SCOALA POSTLICEALA SANITARA ,GRIGORE GHICA VODA” last Dr. ge CF ; Chirurgie generala ANUL II asistenti medicali generalist MODULUL 27 suport de curs curriculum pentru pregatirea asistentilor medicali generalist : probat prin OMEACT Nr. 2713 / 2007 EDITURA Studis WASH 2024 soon SNE necivenrnn BM Adealtura Studs adienter@yahoo.com sewwadicentereu agi os. Stefan cel Mare, nr.5 “Tel /Fax0232-207 754 ‘Deserirea CIP a Bibllotecli Nationale a Rominil (Chirurgie general De Cristian Vices es Sil, 2014 ISBN 978-606-624-620-0 Coperts gi tehnoredactare: ‘Mihaela Postelnicu Preyer il are coprigh ame Tote dep aapa zee snl zara cuprins 1. Orgoizaresfuncponarea seri de cituaio ‘Th. seri dechirurgle 12, peat personal medical dn servic de chile 2 Asepsia gl antisepso Bi pregstren personal mesial entry operatle 22. Insrumentru eras, 2. Infect chirurgie i afc locate Bt Fobeuita 322 Fauna! 323 Harosadents B14. Aces els 215, Hagman! 216. enapetl 327. Oxomielt sats 42, fetta gneraliate 221 Sepleoma 322. Gongrenagaoest 323. Aral 324 Tetanosu 4 Hemorala i hemostara Te Clostcares heroragilrssimptomtologi pacentior 22, Clsifearea hemostazelor 5 lig “54. claicareapaplor 3.2. Simptomatloga 3 watare por "ed. Clasiiearea tumor 62. Caractere de matntate 63, Diagnostica! tumor maine G4. Conduit prlnap de atament1. Traumatioms 7.1 Caueare oumatsmelortoracce 743. Sndroe ntraumatiomele toracice 72, Traumatiemelesodominae 722. Detine sl eaieare 722. Gxaminareatauratiat sbdorinl 72. Sindroome cine 724. ‘atamentultraumtismeorabdominae 8. Ingriives preoperatoribolnaall cur ‘21, Exporteapaasincs 22. Pregtve pick bolnvlorcurcoperator 282 Proghtea ach a bolnviar curse operator 9, Complicate postoperatortimedite Mri. Complatilesparatul respirator 2.2 Complete spratull cardio vasar 8° Compleat part real 3.4. Compbestileabsominalepestopestor 10 Ingres postoperatonie OL Ingres in sexi de terapleintensivt 10.2, Ingen postopertorie generals 103, nares postopeatoiea lap chrrele 11, Apendicta aut TL. Delniges! pur anatomapatologice 112. Serme ganetle 9 oclemapendt cuts 313. Evoute complica 1 Teatomertl spend’ sate 12, Ucerl gastroduodenal “21. cfs lasicare 122, Diagnostics parsctiic 13 Oct intestinal 413.1 Definie i laseare 132. Diagnostic practic 133. vole sleomplean, 14 pancestite act 141. Defies casicare 142 Dlagnest cies porcine aa) bees eeeenl 15, oledita seuts BSL Define care 452 Diagnose cine porcine 182 volley tratment 136, Pertonts aut 161. Define dasifeare 162 Diagrore onic paracinc 17, Hemorage digestive superioae 71. Define geause 172, Diagostedinie paradise 2, Colicte abdominals 81 Coles ilar 183. Cotes intertinat 184. Colca alpngant 1, Heri eventrai, visor “D.L. Hernile~ define compo sratome patolasich 4182 Hermilesemnecinice 5 complatt 193. Tratamentlherior 4194 Eventi factor fovrzay, sere rice, watament 195 evscerapile dete casiicare fat avonean 4196 Gueeratile— seme cneejestamentTTT La aivelul sptaiol se sigue o asstenis mediald completd de specitate,provent uate ecuperare a balay. ‘Actitatencricurals se destyaar ry cael une in sau sect de chirupie din pit, pecu ls vei eabinetlor de speiltate dn poli 11, Serdculde eile Acti crurgiele din spt se destoar tn te mari compartment: Insecta atu strona: 1 india operator oct chirurgie 1 ta camera de gr, unttedeprioreurgente (UPL) unde se primese sini eta og primul at. Camera de gard (UPL) treble 38 asgureo pelvare rapid un examen Completa paentulti ectre medi de gard, acordareaprimul ‘Sortable unt diagnostic prerurt, dexbacarea,Imbriare anspor Insecta de crue. Sayonara tebe <4 aigre conti de czare, vatament sf alimentaye Boinavu este cat salon ch respestres onl nit epi genio santae ‘volts minim de 10-127 de ae pete lecae paint, temperatura de 20-2, dardoseala tebe +8 pert efectaren cust! ur de mal mute oe 2c Tecomandares ca fear sain 33 beneize de tuslet propre. Sci cu pat “tabu ip intram compartment spe destiatblnauor cafe Chirurgie sepie sun compartment aeepe pene restl pantie, pent 2 se et dedlnjarea unor ine space ocul oprator se comune din de operate care treble fie ct mat sproage de seca de chug ic ext anumte eeu care are aces oat personal Hoc operators) pasen cae neces Intervent cha Inverea in locl operator se face noma ip ce a fort schibats pata de spt incetumul de itu camerade itu astra sal de opera) Aid ma ens: oe amicamerd petra stainarea boiler inane de intewerta thir petra arinistrorea preaestze “+ umspator steizator pentru intervene crac {grupo sontre pent pacer + camera de wes, unde bolnoe ext suproveghit de neste pind lasobicres fancier wae Tn apcopierea oul operator se 28 secia de reanimare s eapie intensis,precum s served de tanstuze. Seta AN este situa in vecndates Moc operator 412, Aativtatee neonate medial in seri de chirurale Aeivtates personal maicaldint-an see de chirp ete deosebt decomp, reco constndonte perfect, un nat rad deresponsabiate ‘lemosingstemeinie de spedaltate bution median staionar: 1+ porto efectuarea ve, 1 Tesnetd indcople medicale cu pre (a trotamental press de med 4 erfeb reximal omentr iio bone + minsreazd persona tratamenta + supaveghord noted permanent streo pocentu in fais de fobrenotie ftemperatirs, tenaurea arerai, pau, dren pe {uburle de den asirotl gsr pe sondé dure) + programeard i sopst pacts exporieporocince; 1 freleeasd podusele btopce entry anolaele cuenteicate de ese + prepsterte bolnvu! pent ioterentio chiwpicl6 (borin, splot ee): 1+ easpunde de orang scurbeniain sloane: {urd buna utlaore instrumental vatin gi rutile este mecca n Boca operator ‘+ prineebolanuin sla de opera + prepitestenstromentarl pen interventia char ceed evenly cept ppt cement! pent sig edspunde de curdtonio sai de operate; + raspunde de buna an gestureAut sistent mesial n camera de gad ‘+ realzearaprimul examen pacientl onan medu de god; ord primol autor la nevoie, noteasd pasintal in reais 3 Intccmeste document necesre intern ‘+ rispunde de corectaTuneonare a sport se buna psrace @ ‘+ pregitstistumentara penta strive; ‘+ asigurd materiel necerare intervene medal ogre Ceres M, Munten ¥.