Urgent surgical care. Emergency Surgery_rus

At the EMC Surgical Clinic, care is provided for patients with urgent surgical conditions around the clock.

What do we treat:

acute cholecystitis (biliary colic), obstructive jaundice;

perforated ulcer of the stomach and duodenum;

acute intestinal obstruction, intussusception of the intestine;

acute pancreatitis, pancreatic necrosis;

peritonitis;

acute paraproctitis;

gastrointestinal bleeding, bleeding from the rectum;

injuries of the abdominal and thoracic organs;

abscess, phlegmon, furuncle, carbuncle, felon, infected wounds.

A qualified surgical team specializing in emergency and urgent surgical care is on duty at the EMC around the clock. EMC diagnostic services also operate around the clock. This allows you to conduct both laboratory and instrumental diagnostics, including performing, if necessary, any types of ultrasound, X-ray, endoscopic examinations, as well as computed and magnetic resonance imaging. The presence of diagnostic departments, equipped with the latest technology and working around the clock, allows you to make an accurate diagnosis, determine the amount of necessary surgical intervention and prepare for surgery as soon as possible.

All emergency surgeons have many years of experience and are proficient in the full range of methods for performing urgent and emergency operations, including minimally invasive and laparoscopic ones, which makes surgical treatment less traumatic, minimizes pain after surgery, reduces blood loss and the likelihood of developing postoperative complications, reduce the recovery period of the patient and the length of stay in the hospital.

AT postoperative period the medical staff of the clinic provides a high level medical care and service, professional care, care and attention to each patient both during their stay in the hospital and during subsequent outpatient monitoring.

If you need urgent surgical care, you can always contact EMC clinics directly, call our multi-line phone or use the 24-hour ambulance service. If you need hospitalization and emergency surgery, the ambulance team will take you to the EMC Surgical Clinic. The emergency physician hands the patient over to the emergency room doctor and emergency assistance, and then - to the surgeon, thereby ensuring the continuity of medical supervision and maximum safety at all stages of support and treatment.

Discipline: "Emergency Surgery" in the direction of "Surgical Diseases"

Emergency Surgery_rus

For the initial period of acute appendicitis is typical:

A) diffuse soreness in the presence of signs of diffuse peritonitis

B) the appearance of pain in the upper abdomen with a shift within 6 hours to the right iliac region

C) the presence of girdle pain with repeated pain

D) the presence of cramping abdominal pain in combination with diarrhea

E) hectic body temperature

(correct answer) = B

(Difficulty) = 1

(Semester) = 14

Most common cause gastrointestinal bleeding:

A) peptic ulcer stomach and 12p. guts

B) erosive esophagitis

C) stomach tumor

D) Mallory-Weiss syndrome

E) colonic diverticulosis

(correct answer) = A

(Difficulty)= 1

(Textbook)= (Guide to Emergency Organ Surgery abdominal cavity. Ed. Savelyeva V.S., M., Triada, 2004)

(Semester) = 14

A 30-year-old patient on the 5th day after appendectomy, due to acute gangrenous appendicitis, appeared heat, chills, pain in the right hypochondrium, hepatomegaly, yellowness of the sclera, fever, chills. On ultrasound in the 8th segment of the liver, a hyponegative formation 4x3 cm. Choose a surgical approach to treat this complication:

A) Laparotomy, opening and drainage of liver abscess

B) Puncture of a liver cyst

C) Drainage of the liver cyst under ultrasound control

D) Antibacterial and absorbable therapy

E) Liver resection with abscess

(correct answer) = A

(Difficulty) = 2

(Semester)= 14

Due to intestinal obstruction, a laparotomy was performed, during which the presence of a tumor of the transverse colon was established, spreading to the hepatic angle and sprouting into the antrum of the stomach, the adductor intestine was significantly expanded, in the lumen stool, the ileum is not dilated. What operation should be performed?

A) Resection of the transverse colon

B) Bypass ileotransverse anastomosis

C) Resection of the transverse colon with anastomosis and resection of the stomach

D) Right-sided hemicolectomy with resection of the stomach

E) Cecostomy

(correct answer) = D

(Difficulty) = 2

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

At the time of surgery for cholecystitis, a sharply changed gallbladder with multiple cords in the infundibular zone, the choledoch is hidden by inflammation. Under these circumstances, it is recommended:

A) Cholecystectomy from the bottom

B) Cholecystectomy from the neck

C) Cholecystostomy

D) Atypical cholecystectomy

E) Combined cholecystectomy

(correct answer) = A

(Difficulty) = 2

(Semester) = 14

Explain the reason for the appearance of muscle tension in the right iliac region, which occurs with a perforated duodenal ulcer

A) Reflex connections through spinal nerves;

B) Accumulation of air in the abdominal cavity;

C) Leakage of acidic gastric contents through the right lateral canal;

D) Developing diffuse peritonitis;

E) Viscero-visceral connections with the appendix.

