Abdominal surgery -commonly deals with a large problems in the abdominal region and digestive tract Where to start? Inflamation Tumors Trauma Morfologie/Fyziologie Oesophagus GERD SpinoCa Atrezia Stomach Ulcus AdenoCa Hiatové hernie Intestine M.Crohn, UC Adeno Ca Divertikls, maldigestion/malabsorption Anus UC, Abscess Adeno/Spino haemorrhoids Biliary tract cholecystitis cholangioCa lithiasis Hepar Hepatitis, abscess Meta, hepatocellular cyst Pankreas pancreatitis AdenoCa p. divisum Spleen abscess Hemalology Delayed rpt Abdominal wall Blunt/sharp/…. Hernia Diagnostics •Anamnesis •Clinical exam •Laboratory methods/tests •Radiodiagnostics (sono, RTG, CT, NMR, PET) •Endoskopic methods •Functional tests (manometry, pH metry…) Therapy •Conservative • •Miniinvasive (endoskopy, angiografy/embolisation, …) • •Invasive (OP) • •Curative X Paliative Esophagus GERD: inflamation…overgrow of cylindric epithelium…Baret´s oesophagus (precancerosis) Esophageal Diverticulum * true (all the wall layers) x spurious (mucosa and submucosa are going through the muscle layer) * tractive (arising due the external traction) x pulsar (arising due the higher intraluminar pressure) * Faryngeal (Zenker´s) x parabronchial (middle) x epifrenic Achalazia: motility disorder…swellowing/passage problems …dilatation Atrezia: embryonal/congenital impassibility Varices: compound with portal hypertrnsion Hernias of diaphragma: slide x paraesofageal, Hiss angle https://upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Esophageal_varices_-_wale.jpg/300px-Esoph ageal_varices_-_wale.jpg Jícen https://upload.wikimedia.org/wikipedia/commons/thumb/8/86/Hiatus_hernia.svg/250px-Hiatus_hernia.svg .png https://www.wikiskripta.eu/images/thumb/3/3d/Divertikly_j%C3%ADcnu.jpg/300px-Divertikly_j%C3%ADcnu. jpg https://www.wikiskripta.eu/images/thumb/a/a9/Jicen_klasifikace.png/800px-Jicen_klasifikace.png Esophageal tumor •Benign: not common • •Malign: mostly in G-E junction • • Spinocelular • AdenoCa • •Symptoms: dysphagia, bleeding •Dg: gastroskopy, biopsy •Th: often paliative (stents) • Stomach •Specific HCl environment •ulcus – mucosal defekt, going to submukosa or deeply •erosion – mucosal defekt limited in mucosa (not through muscularis interna into submukosa). • -Dysbalance is leading to desease/problems - •Agresiv factors – HCl, pepsin, NSA, ethanol, smoking, coffe, spicy food, Helicobacter pylori infection •Protective factors – mucin/phlegm, prostaglandin, secretion HCO3, food - f26-12a_gross_anatomy_o_c.jpeg •Ulcus ventriculi – pain (visceral) in epigastrium after the food (antacidas not leading to decrease the problems) •Food aversion, fullness, heartburn, intermittent vomiting with bile – the patients are hungry from fear •Within elderly patients • •Duodenal ulcus – pain in epigastrium in hungry (often leads to problems in the night/sleeping – „night hungry pain“) •Food ant antacids leading to relief •Typical seasonal incidence for 1–2 weeks in spring and autumn •Within younger patients • Ulcus desease •Diagnostic: endoskopic methods, H. pylori detection • •Therapy: on the first place conservative (H. Pylori eradication, H2 blockers, PP blockers) • •Surgical therapy: today only treating the complications (acute bleeding/perforation, chronic stenosis) Infekce Helicobacter pylori vede k narušení protektivní hlenové bariéry a tím vytváří teren pro vznik ulcerací Ventrical tumors •Benig: polyps •Malign: AdenoCa • •Decreasing incidence in CZ •Dominating in Asia (Japan) • - another dietary usage • •CAVE: often without clinical symtoms for a long time operation_Billroth.jpeg Small intestine •Congenital: Meckel´s