lumbar region and the retroperitoneal space.

3. Extraperitoneal accesses to the kidneys (by Fedorov, Bergmann-Israel), the principles of operations on the organs of the retroperitoneal space.

4. Technology perirenal blockade.

With a graph of the logical structure to the topic can be found in the Appendix № 1.

^ INFORMATION SOURCES:

MAIN REFERENCES

Source:
MAIN REFERENCES

  1. Clinical anatomy for medical students / Richard S.Snell- Philadelphia: Lippincott Williams and Wilkins., 6 edition, 2010. - p.

  2. A practical guide to operative surgery / S. Das- Calcuta: 4 edition, 1999. - p.

3. Lecture on classes. 

^ ADDITIONAL REFERENCES

  1. Clinically oriented anatomy for medical students /Keith L.Moore, Arthur F.Dalley- Philadelphia: Lippincott Williams and Wilkins., 4 edition, 2010. - p.


INDICATIVE FRAMEWORK FOR ACTION

Students are invited to help the algorithm of actions in the simulation of operations on the kidney (see Appendix № 2).

Set of tasks for achieving specific goals

^ VERIFICATION OF TRAINING


Test № 1

As a result of injuries in the lateral section of lumbar area superficial soft tissue, thoracolumbar fascia and superficial muscles of the muscular layer were damaged. What superficial muscles can be damaged in this situation?

A. The latissimus dorsi and external oblique (abdominal)

B. Latissimus dorsi and internal oblique (abdominal)

C. External oblique and internal oblique (abdominal)

D. Erector spina and posterior inferior serratus

E. Trapezius and psoas


Test № 2

The patient revealed lumbar hernia on the left, just below the 12th rib. What defect in the lumbar muscles could be hernial ring in this case?

A. Petit’s triangle

B. Morgan’s groove

C. Larrey’s groove

D. Lesgaft-Grunfelt’s rhombus

E. Bochdalek’s groove


Test № 3

A left-sided nephrectomy was performed. What is the most efficient incision access usually used for this operation?

A. Fedorov

B. Kocher

C. Israel

D. Pirogov

E. Larrey


Test № 4

Patient with pancreatitis was administered perirenal blockade. In which tissue did the main part of the anesthetic enter when performing this manipulation?

A. Subcutaneous

B. Kidney

C. Paraurethral

D. Adrectal

E. Paracolonic

Standards of responses to the target tests: № 1 - A, № 2 - D; № 3 - A, № 4 - B.


^ BRIEF INSTRUCTIONS TO THE STUDENTS FOR PRACTICAL CLASSES

In early studies carried out monitoring and correction of the initial level of "knowledge-skills". Then students independently study the characteristics of topographic anatomy of the lumbar region and the retroperitoneal space on the human cadaver, plaster casts and posters. Students learn the features of layered structure, identify possible pathways for the spread of pathological processes, justify the execution of surgical interventions and manipulations. Using external benchmarks, students define the boundaries of the lumbar region and its "weak" points, hold the projections of access to the retroperitoneal space (Fedorov and Bergmann-Israel), model perirenal blockade. During independent work, students reinforce skills in the proper use of surgical instruments, separation and joining tissue. After discussing the results of independent work carried out test control and summarizing its results.


^ APPENDIX № 1

EARL OF LOGICAL STRUCTURE TO THE SUBJECT:

"Operative surgery and topographic anatomy of the lumbar region and

retroperitoneum"

Lumbar region and the retroperitoneal space






Lumbar region

Retriperitoneum


Topographical Anatomy















Triangle of Petit

Lesgaft-Grunfelt Rhombus


Surgical interventions and manipulations








Primary surgical treatment of wounds

Operations on the organs of the retroperitoneal space





to the kidney (according to Fedorov)

to the kidney and ureter (the Bergmann-Israel)


the kidney (dissection, resection, closure, fixation, disposal)




Appendix № 2

^ INDICATIVE FRAMEWORK FOR ACTION

when performing nephrectomy (Fedorov access)


The sequence of actions

Directions for action

Self-control

1

2

3

Defining the projection line of the cut skin.