(correct answer) = C

(Difficulty) = 2

(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)

(Semester) = 14

What is the purpose of fixing the stomach stump in the mesocolon window during resection of the stomach according to the Billroth-2 type:

A) delimitation of possible inflammatory complications in the upper floor of the abdominal cavity

B) prevention of the development of small bowel obstruction

C) prevention of insolvency of the gastrointestinal anastomosis

D) prevent reflux

E) normal passage of food

(correct answer) = B

(Difficulty) = 2

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

Patient D., aged 47, was taken to admission department with complaints of repeated bloody vomiting and black stools, loss of consciousness, severe weakness and dizziness. Ulcer history for 5 years. Upon admission, the condition was severe, pulse was 100 beats per minute, blood pressure was 80/40 mm Hg. st., pale. In the blood test Er. 2.2x1012, Hb 80, hematocrit 30. Emergency EFGDS revealed a chronic callous ulcer of the body of the stomach with a diameter of up to 3 cm, covered with a loose red thrombus. What is your tactic?

A) transfer to the intensive care unit for further treatment

B) probing the stomach, followed by lavage and administration of aminocaproic acid and norepinephrine

C) operate immediately without preparation

D) carry out hemostatic and replacement therapy with dynamic observation

E) emergency operation after preoperative preparation

(correct answer) = E

(Difficulty) =3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

On the radiograph of the stomach and duodenum, the patient has the following data: What operation should the patient perform?

A) Resection of 2/3 of the stomach according to Billroth-I

B) Resection of 2/3 of the stomach according to Billroth-II

C) Selective vagotomy, ulcer excision

D) Proximal resection of the stomach

E) Gastrectomy

(correct answer) = A

(Difficulty) = 2

(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)

(Semester) = 14

On the radiograph of the patient's stomach, there are the following data: What operation is indicated for the patient?

A) Resection of 2/3 of the stomach according to Billroth I

B) Resection of 2/3 of the stomach according to Billroth II

C) Selective vagotomy, ulcer excision, Finney pyloroplasty

D) Stem vagotomy, ulcer excision, Heineke-Mikulich pyloroplasty

E) Selective proximal vagotomy, ulcer excision, duodenoplasty

(correct answer) = B

(Difficulty) = 2

(Textbook) = (Hospital surgery, Bisenkov L.N., Trofimov V.M., 2005)

(Semester) = 14

Patient V., aged 30, complains of persistent abdominal pain that appeared 3 days ago in the epigastric region. A day ago, a single vomiting, independent stool. Tongue dry, furred. The abdomen is tense, painful in all departments, but more along the right lateral canal. Percussion-tympanitis in all parts of the abdomen. Hepatic dullness is preserved. Shchetkin-Blumberg's symptom is positive. Peristalsis is not heard. Blood leukocytes 18 thousand / ml, fell - 10%. Plain radiography of free gas, no Kloiber cups, loops small intestine pneumatized. What is your preliminary diagnosis?

A) Peritonitis of unknown etiology.

B) Acute appendicitis. Peritonitis.

C) Acute cholecystitis? Peritonitis.

D) Perforated stomach ulcer.

E) Acute pancreatitis? Peritonitis.

(correct answer) = B

(Difficulty) =2

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

During surgery, a patient with phlegmonous cholecystitis was found to have vitreous edema on the hepatoduodenal ligament and retroperitoneal space. With intraoperative cholangiography - choledochus up to 10 mm, contrast enters duodenum, there is contrast reflux into the pancreatic duct. What should the surgeon do in this situation and why?