— hue perro ata Css Cr de ‘sting, Cluj-Napoca, 1996 . Keutmann A Poteet 9 senogt chuga, EDs Cy Minite i-Popdeic semilgk cned_crwge,tOP Vs, rere! specie ne pen ob ‘sonitare posticeote), EDP, RA-Bucuresti, 1994 ie ‘Aepsia eprint totaltatea miturlor ftcochimice ce au eal de» Implesca eontaminare pligior Waumatice Sau operate cu agent icrolen ‘hoi au patogent Asso ene deo metod prolate, ‘Aatisepsa reprints totalitates misunlor ce au ca col stugeres ermenior presen into plagdtraumatcd sau ehrurgcals ch ajitora agetor fac-chimie Aniepi esto metods erties Prostertnaes const in pregitiea mtvaluts chr in vederes teria aste > "Progra materi moat cbmpur, compres, haat, mou ae ete} seface pr 1. spire cu detergent special nou Indeportreopetelor de Sng puro tesa ‘> sear sortare, verficare, Impatient onumit mod © Invodicerea i costetemetaice specie, seperate pe Sorimens folate, compres, crm ee} > Pregstves isrumentras dips spalre, degresare, se pun in ‘alte saree, lst ete ors pentru cate operate in pane Est mute teh de stetiae > utodavara este osteizare cu vapor de ap supraineia 180°), Ib presune ceseuts (25 atm) imp de 30 de minute. Stel 32 Serle maternal mone seitarea Hndalas 24-48 oe > Strzares prin irbere in aps 100°C timp de 30 de minute. Fentra ficiarea temperature Rerbeese ada atbonat e ods > strzares pin ilar vacate fac a pupil pene instromentate reali la temperatura de 160 np deo od sau prin lamba ting (dez0 mite, > Stertzarea co vapor de forma lear un tetmos inchs ermete pe fundl elrua se pun tablet de formalin a pe tore re gears insrumentaral sondele gi tubule de dren dn cua [o oa, on‘tor {Gos oe. Desai acest mete ste stone ‘Y2p0ri deforma inant pentru ochigimutoase. . ers on adr ie gm ne mete se © serone od de een a te fla pet tees inane tal are en congnent ste ae st pert ine doce Acfioneaz’ doar pe suprafete, fird a avea efect de | fetes 24 Preadies personal mete! pentru operate Pneeseihddiehorertptaetrield pla > Imbracorea halt stenes gutorstaasenten nee a, > Rinse erent ‘Anise de bed sunt © om tac de ko! i concn Se 70%, state peta preter oe pe a at cote pecs pine ab re ghee mee continua s8 se multiplice; ame “+ pe bad de od oo fda su in nuite concent Ete mn foarte bun antiseptic al tegurenteor, cu mare putere de penetrate, Betaine este antseptal prefer In stearea Fegiani operaon + pe box de substante ovidoreducstoore: api oxgenats, Pevmangant de potas cloramins Apa ongerats ese on bun Entei calc, cu efet hemostatic 5 decaoront. Apts pig produce spur cu elect de curare meanica, de asemers ate In pgs omoara bacterle anaerabe.rermangantu de Dota are prope odante, cite, ceea ce face ul a (esinfecares pligloranfractuase, gap vagina ete Clraina insole de 2 are propriett puter bocenade 6 in als) tiny crbfectice, cea ce conferd on org spec de Uz, ‘Stoners clonal in conact cu pla, + pe bass de sustont colorant: albssr de met vena vet fe gemandsunt bone aseplce ctolactce, cu prope [Antiepticeatbumino-predptonts iui de aint de mere acd bo vat de arent se floret sub forma de reloane, cistle su soli ev derse Concentra Ae estuneaetngem caus aniseptcs de tp bacteriostatic Su boctreld, Se uileaes in proline ofalmie: gonocoer Is nuns in ‘atamentl plgiorinfectte cu bacul pace, precum 5 In dvrse afer enmatoiogie, Orkianura de meveur poate Moos fh solu uate pentru ‘esinfcareamucoselor. Ail borieste ecomandat in watare local page infectate cu poceane. 22. (nstamentarl brwaeal Insrumentole Floste in practca chills sunt deo foate mare versa, ne staan et ins o categorie de instrumente uz, foster tice intervene repretetind un minim necesr orice manevre, blgator + eco irene ul poate vor de umtotlectei + instament penta setonreo estar; 1 insteument penta prebenstoneofesstuior+ instrumented hemostot {instrament de exporre coir; + inswumente pent depressor, + Instrumente penn fat eampurie. Clesicsuntfolsite dus pur: sur feck, Betula churle ~ ete fat olen tots hats pean mel (ea, & 3 0 Reese pot th menace mettng a nen ‘esterabie Saude une fons, (Rote ciursicle (ea, ©. + $a av ole dvene forme 31 freien ee 24) sou cre gi fa) boat rare) ac een {eth delunems ere, sdatate protunam unde se baer ana sting» ehtugulu este cea care apc instant fu pense Statomie) sure, orecentodie ele erepte cre secon dea ee surat easel chur pot 6 cu inl sauf:3 dati (Ftp « 5) vor ‘Gets fine de caltats tent apurate, ase tegurertul ee ae ‘mee Pens cv dn care inion upurnd mennees;o mene ne ee Sona, ees 8 en evtnd satel ieparea prt nestig fa ontaminareacimpulu operatorcu cong seen Ira peneaes a, tee benoit cel mal des loste sunt pene de tp esa ce ele eo Feo 2 au rare ite ded, dr ees Alon ~ entice dr mat ang Overhold—lung cube, folste la foarte sunye, Alison =i re i hae ac ens siidia te eae ima ee ec See ae touls Faure), inventor ti, ea et sree che: heed oes neselamesatc tenses pt act Dons pense rg daeton a . B~ J "ig. Pensehemosttc tp Pean 4. isirumente de explore sdocere Dire acstea fa pare sonds cael ste butontflse pent mlrrea de tice cm af ale Tatoue. Pina ve none Beriittea de vecyonae a valet expat cu concurs ace fe ‘de aleraformayun anatomic meena Same