Operative surgery and topographic anatomy icon

Operative surgery and topographic anatomy




НазваOperative surgery and topographic anatomy
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2. Operative surgery and topographic anatomy of the pelvic cavity and its walls

Relevance of the topic. A wide range of pathological processes that can develop in organs and tissues of the pelvic cavity, require students to closely study the topographic anatomy of the cavity, both male and female pelvis. The knowledge and skills will enable future doctors to solve complex problems of diagnosis and treatment significantly reduce the risk of medical errors.

^ Learning Objectives:

The overall goal: to be able to interpret the features of topographic anatomy of the pelvic cavity and its walls to anticipate possible complications (pathways of pathological processes, etc.) and justify surgical intervention and manipulation.

^ SPECIFIC OBJECTIVES

Initial Level "Knowledge-Skills"

Able to:

1. interpret the features of topographic anatomy of male and female pelvic organs, its walls;

2. substantiate the stages of the operation at a high section of the bladder;

3. justify and simulate puncture the bladder;

4. justify and simulate intramuscular injections in the gluteal region.


recognize agencies and educational pelvic cavity and its walls (Department of normal anatomy).

To determine the source of knowledge, abilities to self-monitoring and self-correction propose to solve the following tests:


Test №1

During a lower transverse laparotomy through the transverse fascia, arterial vessels that followed from outside to inside in the direction of the navel was encountered. What is this artery?

A. superiorgluteal

B. inferior gluteal

C. The upper epigastric

D. Inferior epigastric

E. ilio-psoas

Test № 2

The surgeon performed the audit of the middle floor of pelvis What is the name of this floor?

A. Subperitoneal

B. Hypochondrium

C. Inguinal

D. Infrasternal

E. Subdiaphragmatic


Test № 3

The patient with ectopic pregnancy had bleeding. Whhat is the most reliable way to collect blood in this situation?

A. Vesico-rectal

B. Parauterine

C. Vesico-uterine

D. Intersigmoid

E. Rectouterine


Test № 4

During removal of uterus, bleeding occurred. What arteries are the main sources of blood supply to the body?

A. Ovarian

B. Uterine

C. Testicular

D. Rectal

E. Lower vesico


Test № 5

Due to injuries, the patient damaged muscle which forms the urogenital diaphragm. Which muscle has been damaged in this situation?

A. Pear-shaped

B. Deep transverse (perineum)

C. Ilio-psoas

D. The internal obturator

E. Lower urocystic

Standards of responses to tests to determine the initial level: № 1 - D; № 2 - A; № 3 - E; № 4 -B; № 5 - B.


The 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 male and female pelvis, buttocks, perineum. Possible pathways of pathological processes.

2. Technique of high cross-section of the bladder, cystostomy.

3. Technology puncture the bladder.

4. Technics of intramuscular injections in the gluteal area.

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

Source:
^ MAIN REFERENCES

  1. Clinical anatomy for medical students / Richard S.Snell- Philadelphia:

Lippincott Williams and Wilkins., 6 edition, 2010. - p.

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

p.

3. Lecture on classes. 

^ ADDITIONAL REFERENCES

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 bladder (see Appendix № 2).

Set of tasks for achieving specific goals


^ VERIFICATION OF TRAINING

Test №1

The patient has an inflammatory process located between the bladder and abdominal-perineal aponeurosis. What do you call this inflamed space?

A. Precholecyst

B. Preperitoneal

C. Retrovesical

D. Retrorectal

E. Pararectal

Test № 2

When suturing the wounds of the bladder after capsulotomy, the surgeon flashed mucosa.which complication could this lead to?

A. Inflammatory process

B. Bleeding

C. Neoplasms

D. Deposition of concretions

E. Formation of fistula

Test № 3

Patients underwent bladder puncture on the line alba. At what level relative to the upper edge of the pubic symphysis should needle be binserted when performing this manipulation?

A. At the same

B. At 2 cm above

C. At 6 cm above

D. 2 cm below

E. At 6 cm below


Test № 4

A doctor performs intramuscular injection in the gluteal area. In what direction should needle be inserted when performing this manipulation?

A. From bottom to top

B. Top-down

C. outside to inside

D. Inside out

E. Perpendicular to the skin surface

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

^ 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 pelvic cavity and its walls (the gluteal region and perineum) on the human cadaver, plaster casts and posters. Using external benchmarks, students define the boundaries of areas that are walled pelvic study features layered structure in them, identify possible pathways for the spread of pathological processes, justify the execution of surgical interventions and manipulations simulate bladder puncture and intramuscular injections in the gluteal area. 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 OF TOPICS:

"Operative surgery and topographic anatomy of the pelvic cavity and its walls"


Small pelvis



Cavity

Wall



Upper (peritoneum) floor

Medium (sub peritoneal) floor

Lower (subcutaneous floor) - the perineum

Rear - gluteal region


Тopographical Anatomy





Fatty space, possible pathways of pathological processes

Features of the blood supply, innervation of venous and lymphatic drainage


Syntopy, skeletopy, golotopiya bodies and entities






Greater sciatic foramen

Small sciatic foramen

Obturator canal


Surgical interventions and manipulations







Primary surgical treatment of wounds

Puncture of the bladder

Online access


Operations on the organs


I / m injection in the gluteal region.






