|
Arabic
Bengali
Chinese
English
French
German
Hebrew
Hindi
Italian
Japanese
Korean
Malay
Polish
Portuguese
Spanish
Turkish
Ukrainian
Vietnamese|
Lecture notes, cheat sheets
Pediatric surgery. Features of the treatment of children with surgical diseases (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 1. Features of the treatment of children with surgical diseases General principles of examination and diagnosis Successful treatment of children with acute surgical diseases primarily depends on timely diagnosis and early implementation of the necessary set of therapeutic measures. The latter includes rational preoperative preparation (the duration and intensity of which depends on the general condition of the child, the presence of concomitant diseases, etc.), as well as targeted postoperative treatment, the nature of which varies significantly depending on the age of the child, the type of disease and the degree of homeostasis disturbance. Equally important is the correct choice of the method of anesthesia and sufficient experience of the surgeon in performing pediatric operations. The complexity of diagnosing many surgical diseases and malformations is mainly associated with the mental immaturity of the child and the functional characteristics of his systems and organs. Patients of early age cannot complain, and anamnestic data have to be obtained from the mother or the attendants of the maternity hospital. This does not always make it possible to navigate the symptoms of the disease and the sequence of their occurrence. Many acute surgical diseases of the newborn should be recognized in the maternity hospital. Early diagnosis depends on the awareness of the obstetrician, pediatrician and radiologist in these matters. The most serious difficulties arise in the diagnosis of malformations of internal organs. General symptoms do not always arouse the alertness of the attendants, since they are too often observed in various physiological conditions and functional disorders. In some cases, differential diagnosis requires relatively long-term observation of the child and the prescription of drug treatment ex juvantibus for therapeutic diseases with similar symptoms. In infants, for the recognition of acute surgical pathology, the correct assessment of changes in the behavior of the child is important. Periodic restlessness, sudden "unreasonable" cry, refusal to eat - everything should be taken into account by the surgeon when examining the patient. General symptoms of the disease (deterioration, high body temperature, vomiting, etc.) in some cases play a lesser role in establishing a diagnosis than "insignificant" objective data. Thorough examination and well-known clinical methods used in pediatrics and general surgery should be combined in the diagnosis of acute diseases in children with various additional examinations, the implementation of which has a number of fundamental features. X-ray examination of the digestive tract in newborns is carried out in an upright position using a non-contrast method. For certain indications, contrasting is carried out with iodized oil or a 20% solution of sergosin. Examination using barium sulfate can cause severe complications (aspiration, blockage of the narrowed intestines). In older children, more complex methods of X-ray examination (retropneumoperitoneum, pneumomediastinography, angiography) should be used. Full x-rays in many cases allow you to clarify or identify the disease. However, the interpretation of the data should be made taking into account age-related anatomical features (physiological enlargement of the thymus gland, various periods of the appearance of ossification nuclei). Special and instrumental research methods (esophagoscopy, bronchoscopy, splenoportography) are widely used in emergency surgery. The choice of the method of surgical treatment, as well as medical tactics, is impossible without taking into account the peculiarities and originality of the further development of the growing body of the child. In acute surgical diseases, the need for surgical treatment is usually dictated by absolute indications. However, in debilitated and premature infants with severe malformations or concomitant diseases, surgical intervention should sometimes be abandoned in favor of less risky conservative methods of treatment (for example, with hematogenous peritonitis, some forms of hernia of the umbilical cord, etc.). Absolute contraindications, which are extremely rare and only in newborns, include only the obvious non-viability of the child, who will not benefit from surgery. It should be noted that due to the rapid development of childhood surgery and the improvement of surgical treatment methods, the scope of absolute contraindications to interventions is steadily narrowing. The final judgment is usually made by the surgeon after appropriate therapeutic measures, consultation with a pediatrician and an anesthesiologist. Preoperative In emergency surgery in the preoperative period, the tasks of non-specific preoperative preparation come to the fore: solving the problem of a "full stomach", improving the function of vital organs and systems, and conducting premedication. The method of premedication depends on the subsequent choice of anesthesia and therefore will be discussed in the appropriate section. The problem of "full stomach" is of no small importance for the prevention of regurgitation and aspiration of gastric contents. Regardless of the time elapsed since the last meal, the emergency patient should be considered a potential aspiration hazard at the time of anesthesia. First of all, this applies to patients with peritonitis of various types of intestinal obstruction and other diseases of the "acute abdomen". Before the start of anesthesia, each child is inserted into the stomach with a probe to suck out gastric contents. Then the probe is removed so that it is not a conductor for subsequent regurgitation. Aspiration can be prevented to some extent by using nitrous oxide with oxygen for induction of anesthesia (2: 1 or 1: 1) in combination with fluorotane or cyclopropane, ketalar. With this anesthesia, the cough reflex is suppressed relatively late, which reduces the risk of gastric contents entering the respiratory tract. At the same time, the child must be given the Trendelenburg position. During tracheal intubation, it is advisable to press the thyroid cartilage towards the spine. With the help of this technique, the exit from the esophagus is reliably blocked, which prevents food masses from entering the trachea. If, despite the measures taken, aspiration still occurs, then it is necessary to immediately intubate the trachea with thorough washing of the tracheobronchial tree with saline sodium chloride solution with antibiotics; if it is ineffective, bronchoscopy is indicated. Measures to improve the function of vital organs and systems depend on the nature of the pathological syndrome that dominates the clinical picture of an acute surgical disease. Most often, preoperative therapy requires intoxication, traumatic shock, and respiratory failure. Special preparation is necessary for newborns and premature babies, in whom physiological borderline conditions during surgery can turn into a pathological process. It should be emphasized that the task of training does not include the complete normalization of the function of the main organs and systems. It is only necessary to "push" the process of recovery, that is, to transfer the pathological state from decompensation to compensation. Authors: Drozdov A.A., Drozdova M.V. >> Forward: Preoperative preparation. Features of preoperative preparation for acute surgical diseases accompanied by intoxication (Preoperative preparation against the background of traumatic shock. Therapy of traumatic shock)
▪ International Auditing Standards. Crib ▪ outpatient pediatrics. Lecture notes ▪ Economics and sociology of labor. Crib
The existence of an entropy rule for quantum entanglement has been proven
09.05.2024 Mini air conditioner Sony Reon Pocket 5
09.05.2024 Energy from space for Starship
08.05.2024
▪ Artificial intelligence will distinguish the original painting from a fake ▪ 128x32-LED with control electronics and VISHAY video interface ▪ Mars was twice covered by oceans ▪ Warming Arctic leads to frosty winter ▪ Jawbone UP electronic bracelet keeps track of your health
▪ site section Electrical work. Article selection ▪ Hero article. Popular expression ▪ How did the formation of centralized states take place in Western Europe? Detailed answer ▪ article Jeweler-fitter. Job description ▪ article In the same line. Focus Secret
Home page | Library | Articles | Website map | Site Reviews
www.diagram.com.ua |
We recommend interesting articles Section 
See other articles Section 
Latest news of science and technology, new electronics:
All languages of this page