pet dein tor De mule or explored in prafunine a une! pli occidentale sau Seite necvts ante samen cre 3 sper ena nena eeicats Sementelerpolnde Aceste instumerte pot fe deal ee mobiles auovatce ele mol flo istumente mobile sunt depose tip Farabeut {63} care conta in doud late metals Indo anh a a ace {poate ere de lrg ulate si ntipste dn nico teh chines Skill ee web epinat al nt sb eee ren etes feng SEL wind ete. sceste insrumente se ponies fo mesic Sy ‘manual it Fia3tearoaredprarbest Fg AModul defo ecarreo ter brine oe ng eae te tet ute Hebe ear opp ae tenn anh dua oper emalind neces cts en een robton ale st adapts, po verse dimers a ist oe ‘sl manevrat acul in re ae se Cpr Sut grea ite de tip pensé, dar cu 0 soliditate @ rms sfient de mare pert» ena sucea 30 separa aca in Umpal rider sunt do mare pant 3 imaneviei Fe == — eqecee Fe instrumented sur. Portage place ascremate anc aue it le dep Mathieu decree ay ana unt oat sire end accra de dove ese solo cotinusea apis deste bose posniee ces nae rie de arene bate sare wt also ite porte de tip Doyen. Hest iensun, adaptate patil care se hres, lterventile choral, se fica a el ogwre, oe tt in ‘nstrumente de tip", pentrua delimita exact zona cperserie hia act or oper i instante “ ezeniate repress dan tens ta vartten clr fosteln gnc eit costein gveralin chp ind mat oe ibogatie Aralescu M —Tott de potoonie chu, Edad Bucur 5 Glemere Tata deca de ent an rior, 2008 2 Grogs 5.0, titescuD.~ Sr pinche, eho iacy ease fi Seoeticu 1, Nemes Chane genera, EDP lnfcile chirp sunt le dus tlpur: locales genelate, 3. nfetilolocatiate infect lcaate sun infec potnicrbien, care se wats de regu rin inca soca deena chiral abl cll localize curing: 4} smnele cosine (5 rgeat ror cdr ool clr, umefectle (tamer), durere (door), imporents funciona, b) seme generate de nec: ford isan, aterare progres a st! generle, adenopote in repinea infec 3.11. lia eae once folios piles > se des in rome cup (ap, pubis ax: presnt cele cin seme cli celsne; 2 Shpet lie mcs pustulecotrate de un de pr cuhalowetematos| ies > rate cont in etracti fil dep, aseptzarea zon, eracares pr, alngerea cu colorant sav aplicres de antbioie, Farincall este un proces ines produs de statloceeu! cre se locales liv garglonlu sabocsie» ntl foul ples. are un earacer ureulozo este rent sparjel mal mutorfyrnaue, eaurte de “ond price: sederea unl gar infec sstemic c stafiloco, gens tegumentard defects ‘Coratrintc acest proces ete fptlc talocoeul produce toxne care determing apa erunornesutc lalate gl denvetarea nor vero ‘Simptometologia const in ee acl sere eine plus semne generale deeb son, ateraren tr generate: Comptes: nfongt odeno-eamen, evap osteomilt,septcemie.‘ratament: > media, pie8 ta formaresburbon ote, marae ig Fmares berbiond eu antitce,printe ele > chiral es ince ev Semin aes HOSE pur, cu erties Zone © Inflamatic sets stafococes france, 2 deol un proves Infaator ites cu necrovs ular tedden’ one predecte sunt: rae aon nerscapulas > par; {Reet alent cy mutate set (abet neonan,caecy RSE fine telat rosevolacs, fare deca eens 2 ince agin ce Juanes © ovaj eu antiseptic, © esol pent dren 343. Hiosadenita osdenta este 0 tandeosuorpae a9 ‘dora Cancer simone cc seme celee; pt oes a pesca ples in aul sau o pend pecans, HSS etsoae cre se samen iil contac coe xeptioey one 314 Abcesl cols comarca parent e spect ait a sil iro 2" top pvnderes tegunene cr > 2 cogent mised > occ nx po cpt tomar een o- Satin, nut mantra noges © Stat med trmat nes copes opi cx cpiore discs fost Oe cout 3 destnyze ct mai mut cin ecle act staflococes oeliats a veal Sm caer nani, reprezentind un abs a stapenn cvoscuanzae fone © Statextem care reprezinao balers este snitase SHloulunde se dents infec, cv aspect ert > continu cava neoformate este purulent _imptoraologie: cele cin sane clene pus semoele generale: > porocine leveoctors, crest VSH, examen bacterin puroise face pets tbiiresgerenelr incriminate > atamental este dieu rin ncaa obec, evacvarea puri, debidarea cava, av) abundent cu Slut anseptce esa) ‘hub rol -hemosatis de rer 3.45. Hleamonut Fegmonul eo infamatio sats + etl cra sbctanat ‘orate de prune ease Caractes > elope sels el racer rpocoet > pose ores ee poe erro exo ih Inept, inp de cee, Apr dips ines imu ind Iserogmarepdedeepeeioieriy > onpectontomo-ptsloi se desir tel sad veut: Sad de dn pile douse dee, riper, ‘rede eter ne cet semne cles + Dips ie opar mi) owt pos neat Sabet tending econo: + Dupis-bae spoilers cot se Sessa oping more cote pl cu prt > sinoromatioe: semode generale sunt oblgstot, local pare 9 {mehr irs urerosh. Uterir apr Wee in cores cargo serosa bran prio > Compleat tej generate Vaptceml sepicopaen te); > totementl vtech pi ni erg cx erecaen poi 5 ‘eptznrencovt, mer cl hemosany dreng nat grave ‘Steines anata. 