A) Cholecystectomy, choledochotomy, choledochoduodenostomy, because it is necessary to remove the inflamed organ and ensure the constant removal of bile, to prevent destruction in the pancreas

B) Cholecystectomy, choledochotomy, drainage of the choledochus according to Vishnevsky, because it is necessary to remove the inflamed organ, revise the choledoch and create a condition for decompression of the biliary tract in order to prevent destructive pancreatitis

C) Cholecystectomy, drainage of the common bile duct through the stump of the cystic duct, because it is necessary to remove the inflamed organ and relieve tension in the bile ducts and pancreatic duct, caused by edematous pancreatitis

D) Cholecystectomy, drainage of the retroperitoneal space, because it is necessary to remove the inflamed organ and eliminate tension in the retroperitoneal space

E) Cholecystectomy, choledochotomy, choledochojejunostomy, because it is necessary to remove the inflamed organ and create a detour for the flow of bile into the intestine in order to prevent obstructive jaundice

(Correct answer) C

(Difficulty) = 3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

During a cholecystectomy, the surgeon found that the hepaticocholedochus was expanded to 2.5 cm, cholangiography. How should the operation be completed?

A) Choledocholithotomy and drainage of the choledochus according to Abbe

B) Choledocholithotomy and percutaneous transhepatic through drainage of the biliary tract

C) Choledocholithotomy and external drainage of the choledochus with a T-shaped drainage, because in this case, not only decompression of the biliary tract occurs

D) Choledocholithotomy and blind suture of the common bile duct

E) Choledocholithotomy and formation of choledochoduodenoanastomosis

(correct answer) = E

(Difficulty) =3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

The patient is concerned about: chills with fever, jaundice and pain in the right hypochondrium. What method of choledochus drainage is indicated for the patient and why?

A) According to Pikovsky, because enables external drainage of the biliary tract without choledochotomy

B) According to Vishnevsky, because ensures the removal of infected bile and at the same time creates conditions for the outflow of bile into the intestines

C) According to Felker, because gives rapid decompression of the biliary tract and prevents suture failure

D) By Lane, because allows you to completely remove the infected bile to the outside

E) Choledochoduodenostomy, because there is no loss of bile to the outside

(correct answer) = B

(Difficulty) =3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

Patient S., 48 years old, was delivered on an emergency basis 12 hours after the onset of illness with complaints of severe weakness, dizziness, nausea, and tarry stools. From the anamnesis: for 10 years she has been suffering from chronic gastritis. The last 3 years were not examined, during an objective examination: pale skin, pulse 90 beats per minute, blood pressure 100/70 mm Hg. Art. Respiratory rate 20 per minute, temperature -37.0°C. From the side of the blood test Er. 2.9x10 12, ESR-12 mm/h. What are the priority tasks you need to solve in this case?

A) establish the fact of gastrointestinal bleeding, determine the degree of blood loss.

B) establish the fact of gastrointestinal bleeding, hold a naso-gastric tube, determine the source of bleeding.

C) establish the fact of gastrointestinal bleeding, establish the source of bleeding, determine the degree of blood loss, determine the degree of hemostasis.

D) establish the source of bleeding, determine the degree of blood loss.

E) establish the source of bleeding, determine the degree of blood loss, determine the degree of hemostasis.

(correct answer) = C

(Difficulty) =3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

After resection of the stomach according to Billroth II, about 500 ml/h of blood was released through a nasogastric tube. Conducted hemostatic and substitution therapy without effect. What is the next strategy and why?

A) continue hemostatic therapy

B) urgently operate on the patient, since conservative therapy has no effect

C) insert the probe into the stomach stump and carry out local therapy since it was not held

D) carry out replacement therapy

E) observation in dynamics

(correct answer) = B

(Difficulty) =3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

Patient K., 52 years old, suffering from atrial fibrillation, developed 5 hours ago severe pain in the abdomen, there were double vomiting, liquid stool. On examination, the patient's condition moderate. Dry tongue. The abdomen is soft in all departments, severe pain in the mesogastric region is determined. Symptoms of peritoneal irritation are questionable. Intestinal peristalsis is weakened. The content of blood leukocytes 22x10 9 /l. What disease corresponds to this clinical picture, Your further tactics?

A) hemorrhagic pancreatic necrosis, surgical treatment

AT) Acute violation mesenteric circulation, surgical treatment

C) Acute strangulation intestinal obstruction, surgical treatment

D) Budd-Chiari disease, conservative treatment

E) Dissecting aneurysm of the abdominal aorta, surgical treatment

(correct answer) = B

(Difficulty) = 3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

(Semester) = 14

Patient K., aged 52, is admitted on an emergency basis with complaints of repeated vomiting of the color of "coffee grounds", weakness, melena, epigastric pain during the day. A history of severe pain osteochondrosis, uncontrolled reception diclofenac. Objectively: BP - 80/40 mm Hg, Hb - 70 g/l, er - 2.3*10 12/l, Ht - 28. Determine the operational tactics?