Lower median laparotomy


According to Pfannenstiel (extra-and transperitoneal)

Capsuloto-my

Cystostomy

Appendix № 2

Algorithm for high section of the bladder


^ The sequence of actions

Directions for action

Self-control

Defining the projection of the cut.

The projection is carried out in the midline of the pubic symphysis to the umbilicus by 10-12 cm




Dissection of the surface layers.

Cut the skin, subcutaneous tissue and superficial fascia with a scalpel to a white line of the stomach.

In the wound becomes visible linea - white stripe.

Dissection of the white line the stomach

Hooks to push the skin and subcutaneous tissue. Scalpel to cut the white line.

In the wound is visible transverse fascia.

Dissection of the transverse fascia.

Farabeuf hooks to dilate the edge lines of the abdominal muscles, take a thumb forceps to fold the transverse fascia, cut with scissors along the main section and locking clamps Mikulich.

In the wound is visible preperitoneal fatty tissue

Exposure of the anterior wall of the bladder.

When filled, bladder moves up preperitoneal tissue, together with a transverse fold of peritoneum, located in the upper part of the front wall of the bladder. In a wound or abdominal retractor inserted mirror.

The front wall of the bladder has a pink and longitudinally arranged veins. Fold of the peritoneum at the top of the bubble has a bluish color.

Overlay provisory catgut ligatures-handle

In the middle of the front wall of the bladder to flash two catgut ligatures provisionally at a distance of 3-4 cm from one another, capturing a suture adventitia and the muscular layer of the bubble.





Dissection of the bladder wall.

Capture the bladder wall between the taped thumb forceps and cut with scissors in the transverse direction at 2 cm mucosal dissection to raise it with tweezers and cut separately. In the presence of urine in the bladder, a hole to insert the suction and remove the contents.


Becomes visible to the cavity of the bladder.

Revision of the cavity of the bladder.

In the opening to introduce the index finger and palpate the bladder wall.




The introduction of drainage tubes.

Drain pipe with a curved end and the extra holes catgut stitch at a distance of 2.5 cm from its end and insert it into the bladder lumen. Ends of the ligature flash bladder wall from the inside outwards.

Drainage pipe located in the lumen of the bubble so that its end is no pressure on the rear wall.

Suturing the bladder wall.

Wall of the bladder take in the hub catgut suture in a longitudinal direction. Needle stitch all layers except the mucosa. Ligature tie between themselves and with ligatures of the tube. On top of that seam to impose a series of nodes catgut sutures, capturing a suture fascial and muscular layers of the walls of the bubble.




Plugging.

In the space before the bladder introduce rubber-gauze and put it on your skin.




Fiberwise suturing operas. Wounds:

a) stitches on a transverse fascia;

b) the seams on the aponeurosis;

c) stitches on the skin.

Remove retractor (mirror). The edges of the rectus muscles to separate hooks farabeuf.

Imposed on the transverse fascia nodal catgut sutures (№ 3-4) at 1 cm Remove hooks.

On the white line to put a hub or a silk suture through lavsan 1 cm drainage pipe tightly covered by these sutures. In disclosing rectus sheath to lock in a seam of the front wall.

Anchor silk sutures on the skin and subcutaneous tissue to impose a 1.5 cm skin edges adapted. Suture, which lies next to the drainage tube, the latest fix to the skin. Tube should be in the bottom corner of the wound.

The edges of the transverse fascia adjacent to each other. Drain tube is well fixed.

Seams between the white lines are no holes. Drainage pipe firmly fixed soft tissues. Anterior abdominal wall tight to the front wall of the bladder. The edges of the skin wound sutures are fixed and well adapted. Drainage pipe located in the lower right corner injury.




3. Operative surgery and topographic anatomy of the belt of upper limb (clavicular, deltoid, axillary, scapular) and shouder.

Relevance of the topic. Knowledge of topographic anatomy of the shoulder girdle and upper arm to predict the possible pathways of pathological processes, validate puncture site of shoulder joint and the subclavian vein, to carry out interim and final stop bleeding in the damaged arteries.

^ Learning Objectives:

Overall goal: To be able to interpret the topography of areas shoulder girdle and upper arm to justify surgical interventions and manipulations on them.