346 felt rape este o bois nfecioush tegumental prods de sveptocn betahemoltes Caracerisic > cline: cele cn semne edlsene, placard de dermis eu tenants de tiparsione cre ete nsf de fenomene generale de ip sete Hab, ‘ron, aterarea sti general), 18porta de inrove est tegument; > simpromctologe:pevoods de neta ese seu 4613 He, debt fu febrd mare de 28-40%, alterarea stil gonerie einer 2ngonior reglorall unde va apirea placard, apart parade itpeod cu marin eae, nt contrat, de eloare ove nonce, tersiune local dueroasd. Placard are o eve cones, cone ut deverind mal pld | mai putin nein entnderes lace até dee”. Cle mal fetta reghnisunfges momma > comphcaile pot cle gangrena tegument stete,Regmeane) Si nenerle setceml platrecie purulent ety > wotomentu pansamente leale cu sola antsepie (eano, ‘toramini) sehimbate de mai multe ope pening nec 347 Ostomittaccuts steomieita aut este onilamatie ou prods de agent microbe! Septicemia est 0 eap vet unl nec bacerene lace are secarecefieas in rerenfe german mobo song; ae > eng nu ocr Soe a egret e 9 desi evan tig, sepia cto > posbtote exstrt anor mettre se sem 2 presenta anor manfetr generale grave Ue ewe ep cotnatte > Sola rnd cu martlate more ‘septicemia cunoasteo mare dverstat eto, stl Groin! feu exci und traumatam exter {Ieee Coes brovernd dino inleceendogendcind agent miseian oe oshi octviemia este caractoriaté de prezenkatecitoue 2 german: In ‘este provenit pe ale hematopend Carteret sing, Ea poate oma expres dic su 8 fe cl mut asia ou eb pare deobc! a tine pins a vteta de 20 2 boars de intrare este In pci fracture dar ifctite oatzate ip inate os lemon, carbunea) > tape de evolu: © UU, cnd Semel nce de intamatie fect predomind {abl cin: se produc miroabeese pe fou mtrné scorers rare de deze pros de pe os © ernie proces infetios mi mot oe manfestén vente infecio se poate cantono in interval ost or aoe Pevioadd de tna e0 se pate reacting, > simplomsolpe: ele en! ere celene, feb mat, ison, Serine sindromt feb (ahr, apa, pu oelan sidenopatie in epunes veins 2 puadine:iperteucoctod SH crescthemoculur est pervs > tamentul const in: adinistare de antlete, renee Imobizaespsts, evecare cect subparts 20 a vpr, darn evr cgnrs ce than exer poste pred Septcea, rigs sree Hoan se ‘Sltsome elie, presi reac Sertcpoenia ew oo acest sec ceo ote rod, metastaole sopie dela tant transforms in afc de feptics a germenrin elaa genera Simptomatlogie(emnecincel oe Fee bre cu fo mare (20-41) osclond, nereouat, fr ‘hteroea sti generale ——— Sart ni ements fon emt pee eam 5 opario. tltrdrior "cardio woscalre: ohcore rte tendogS io colps celta : > por tub resreori ea teipnee,preumon ‘Ser sue uence bes hepatic sain sl. prin metastoze In iat apar sete cnc ale you oscoseptic esha namic gue, tlburn neropsice,Diagnostica paracinc. Expl parece pot nae: » Teucostort eu neve orem hemody care degrade is > iburs hoetectrotie eu eaters de Nowe, > ecieré metabolic, ante, > restereo Val 2 1509.9 TO, > wocuturs posting, fecolares bene ef ntl kon 3 de eg et douse determina De obit hearse este Soles Teta te conse: actrees ly de st sips uae cr spt, ones rls wegen ‘singe, nutritie parenterals bogats, imunoterapie. “ Profil spcenior se fce prin depts preoce 41 watamen -corect al focarelor 51 al plagilor infectate. : : “ 322. Ganarenagozoesé SSongrena goroosé repress © infect cu germeni anaerobi, care determin ogangrentestensiv a esutuni, cu produetea de based oercrone a fv rove, ce evohisd spre dc In Ips Unt tapi pane 9 Semen re pra rea uo sit ane sch tnt se spor in pit orgie telus), ar ct mal fecen tone cnc serine ell enemas iri! See, tc pi Produ toxne cue, ceeace expe evolia rap a ysl tone seme ni a Condi oa sag cont neste eoae lat dtc nas rca ste mana ese ‘sel ge mane wep, ei are se ee gt 1 uprated deport dup acu oeece nem 8 Simptomotologie: debut apare dup 223 ale de la acient 5) se ‘manifests prin edematiere plagh eontize cu seneoia de tension e nnesy ansamentul, parfum mos et, serete a pap de elewe bran merce, 2 tegumente luoase, pale, clanotee, re, marmorste;starea genera se ‘ered co eb ison aii, pee tabiarde, pul rai ier, Parainie se intneste:hiperieecctord; hemoconcentave; retenbe svat are cept urea erential este iin in seshmentu wnat pot Spires lbuminure, hermalabinura. In pin fson a6 sa face hemcaltir, Tecoltare rerio: ptaloge da plagd este obligate Tetamentl ete local deur gener: 2} Tratamentul curio) mete seschiderea lags 2 foc infec pnt» desta conde de anarbior. Cine genera tote ens este necesirs ecrctamia sou armputaia, Plaga v9 ‘pit op ongenat ea beading pv fens org desc > Trotamental general eupinde:atarea sti de 30% toieo-septi rin chilorarea ldosecrlties, hematologi $§ metabol cxgeno” ‘eral hperbar;seroterapleangangrenoas; antbiteapie—dntre stb ene ma des tat sunt panna clramfeniot 323. Anton Antronl ete 0 infect cxbunoas,e9 apicnd sb forma cxbunes tana (98%), Carbuncle cutana survine debe: a inbtndvie profesional a ‘ev care au manipula carne seu es proveit de animale bolnave acl anraoi e deals anlar se manifesta plt-o ust ag, uid sau mali, nls, ora central Find deculore nag 3 Shaul marginal cu vena, un edem important, nedurtes, de clare a} 3) consistent gelatinoas Dlognostiul se pune prin cut pe medi ural gears sip sou sation s hema TrtarmentlSopunde avorabiliadinstrares de PeicinaG tin de 7 2 Tetanora este 0 Boal nfecioast acutddeterminatd de bec tetanie care patunde In organism pritro solupe de continatate tegumentard sau rucob ontaminate cu pam acl ul ingerb > conde betes abomow nivel anterior a hemoglbie! (A) sl hematocrit (0 © sngeare de mich Inensate my are epecusiun|. portant teroragie me 3 gave sunt rete al de tubura npertes Taeg crs, pact acid: ate mac, ame, peti a tress Groat tbh se ore ces ste Ge ate atte ao lipsei de oxigen a crelerulu, os Se comnts nore scent einen 9 mint anh tn ppns,nrtennen arlene eet ree Inde ern, rer neat mic tga), tnte setae Td Schaesogwstclete tab oar orem ore 42. Gosficreohemostzelor Hemastana epresint opts spontnd sau terapete a hemaragi Vmostar sports ena in moa op se ogo czas ‘che pata mal peu vse We! eae, ee, ae) Fae aces cre lo nhold vad lett se prods 0 ‘aromatic > Foun endteto-vombacar incre bsnl enttl veer teat se elreaa omboate cre vr cit 3 Ini bes cn verte erm hog por ren op tern een de fibrina ce conduce la un chiag definitiv i reparare endoteliala; : Faun de couple propa Cd pi