With the help of cotton buds, QS-bounded iodine or brilliant green, conducted through the back of the renal point (the place of intersection of the 12th rib and the outer edge of the muscles, spine-straightening nickname), a diagonal line toward the navel to the outer edge of the rectus abdominis muscle.

The length of projection of the line depends on the thickness of subcutaneous fat

Opening of the elements of the surface layer.

According to the projection line cut through the skin, subcutaneous tissue and fascia of the surface. Edges of the wound dilate mnogozubymi hook-mi and implement hemostasis. The edges of the skin wound obkladyvayut napkins.

The thickness of subcutaneous fat is determined from the skin to the aponeurosis of external oblique abdominal muscles.

Listen

Read phonetically

Dictionary - View detailed dictionarynoun1.self-control0.self-verification0.self-discipline

Separation of the abdominal muscles, abdominal (transverse) fascia and preperitoneal fat

Cut the latissimus dorsi muscle, aponeurosis of external oblique abdominal muscles. Perimizium scissors cut through the internal oblique abdominal muscles. Two serried blunt scissors consistently sever bundles of muscle fibers of internal oblique and transverse muscles. The edges of the muscle farabeuf throw hooks. Transversalis fascia and preperitoneal tissue sever blunt, serried with scissors. Hemostasis.

Fiber aponeurosis of external oblique muscles go from the top down, from the outside - inside.

After stretching the muscles (internal oblique and transverse), the wound has the shape of a diamond, because their fibers are mutually perpendicular directions.

Separation of the peritoneum


Peritoneum bluntly peeled in a medial direction (up) and then becomes visible retrorenalnaya fascia.

Fascia is brilliant, dense groping through her palpable kidney.

Autopsy retrorenalnoy fascia.

Fascia dissected, along with the fat capsule peeled blunt, after which the kidneys eliminate the wound.

Intact in-strumentami kidney is wound on the renal pedicle
^

Revision of kidney


Revision of the kidney.

Inspects bud, noting abnormal formation on it.

The presence of pathological lesions-ray is the reason for surgical-logical correction.

Defining elements of renal-term legs

Guided by the knowledge syntopy, as well as the structure of the elements of renal legs, define its elements.




^

Resection of kidney


Ligation of renal vascular legs


Under each of the renal vessels sum blunt needle Deschamps with strong silk ligature (two on each vessel). The first tie ligatures close to the spine. After tying ligatures, impose a hemostat. Between the clamps and ligatures cross the artery first, and then the vein. Carefully remove the clips, if there is no bleeding, cut off the ends of the ligatures.

Kidney freely lies outside the wound, held by a ureter.

ListenRead phonetically

Dictionary - View detailed dictionary

Ligation of the ureter

Impose time is 2-3 inches below a discharge of the ureter from the pelvis, below it catgut ligature. Between them, dissect the ureter, the stump is treated with iodine.

Kidney without obstruction is removed from its bed.

Summing up the drainage.

Through counteropening sum drainage for renal bed, fix it to the skin.

Drainage can not be removed without removing the fixation suture.

Closure of the wound (out of operation).

Surgical wound sewn up in layers. The edges of the internal oblique and transverse muscles pull together separate catgut (nodal or T-shaped) sutures. On the aponeurosis of external oblique muscle impose silk nodal joints. When overly developed subcutaneous tissue should take in its separate catgut sutures. On the skin impose nodal silk sutures.

Surgical wound sewn up in layers. The edges of the internal oblique and transverse muscles pull together separate catgut (nodal or T-shaped) sutures. On the aponeurosis of external oblique muscle impose silk nodal joints. When overly developed subcutaneous tissue should take in its separate catgut sutures. On the skin impose nodal silk suture
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