diverticulum, malrotation, atrezia, Gasser´s divertikulum (spurious) • •Malabsorbtion: Celiakia •Maldigestion • •M. Crohn (IBD): multiorgan/system desease, mostly in the digestive tract region, first of all as acute appendicitis signs • •Tumos –Benign (polyps) –Malign (not common) –Carcinoid: the tumor outgoing fron the cells of DNES (difuse neuroendocrine system), earlier called APUD-system (amine precursors uptake and decarboxylation system). Relatively rare, but the incidence is increasing Large bowel K85.jpeg •Diverticls - higher risk of inflamation and perforation, bleeding •Colitis ulcerosa (IBD) - chronic desease of bowel mucosa. Disease usually starting in anus and limited into large bowel –CAVE: System desease, the problems could be out of digestive systém •Tumors –Benign (polyps/adenomas) –Familiar polyposis (prekancerosis) –Malign (AdenoCa) • shared_2287_NH-21.jpeg shared_2290_NH-22.jpeg shared_2292_NH-23.jpeg shared_2294_NH-24.jpeg Anus •Atrezia, anal stenosis •Haemorrhoids •Sphincter disorders (↑↓) •Fissura ani •Fistula Absces •Condylomata •Tumors –Benign –Malign (Spino x Adeno) hemorrhoid.jpeg https://www.wikiskripta.eu/images/thumb/0/00/Periprokt.png/200px-Periprokt.png Biliary tract •Atrezia •Stenosis •Inflamation •Lithiasis: without signs in cca 60% of people •Tumors: cholangioCa • •Icterus≠desease=sign 20041104100419.jpeg Liver •Inflamation (ethanol, viruses) • • •Steatosis • • •Cirhosis •Cyst •Parasites •Abscess (imunocompromitation) •Hemangiomas •Malignities –HepatocellularCa –Methastases (often) Pankreas •Disorder of exocrine function •Disorder of endocrine function •Congenital: pankreas divisum •Inflamation –acute chronical •Tumor –Adeno Ca –Endocrine tumors •F.e.: Insulinoma • • – – – – – f20-13at_pancreas_c.jpeg Spleen •Renculisation •Abscesuss •Hematological deseases •Trauma!!! –Delayed rupture •OPSI – overwhelming post-splenectomy infection –typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including Streptococcus pneumoniae. Abdominal Wall •Omphalocoele –/gastroschisis – •Hernias • •Inflamation is rare (phlegmona) •Trauma –Blow x Blunt –Penetrating x Non-… •Right x False/wrong • •Congenital x gained • •External x Intern • •Rare x Common hernia-types-2.png hernia-types.png Inguinal hernia RHB in surgery •Importance: integral part of therapy!!! –Prevention of T-E/dekubits/bronchopneumonia –Restore/preservation of function –Adaptation to changes of status/ability/posibilities • •Curative physiotherapy: –Mobilisation considering to wounds and status after OP – mobilisation with minimal pain – breath rehabilitation Fyzikal fyziotherapy - Increase or reliefe the pain elektroléčba – el. proud způsobuje dráždění svalové tkáně, nervů - využívá se tepelný účinek SS proud – dráždí nerv při ochrnutí - je to proud galvanický (má malou intenzitu) - zvyšuje metabolismus tkání, snižuje otoky, zmírňuje bolest střídavý proud – je faradický (má malou frekvenci) diatermie – k prohřívání tkání, má vysokou frekvenci DD proud (diadinamic) – stejnosměrný proud, zmírňuje bolest UZ – vysokofrekvenční záření, uvolňování srůstů, svalových napětí, snižuje bolest radiation – UV (horské slunce) – zlepšuje prokrvení, tvorba vit D, celkové posílení organismu, kožní onemocnění – lupénka - infračervené záření (solux) – zlepšuje prokrvení, napětí svalového tonu heat – rozšíření cév, lepší prokrvení, zvýšení metabolismu, podpora růstu buněk, uvolňuje svalový spasmus cold – zúžení cév, snížení prokrvení, snižuje matabolismus Wather-therapy – účinek na celý organismus, tepelná, chemická a mechanická složka - sprchy, střiky, otěry, obklady mechanotherapy – přímý tah a tlak, masáž, akupunktura - - -