van Ge sng lesa coh Corto sngola rd errr ssp eres normal emostars rapt chirps) poate provzoie sau defini2) ems provi conse manera de rans Ba 9 ver araare hemor Moda de ealiares aes: Saree poeta junc de nga" ald vos ra, pen plan oss ( Y2meO", comres em restart densiro vu deeb oni sae (8 90 sar coce prove cures, cevet) etn a 15-30 saucy mises be sot cteve minute pen 0 pete terri. Nu a8 ep pe aut moi mar ove Cr se cd ric de pared sul de degoreore sy wont dete etn pi cto arena ee etn, ome sie: 7 ect eae eto capes. te oe et ethene pa ag ee re i so cove mo i care tempore pte cv abe ongea cre Serer ipa ore : nt eclectic erat > ta es pen eee 3 a esr ol ea 2 rales eg crs rape sae bur Dt sere deca 1 ne a et te 0 ei ease seein corn oe singe : toe chi EO Bet 195; 2 Pie prope capicoelit |W, EéMedah ucurest oar coruaie geneatvo, £8 Anatloni t 229% : a att de eniurie procic, voll # 1h EAM cies 1982 Ea Imecans, chime, temic, oti tegumentelor sau emucaseor. gle reprint lenun traumatic produse de factor evolope! avers ‘lectic) se caracterzeas pin Toreruperea 54. stares dar elem recent pur de pie nite in practic se pot dass: 1. Dap oséncine: 9) lll supertle-ineresens oar tegument: 1) lla artunde~ ineresear statue subaponewotce, 8 pot fi epenctonte — oy inereseass inraea rato |< genetiante — se pitrunde inal caate anatomics {sominals,toraea), Pape pentrante pat tarde ale ato ovgane sme) * elesarea ator organe (perforate) in ats covtate ‘upd tpl scars de la agresune pn le prezentorea la med: 2" ai acane~pacenl Set in pine 58 pot 1) ida compiatesupranfetate, Se sutwear petsecunds upd fctoal elon mecanic core a determint pogo: 2) dpi tote sunt sccentale si chirurgie. Pagle tie, ‘acadentale produse de un corp ties (lam, sabie,Baionets, rich, fob desta) au margin regulate, Tor estrugere tlre sunt Tmitate, de sees se vines repede. Plaga chirp ind 3 vent ined septic neste infect ) eld inteoate sunt produse de inset, agent contendent saat eae me a deen et) 29 eae ert In Tone de anime 9 supraineci. Dat inept fest adc psa de ongen ereszd ond pent apriia une Infect grave canoer »«ba cntze v8 eraeens cn fap A nee a conten ess sacl, detail Pt ct overeat angers E2035 4 hie act ur proven dais om. Pie pen aot pl ot ise In EN san 8H es rtres (muvee de ine, ph eh vr ea er henarapel ue de gba, HA (rugesura de om cy etLimoacte se de 0 ot 1 nie tae eect opus To ges sa Bears chun oo era ald et 06 eS {cn aera lrg. echt car fete Smt Set si fete neces tone NB: 4) Patou ote cae ecules Bes Loe am site ove co aune ano roe iat produe de animate banave = a, 1 Aste Get ut ences (are, wes, ea veri Sant cous categart tie, seve Ne! eee mute ain, ce ap Se act nu mse ote pit eet Cl MNS uses ears Tiers cr pags wet set eo ewan soap, sale suds cl 8 1 SP ae subs ePgous vein, marten 0 aay are) er atta een vernal nose iene 52. simatomatolnia sitter ior rotuceren eet ag st ait des re, moons We, ina i ey nda 20 Wamerie Mee, , (et auto cpa vost re ancora 22 nse Seeseatizae) feb 9 son Vindecarea pg se fce intel tape: 2) Sead earacterat pi elmaares suture Se actin tor dstrse sub aces 1b) Sail cuprinde totttates transfo a former care due Is apactia Stil euprindsrfocerea tegument St ud eee tegen, oe cae are de Contaminares pigs produce odat ca aie, dar infects proprusss incepe ly 68 ore se devs In 24 re. Devoe eNsteanebeneerscnosnisamc: nn Tratomentl lige ste general or. ratamentl genera cprnde: trtarea Soc cd ent, combateea tree igoclmin sau opiace, profit anietanics. omen ind roe ay hemo ate eh SBetcoenndscammeceperseaes arate very in sur ll eer au fs ena ldgile vec yprainfectote, ca si in cele impuscate, sutura primard e wth, dec pop ese braid me sae ma > plone muzote, dup oot prime Plt ie ane ere at i bo sibograie 1 2 RadulescsP. ~ Clemente de pool st ie oe 9 trope cruel, EDP azesu¥. Chiturgle general, generals, ERs, 2008; Sivu V.-Urgenechrurgialeobdominole, 8 Metdcals Bucres, 1999,tumor care insu Cavintl tumors, est deriva din tines nit 62, ascoee tumor: 1 bagel vo distin i ree relive de coud ptear capactten ernment ee en S SE eee aa, rh ae sn Se sare dele, jun enters sea cer astra aE 8 > ere o § te clo 3 de ra opp pers crcestice cabe e rover mre ae apc, le tunct, St isan (mea heparan eh ore Sie teria 5 eet mater meta ere 5 onmatgn ab ere: 7 aes aie erent rest le functie de osu de ups efter stg erent se foce In cic reine repel cena ys pies umerenietle vere 2 naiee. 2 stp 2 lamer nie maser # gnu co se cou 2) Tumor ene: sey in eptie gator (okion, mame 55 te edt eps OPE et en mucone, nu spa ote wpe tala soe ra ase anh in ents panei 9 tans 2 san eg ur rg ce mle by Tumorie mare: 2 adenocaringame se deat In epitelile slandlae (ganda ‘amar, rid stomae, ion ree, pancreas, arboele bong) ‘cnoame se devo in ees pavimentos a tegument 2, Tumori ole teat coniuti 0) Tor beng: {3 018, poate ajnge I mersun: importante 202m amet), fonsistenta este dts poms este locatats cal msi fecvent in feutal cer ssbeitant bine deltas extrpdcheurp fr felt fondromul se deol In esta cartaghos, se inaineste rat Bles Ia oasele mic fale, metacrpene), consistent is, produce adeseaderegl unconae ‘bstzmul se ompune din es oss compact sou spon. 0) Tamer maligne (seecar: ‘Hbosarcomuloturord maligna esuta conju proprivas Iiosacamu otumora malas afesutll2aipos ‘indarerau provert nest crtlaginos ‘se0saromul proven in fesutl sos. Din dervatele mezenchimale ae esutulconunci, pot hi mater © mare vaeat de uma benigne # magne ‘+ in ests mosculrnete:eomsom (beni letomiasarom (malign fn test sel stat: rabdorom (bsign) 3 rebtonicereom (aban 1nyesut asculrongiom (Onin