A) resection of the stomach according to B-1 in order to remove the callous ulcer of the duodenum 12

C) resection of the stomach according to B-2 with the aim of removing the tumor of the antrum of the stomach

C) gastrectomy to remove a tumor of the lesser curvature of the stomach

D) suturing of an acute gastric ulcer for the purpose of hemostasis

E) economical resection of the gastric polyp for the purpose of hemostasis

(correct answer) = D

(Difficulty) = 3

(Textbook) = (Guidelines for emergency surgery of the abdominal organs. Edited by Saveliev V.S., M., Triada, 2004)

Emergency surgical care is resorted to when a life-threatening condition sets in, and time is literally hours, and sometimes even minutes. It is easy to imagine that the responsibility lies with the surgeons who provide emergency care, lies colossal, and therefore the most competent and at the same time the most skillful specialists work in this specialty. But the salvation of a person depends not only on how qualified the doctor will be. It is important that emergency surgical care is provided in a timely manner - as soon as possible after the fact of a life-threatening situation is established.

Life-threatening conditions

Conditions that require emergency surgical care can be divided into two large groups:

• Arising under the influence of exogenous factors, or trauma;
• arising under the influence of endogenous factors, or acute complications existing diseases.

Injuries that pose a direct threat to life include not only those terrible wounds when there is a lot of blood loss and traumatic shock obvious. Often blunt force trauma, without violating integrity skin no less dangerous, and also subject to surgical treatment. Examples are blunt abdominal trauma, which causes rupture of the spleen or other organs, resulting in massive internal bleeding, or brain contusions, in which damage to brain tissue can be severe, although the first symptoms may be subtle.

AT pediatric practice often there is another type of condition where emergency surgery is likely to be required, this is the presence of a foreign object in the body. Small children, when playing with small objects, often stick them up their noses, ears, swallow them or inhale them. This situation requires immediate medical intervention, and if the object cannot be removed by conservative means, an emergency operation is resorted to.

Acute complications chronic diseases that require emergency surgical care is an abscess or empyema (suppuration of an inflamed organ or tissue with the threat of its rupture and outpouring of pus into the surrounding space), phlegmon (acute purulent inflammation of the fiber), appendicitis, peritonitis, intestinal obstruction, internal bleeding, perforation or perforation of any organ.

How do you know if emergency surgery is needed?

Emergency surgical care for injuries is necessary when there is outwardly visible serious damage to organs or tissues, and not necessarily with bleeding (burns and frostbite, for example). If there are no visible dangerous injuries after the injury, but the person feels worse, turns pale, the pain intensifies or he loses consciousness, this is a direct indication that he most likely needs urgent surgical care. In this case, it is unacceptable to self-medicate, you must immediately call ambulance. It is especially undesirable to give any medications especially analgesics. Medicines in this state are unable to solve the problem, and they are quite capable of confusing the symptoms or even causing the patient's condition to worsen. All medications without exception, the doctor must prescribe after the initial examination. In this condition, the patient should also not be allowed to eat and drink until a medical examination is carried out.

As for the complications of inflammatory diseases, there are also some signs that emergency surgery is required, and it is very important not to miss them, especially when the patient is at home and not in hospital.

How to determine that the disease has passed into a dangerous phase? First, it is a long pain attack. It is believed that if a pain attack during a bile or renal colic lasts more than six hours and is not amenable to relief with analgesics, then this should alert you to the appearance of one of serious complications- either perforation of the organ, or its suppuration with a rupture. In such a situation, home treatment is extremely dangerous to continue, immediate assistance is required in stationary conditions because there is a high chance that emergency surgery will be required.

Increasing pallor, worsening condition, sharp pain in the abdomen combined with tension abdominal wall(syndrome acute abdomen), confusion or loss of consciousness, a weak voice, a forced position of the body - all these are symptoms of a probable surgical pathology.

The first thing that doctors' efforts are aimed at when a life-threatening condition is detected is the fight against shock. For this purpose, anti-shock therapy is urgently carried out: electrolyte solutions are administered intravenously to replenish the fluid balance of the body, and drugs whose action is aimed at maintaining cardiac activity. When the condition is more or less stabilized, proceed to surgical intervention.

If it's about open injury, the stages of emergency surgical care are as follows: anesthesia, revision (examination) of the wound, removal of tissue fragments and bone fragments, layer-by-layer suturing of tissues, establishment of drainage.