^ SPECIFIC OBJECTIVE:

Initial Level “Knowledge and Skill”:

ABLE TO:

1. interpret the features of topographic anatomy of shoulder girdle and upper arm;

2. substantiate the performance of accesses to the main neurovascular formations shoulder girdle and upper arm, the level of ligation of the arteries to carry out the projections of these approaches;

3. justify and simulate puncture the subclavian vein;

4. justify and simulate a temporary stop bleeding in wounds of the upper extremity.

identify anatomical structures shoulder girdle and upper arm (Human Anatomy Department).


To determine the source of knowledge, abilities to self-monitoring and self-correction propose to solve the following tests:

Test № 1

An objective examination of the patient noted atrophy of the deltoid muscle. What nerve innervates this muscle?

A. The medial cutaneous forearm

B. The medial cutaneous arm

C. Median

D. Axillary

E. The ulnar nerve


Test № 2

The patient complained of the impossibility of abstraction hands in the frontal plane. Which muscle allows this movement?

A. Small chest

B. Pectoralis

C. Subscapular

D. Teres

E. Deltoid


Test № 3

In the victim's wound in the left armpit, profuse arterial bleeding from the damaged axillary artery. Continuation of what artery is damaged vessel?

A. Subscapularis

B. Chest-back

C. Lateral thoracic

D. Suprascapular

E. Subclavian


Test № 4

Patient performed venesection head vein in the deltoid-pectoral sulcus. Which vein catheter falls out of this vein?

A. Subclavian

B. Subscapularis

C. Chest-back

D. Suprascapular

E. Lateral thoracic

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


The 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.  Topographical anatomy of the belt of upper limb and shoulder.

2. Accesses to main vascular-nervous formations of the belt of upper limb and

shoulder. Level of bandaging of arteries for saving of kollateral blood

stream.

3. Technique of punction of subclavian vein.

4. Temporal stop of bleeding at the wounds of the upper extremity.


With a graph of the logical structure to the topic can be found in the Appendix. 


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

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


Set of tasks for achieving specific goals

VERIFICATION OF TRAINING

Test № 1

When cellulitis in the subclavian area surgeon cut a small chest muscle and was pus. Phlegmon of the fatty space has occurred in this situation?

A. Subcutaneous

B. Pirogov-Paron

C. Subdeltoid

D. Surface subpektoralnogo

E. Deep subpektoralnogo


Test № 2

Surgeon must be run to access the right axillary artery. What is the projection of this line for access to Pirogov?

A. Butt hair

B. The front edge of hairline

C. The posterior margin of the hair

D. The front edge of the deltoid muscle

E. The posterior margin of the deltoid muscle


Test № 3

Patients showed axillary artery ligation. Above which a discharge of the artery should be carried out this ligation to preserve the collateral blood supply of the upper extremity?

A. Suprascapular

B. Subscapularis

C. Envelope shoulder front

D. Envelope of the shoulder from behind

E. Deep (shoulder)


Test № 4

Induring punction of the subclavian vein, the surgeon damaged the artery of the same name. What position, this artery is about veins?

A. Lateral

B. Front

C. Rear-medial

D. Medial

E. Lower


Test №5

For the introduction of drug surgeon performed a puncture of subclavian vein in a typical site (under the collarbone, between the median and mean her third). What should be the direction of advancing the needle when performing this manipulation?

A. Down and medially

B. Upward and outward

C. Down and out

D. Upwards and medially

E. Perpendicular to the body surface


Test № 6

To stop arterial bleeding on the shoulder of a tourniquet in its middle third. What a nerve can be damaged if such imposition of tow?

A. Shoulder

B. Elbow

C. Median

D. Musculo-cutaneous

E. Ray

Standards of responses to the target tests: № 1 - E; № 2 -; № 3 - B; № 4 - A; № 5 - D; № 6 - E.


^ BRIEF INSTRUCTIONS TO THE STUDENTS FOR PRACTICAL CLASSES

Teacher provides a motivational introduction to the occupation, carries out control and correction of the initial level of "knowledge-skills". Then the students under the supervision of a teacher embarking on the study of peculiarities of topographic anatomy of the shoulder girdle and upper arm on cadaveric material, plaster casts and posters. Operates on cadaveric accesses to the main neurovascular bundle, taking into account the projection of lines and layered structure of the region justify the level of ligation of the arteries, operates out of the operation (in series connect the dissected tissue), simulate puncture the subclavian vein and a temporary stop bleeding in the upper extremity. After discussing the results of independent work carried out test control and summarizing its results.


APPENDIX

^ EARL OF LOGICAL STRUCTURE TO THE SUBJECT:

"Operative surgery and topographic anatomy of the belt of the upper limb and shoulders


Belt of the upper limb , shoulder



The fixed part (belt of the upper limb )

Shoulder






Topographical Anatomy






Fatty space, possible pathways of inflammation

Features of the blood supply, innervation of venous and lymphatic drainage

Syntopy, golotopiya, skeletopy formations


Surgical interventions and manipulations























By

Janelidze

By

Petrovskii

By

Pirogov

By Lisfrank

By

Langenb

1   2   3   4   5   6   7

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