angioserom(motign: in fesutl mezotel exon benign) mezotelasarom (malig 3. Tum test ners: @) Tumor! berigne: glam, enendmomd, meningomd, ingatoml, seuretrom ») Tumori maione:qlblstiom, merinsobasvom,_neurcbssom — sunt rela ma ae se devo cu predece sistermul newos simp 4 Tumor test iment: 9) Tumor berigre eval pimentae 6) rumor magne: melanaml malign ~ vou din neopasmele cele mal saresve,cu vote apa grave putere demetanacaretame embinae un on aco stare sarang i ame en ey se foment dn Sera dba 9 era. aia tston,deexerpunetrobeton, hepato 62, cometere de motte atin mates prove deo chi norma ea itt asa Foca ae aps wanseare aan cle ores ey oe nets rire cnet ee 9 mai, Se eee mere coor coun eat onan reel unordered de, 28 cream te sneer po lint ad masters a mabe Coe ye au nieve, obo strat staid See dedtaee ca svi pita rater) a. ste ri 2 er aes ve mare on 2 ie) copactates eo epi opre econ. Mejia ONE? saelap dete capris 2100276 5 uu ete else Init, fd one denote 1 em se ort ie reteset Saarec epee rear insond ne molt far de ore ne tg, cul ra re dent 3 fre a gears mare ymetotnce (ove mars ert, ome) 52 wee apr MC hopin: oa Jaina ev dn so erin laston ae 2 ear, andes tere meas ale de metatarre: cn grec a ctr mafane pn mire Im sate wéecent tumor din opreape in Bron : ama tga, gra! tnt gone care smi un it fetes eter umole: peal vaselord (venoasil <) rentere raumena (bul gest in, impor © Pa ese pertons) 501 culms NFB ) bse che ret n goer cosine metre ‘Glenn socaomee pe oe hematgend — 63. loanosti/ umes maliane 0 cle mt i mite oi evi neoplsmullrimine netomat vont teas emp’ ures ngs tesa a wr 8 psa (Gama ci penton eae i rete Santa noma oarnncra pune deve te gemra, ind 0 tumors malig se epi Sinotonatloge, proces naps at als de el mal teint ts sa eee inh Pan anna SSpumatrre peece cid nate cre pote cndee ele fore ince oe Deptt orca pin metode de reeig”n 0p dc hot se see pen ngostres once te canter San neoplaul de rsa eaplamul ron plmonar Sinptomele generale sunt respeciice 3 evluezS ins 7 nena in mod deosbi le unt ' "mele fa presenta n principal de stnie fl ale, se pftel de ménar une sl cm chs er sles pens cre, pn a 73h) Sor aterorentcer ys ome sire ponder importer. Sra pope seo at sion mse Dine eae mal "Tee mere a tom ri mm, nto cco oe de wid edo pevferc dors, dee ‘estmatiform) datorat tumoriior carcinoide; : a Apeateni eet cre tepid n hace Selec etal doe ete Imarfestcutonte la dstant de tumors, dotrote unr secre de {ubsont homenae cate produc erp egumentre man sielt lcle wake Snore mane int vat, ie slorttescazinior sunt trave, spar lor widend o extents 0 lntareneoplaric loco elon areca, aceseo pot fo expreie ain males * cree nennaase fa nerioe aiacen! sand ca eect durere, purest pareze, pra nel come in re sa ace woe # ott ean canara erent adn mart gr Mest te. semne pot fh singerarea 3 suprainfectarea lexlunt maligne. Morte ential gests roid pn meld su Hera ote retical neo ee sae eemaraope aic oedorinat de gees meat eon putes un cnet aie; taste Bi are ara heptoneyie Gr, nar, snr Hee 1 ea cer in consledgesie: scka (rane a eh supp, matte pee poste ape net Semester In stbies agnostic, de importants capitals sunt explore paroinice s aaiale e loberatr:Remoglobna complet, anazele ochince ca imal de win, rasegrafa pulmonar. Pent sebiies tad seria neopleiml se pracies o serie de explo species cum a Haan ay ipo su bron compietts cu prelevare de mater! Bop eae comcta sbiominal, omega computeriat, RMN, sciigaa oes stables agnostic fstooge de matte este obligatory nantes Incepeni rcpt mieancerose ecohores matrahiol ce umensd » fl sup evamendti en numa cao kingpin cre spo me ere am for} sou nla ce prelvez9 un frogment tamara! eee angio extemporoee ce presupune expres tad amen ormat eesarinreMstopeobo0e3 26 64 Conduit feotoment “eatamental boli cancroase este complx 9 trebuleindviuaat in fungle de lorlzares process malign, gradu de exthdere, forma clinics ‘rational Bolo bona, Stables precoce @ diagnoses de neoplasm consttule © conic send pent sens terpresPentty stables statepe) complexe de treument oe vo ne seoma desta evolu al neopasmulul exrimat pen Sstemul de staiouare TUM, cps tpl stooge a ecuni maligne Stooarea TM. a canceetor ain considerate tre paramet "eerie tr naar Tiers or at > Stren ganglion nti nteresai sau nu prin diserninar 5 Presents evenesisameacazelor Mla tani in tatamental neoplasm 26 utllessS 0 gamd larg de mile terapeutce chr, rads chinioteapi, honmonoterapia timunaterepi inte acest, sngutle care au elect de aseitate sunt intervene chrurpele slorocedule de vader, 1. In ghiuriaconcereor, trebles se urméreosc ndeportareo in tototore@ Tectniprimare cu exces, Impreun cu anil gongfonare lcoreqionale ‘acest ers se pote foe ia Jase ngpnte de evolu. I azcleovorste, interven ehrrgels ore door un Scop pleat pentru depdsreo unor Comat evalu (emorogi, cu, puri dure intense. 2. faiterania are co obiect sterizere aneolgid 0 tumor primar $1 0 xtnderlore1 resionole. Radoteopio se floseste deseo In osocre cu Irotomentul euro, rezltnd 6 rat eescutd oe vndecoe a concer locate De asemene, advo cpg tren a apart cu chug insole covnsate 91. 