Emergency surgical care for closed wounds, as well as for complications internal diseases, is complicated by the fact that it is not always clear what exactly happened. Therefore, an urgent diagnosis is necessary. If we are talking about a traumatic brain injury with suspected brain contusion, carry out computed tomography. In the case of diseases of the abdominal organs, the approach lies in the diagnostic surgical intervention, as a rule, this diagnostic laparoscopy. This saves time and, if a pathology is detected, immediately begin to provide assistance. Sometimes this happens by means of laparoscopy, which goes from diagnostic to therapeutic, in some cases, laparoscopic intervention is transferred to abdominal surgery. The essence of the actions is similar to those for surgical intervention for trauma: revision, washing the operating area with an aseptic solution to remove pus, blood or other foreign substances (for example, intestinal contents during intestinal perforation), restoring the integrity of organs with subsequent suturing of tissues, if abdominal surgery was performed . With laparoscopic intervention, an incision is not made, so this stage is omitted. The wound is then drained.

This completes the emergency surgical care, the patient is transferred to the surgical intensive care unit, where he stays until his condition stabilizes.

Emergency operations - operations carried out in cases where there is a threat to the life of the animal.

The time for performing emergency operations is from several minutes to 1-2 hours, these include:

• stop bleeding;
• wound treatment;
• suturing of skin and organ defects;
• operations for asphyxia (edema, neoplasm or foreign body of the respiratory tract);
• surgical interventions for extensive purulent inflammatory diseases(phlegmon, osteomyelitis, suppuration of a neoplasm, pyometra, hematometer, etc.);
• urethrostomy;

An operation for obstruction requires special urgency and attention, when every minute matters and therefore the struggle for life is still going on in the ambulance, where they are obliged to put the animal gastric tube and provide decompression internal organs. Therefore, competent actions of the mobile team and proper transportation determine the success of the treatment of these patients.

The most common emergency surgeries involve polytrauma in dogs in a traffic accident and in cats in a fall from a height . They are carried out after or simultaneously with the removal of the animal from shock. In these cases, emergency operations involve:

• stop bleeding;
• wound treatment;
• suturing the defect in case of rupture of the organ ( Bladder, intestines, spleen, liver).

Limb immobilization, repositioning, and other interventions may be delayed until later after the animal has recovered from shock and stabilized.

Traumatological operations occupy an intermediate position between urgent and emergency interventions. In case of hematomas, dislocations, closed fractures and other injuries not complicated by depression of consciousness, it is possible to provide assistance immediately upon admission to the clinic after anti-shock therapy (reposition, immobilization with a plaster cast, blockade), or, by decision of the surgeon, may be delayed for some time.

in Moscow veterinary clinic SanaVet, equipped with endoscopic equipment, belongs to emergency interventions. In cases where the foreign object is located in the pharynx, trachea or in the upper digestive tract, it can be removed using an endoscope, without surgery (regardless of the size of the animal). If endoscopic extraction is not possible, a large abdominal operation is performed - laparotomy, gastrotomy (or enterotomy), or surgical extraction of a foreign body in other ways.

Emergency surgery may be required for conditions life threatening patient. Conventionally, such conditions can be divided into two groups:

arising under the influence external factors or injuries: abdominal trauma with a blunt object with rupture of internal organs, the presence of foreign bodies in the body;

arising under the influence internal factors and complications of diseases: abscesses, phlegmons, appendicitis, peritonitis, etc.

How is emergency surgery performed?

Upon admission of the patient to the Department of Emergency Surgery "Best Clinic", his immediate preparation for surgery begins. The patient immediately undergoes the necessary tests, x-rays or ultrasound to reduce the risks of surgery.

If possible, our specialists try to perform laparoscopic rather than abdominal surgery - mini-punctures in the place where surgical intervention is necessary. All operations are carried out on advanced European and American equipment - for safe surgical intervention with minimal trauma.

For anesthesia, only high-quality drugs are used. The injection is given while still in the ward, so that the patient is not disturbed by the natural fear of the operation. And in the operating room there are monitors to measure the depth of anesthesia.

Rehabilitation

After the operation, the patient is observed in the hospital. The length of stay under supervision depends on the complexity of the operation and the condition of the patient.

In the hospital "Best Clinic" you will be under the round-the-clock supervision of specialists and medical personnel. Each bed has a call button for staff in case you need anything.

Upon discharge, the Best Clinic doctor will give detailed recommendations on the limitations of the recovery period.

The most important thing is to determine that the person needs emergency surgical care. Even if no damage is visible, and the person turns pale, feels worse and loses consciousness, it is urgent to contact a medical institution.

Do not give the patient food and water until examined by a doctor.