3, Ghiniotergiacosgd tere in wotomeotsantineopec, flsind in preznt Dotru rune dectestatce agent olden antmetatoy alesis in Vine 3 fnibionce). Tatomenta! eu castle mu re intent de radieatate oncologic, ef ete 0 sole terpeutes ejuront, eset tratamentu hiargel peor. in. sade ovomsote ale bol. ste de. preferat a”polchimicterapa, edict uitaea unar combina de cate, deoorece 6! se pot uize doze mal mid care reduc ase cul de each eaves 51 foreloraed rerutotle terapeuice. Aeest totment se efctulad in cure Intsrmtente suum contol ert medic deorce pot produce aemi, fewcopenie Homanoteragia se plc nur fone de neoplosm fmamor prostate) de bers n concer de nce produce o inhi ovarian prin adminstrare de Tamouifen,ovorectone bietras #0) sterare pin racereovarand lor it ance de promot flere terapi estrogen ahr harmon ‘androgen Hormonotrapa este seo 0 metodo complement, fd ite erodieatate, muncterala este 0 metods poles de trotoment, adrsat8 connor ‘srorste, cv metstce precnte minoteapia act contd in floien de Soecrun preporate an struct! ontigenice roveite sin celle neolaie Imunoterapi posi focsste srl antitumor interferon! sou enrcte de infact sensual lmanoterapa especies se areaz0 pe stmulreo "steal de mnt of orgonemul Bibgraio AL Angelescu , ~ Tatar de ptoople chiuriol,Ed.edeatsBucurest, 200%; 2. Calogherac~ Tota decheurgle de urged £4 ANT Tiara, 2008 2. Constantin, Try C= Cond line ehruricol, Ea Madea Bociest, 28 71, Teaumatiemetoracce 74.3. asitcorea toumatimeostoroce Taurasmele toraee repeeint lei! Ia boul cute toracee #3 ‘serlor minterorlacestel, cauzate dun agent raumatc ‘i cunoscne varantee posible de etn’ anatomice, mecansmelepatogeice # tubule lopatloge De aeeain waumatsmde trace sunt rel case 1 coscareaanatomiet: 1) Traumatmel racic areal, pot {leo oxoore rotor costo, ocr {idles osase echimore, xcoray, hemetoor). ) raumatismulatragmati poate ‘cu perfrorea dofogmel {foe perororea droge. 6) Taumatmul ues endotracce ‘i lestun de peur, pulmonar, Waheobronse, cardiac sou pericordce: ein ole woselr ma (oe era cova ‘eb ol nerlor intercon imtrorroce 1 Coscareeetio-potogeie, et oa mai flo, Ease face nuncio eintegtate tegument ast: 4) Traumatiome ore inh conus) 3) Traumatsme trace deschise (pl), care pot Wprovocate prin Dri abl su defo, avind ca ena laga tora, cae poate f epenetont, ind nu interesaaa8 pleura ou pitrunde ta ‘otates pleural Denetant, cind iterzearh pleura lar agentul vuneant patrandeincotate pleura are pot 1 Ford lesion sere (cord pia, vase mol1, esieareefopatoogiedimpateraumstemele oracc 2} Traumatsme foe medtiese patalopcs fear SU venta, 1b) Traumatime ex tube teopsttegice insufients caro ‘heulston,nsicen respirator). 742, Testamentultoumatismelr trace Tratamentl traumatismelor trace exten faci tpl ein ate 4) Faz primar de aetane (pl tr), const din conta Hemera: Imoozarea actrh cu volt costal; controll respratie 2 revere Cardace,stonerea sctlentt in focar cu. maturi de protec 8 Coloans vertebrae; enigenoteranie transport op a spl proora ‘ea privet site rena bola ‘eldematul va mentnut si ap transport pe o supra ii ar obizares seve face cu maim precutie penta se ela lexaea vrtebta ‘eciars In camera de gard (UPU) se conolezd liberate ei respatat 9 se liad miele respatorsceula singe evo insta n etter veo ena pentru a rdsu presume ves cenal (PVC) se isi ated \dereecibrareeoseevoliis se determin gps 5 Rh ul sani 6) Faas secundord de acne fiiraspitalese) se realest anamners paler refetoare la modaltsea de producere a vaumatsmu $ fare fst agentul vlnerabi se efctuis8 EKG wi adiograin eros 3 copra, sest examine umiriod evalureafecuror cesta, lesunlor puimonace caraace 743. Sinroame ce po separ in treumetismele torcce Din pane de vedere clin pacentul este in apnee cu sete intense er {ste aipree. Co milo de prim ter: se ebereazo cle respeton supericare {cu um deet ifort cv 0 ompress secu cavtateo bul aeforingiand: > Gocd mares bine, 5 face inte oo ral: > oct nu este posit inebapa oral e oped rcatreidtomva, kare ‘ete 9° mone 36 dette 2 rere soe 2 Preumotoroau ‘pare pint seumulare de 2erineavitaten pleas. Pesiunea creat in spayul pleural va. conduce la calabores ulmonuhi, sncres.sbuctunlor eds On pel ener ce) chee tact vero 3 ela faren x punetrn ens mir ve, hipsters, jute Tatamenal const > itraducerea anu acorn peur pet decom > iiracere unu th de arene} pera care acetal eapt vo f pus Inga flaon evap, pdr mallee ar pe ub 2 situa ene prin core o fost todas tb 2, Yoletltacicot Exe relat 9 rl de dou const consecie ne pa ‘dous locuri diferite " Cin por tub etl de mperepnonar care auc rex Nooventae aber umats Se Rene i prope, ae ane > stbiiores volta cost! eu beni de Seucoplst sou cial x {atoare extern sau oxteosinend eine soy bog ub, > intaboyi oreraeald pen gira espinata i vlete costle mar 44 ‘Hemetorax masy cate contin aeymulore singe in cavatea pwr Din puncte vedere cn se manifest rin: oc hemoragi (hipotensune, ‘ahi, plore, anspai ree iacena espiratne, matte pulmonar lo percutle; sents murmurula Vesicular; opacfere a hemtorech redlogtate “Terapeute se impune tracocenteza petra vacvarea hemor pin ince costal sou peurestoms Dees sSngraea nu se ops este ecesrd emostata chiral pin teacatomie a5. Contin pulmoners Se coracersaath prin zdrobiea una segment sa lob pulmonar de uta tora stl net rerpetve ve pulrtonar8 nu se mal mpl cae, rmdnnd © agnostic se stable prin absents murmur vexicuar 5 radiologic prin gon de matte PF inastes mesa cu mist mole; > ntaore aroranea® 2 vena cu presune usr rescut 6 tutu testo oe loc cnd st ep coats Sorte be cnt ae ‘emfizernul subcutanat extensive in regiunea cervicald: i terocc tle pr pnd nears cre dese mi ab pele pen © eae ble de ga Spoor eronona > Miko see nal bret roe oe. 7. Rupture doframatica pote fimare sau mich fin ropurl mart agare neuen tespratorie acutd decarece fiaroema pati Ta espa; potestune: henereaunor forge dn eoitatea abdominal In cvtatea tori rata Ia petet; gemate Monee In force dminuarea murmur evar 1b) Iruptr mielwatamentul este conservator. “Tatamentl jn rupture mar const in: son naz eas laparotomy pleurotomie mii store ciara datragre 72, Youn inal 721. Define siclasicre “raumatisle abdominal repens esi ale scerlor abdominal au te pereiorbdomina produ de agent traumatic. “Trauma abominale ot 23) conta, end tegumental inact; 1) pli ci tegument st up. lige pot fi epenetrant, ind nu pltund in catatespsitoneas, = _penetrone ind agent valnerabl a pans n eats peste heertea po Faro esa cere; ex ecunl vscerale, nd sont interesate_organe Darenchimatosse rin sdrobre pe un pln duce au oreone {utare prin emplone sau prin suger Page pot frproduse de grme abe sau de protect als armel de foc Pape produse de arme ae se carateraea prin sc reltve reuate ale tesututlor,apar de regu in ura unor luc din fa, sunt plasate pe partes Stingh a corpulu sunt ecvent situate In partea supercars 4 abdorenul, Pligle produse de proicte sunt malt mai complee, lene produse tnt Dlraerale sunt eater 722. txominoea woumotzatil’ abdominal [xaminarea dnc 9 bolnes waumatizat abdominal are urmétoorele > investigoi onoa func vole aus, epi 7A) > serelueozd anarnera complet a pacientl asyro modal de producers oordent sa apental traumatic, > Se face nspecio abdomen echimoce escrel soy lig oporeaabdomenuli pent a sez punetele dureroze# onele cu tambon, tumefactie, contacarS muscular > scuttle ‘abdomineld poate” inca prezenta sou -obseae bevstaveml ternal > eu rectal vogine pent a sei sdnger, Exainares paral este necesar® pentru 4 complete ea inforati mporante examiareaeectuat cont In "> recalara de snge pent stailieo grup sanguine 0 Rh, MG emu detectreo Wb 3M, lceme, ure, cea onogroma (Ma, cay > ‘racogrfio obdominatd pe gol pent stolen presente sou @ ‘ansene! pneumopertaneull prin rapture uni segment 9 tbl figesve, pent stoileo eventualor fact costal, fractr de ban> radoorafo tora pent sobre evenuaelor foc de rebors ‘ost sng (vpturd de sping) sou de vebora eesto arept (pur de ead: uneta lov) pertoneat ex 200.300 mi er foo petro se vdeo ‘uloareo leh eras scopal Sabin prezentl sou @ abserfe) Sngeu io obdomen, ecoorfo obdominl6 evéeoz8 ten ale capsule splenic sou se completeoa cv smeston CT, rterigrafi selec tora 723. Sindroome cine Ls troumatiatit abdominal ci Interesare wcerali, do regu, apor rant cine pin 7 Sindrom de hemoragle interns (ntrapectones 8 rtroperitonea) Imanfesat prin hiotensine, this, paoore, tonsa rec Sutaplerdereacongtinte Apare in akin singers, > sndrom de irtatle peritoneal, apare in moment in care un organ ‘awtar 63 rapt In eavtatea pestonals gia deversat continu decoita. Cine se manfests pn apkrae #conrate rosclr, urerentens > sindrom iat, In cazul_przensl concomitente 8 semnelor de heroragle menu ele de pert > sndroml complex, in carl centres) waumatice si 2 ator seamen le ele otra 9 amples snonataas ‘Traumatsl abdominal pote geners# lesan! vscraleabdorinale ea ‘manifesto cine tra certo sin 2 Hemorapie intern dol tip 1D Pit tip = se consti un haratorn mace hepatic sau © Al doles ting ~ se cupe hematoml rovocind hemoraie ines 1 Primal mp necro intestinal; (© ALZIea ten perorrea cu deversrea chit peritoita > uperes sou denser iarenterid, care conduce la nec, porate penton mn do! mp > Orla intestinal In dol timp, care const in rperea rezentri domi hemieres ase iterate, angular, oii ntestinals prin eventaia postraumatic sau heir interns, > ‘Abcese lnvpertonale re, manfstate prin sSngerte mic suprainfectare, aber sbirenie 9 Fundin e s3e Douglas ab, durre Fonceatta act postaumasc, cing pancreas este rob, paint sre dure foarte mare in bors, wea, viru, apirare muscular, cestees 724. Tistomentel oumotismelor abdominale {atamentaltraunatismelr abdominal const in _rechbrorevlemis cu sluvepefuzabil noe reechirare hidosletoitid, Optra hemorogie chien wgent Semone son pen espe nrgeste: raflane attetoned: In con nei pertor, wotomental chruacl const dn nce ‘foombiio® mare pont explore, recltare de bis nraeperator, ectures bemastazelchruricle defini va abundnt 0 cont Pertoneaeclisare tubular de de, 73. poltraumatsete Poltraumatismele repre ste acute severe surveite in ura unr accidents de naturb mecaic,termich sav lected 9 arecerzate pein lent ‘ltl ce afecteasorgae,aprate, ste sau reunite el pun do) Ble organs Poligaumatimlerepresnt aproxist SO% dn tala traumatmeor upd statistcle OMS, poltraumatsmale const 2 Ula caurs de deces (upd bolle cavlovascuare 3 caneae) In imp de pace, ele ma fecvente cae aeoltraumatelor sunt scidetle rire (90%), aexdenele da. mune, Steldentole spore jtaclamele Potitraumatiatise pt dasa ir: » 2 a) Poiteaumatiaia care fei vi arate, Poltsumstati care nuimpan masun de etre urgent, permit 1-2 ‘ore pent iets Foltaumatzayi cre permit tmp sufent pentru. preiar agnostatl Je sunt aerate imine top ‘editing deus etape de ratament in cz paltaumatztlr: Trotamentl aoc aecetulu pe preursltransportl pn fa tates spitlicease va consta din > evolare gt stabiareafncior tale (ckeulto respirator) > conol peemeobit ior respirator eventual mobi ole tofu coxtaevcuarsa nul peumotara, resustara codec in sp crdoe, ‘ord vos pier sou ental: Inemostn tmporar eu gorau sou cordon; trons ct rps Prima paint dagnostcarea esol pita > "reechilbrrenvoiemied ieee > campletre hemostore examen cnc parole como > montorea ine vente sire! > rectarea de probe bilge (Ht, Me, leucocite, wee, ereatinns ‘med, gem anagram gr sngyina sR) 3 radogroft motile frciede za traumatsmul > ecogafisu cr % puncte pertoneals sfectustd in scopul evalua enor fbiominat: > edminstore deter antetanos TPA Tratamentul se efetiad in uncle de sarea general» pacer @} intenentio. chinurgiald in extrem urgent pentru scooterea ipsietu dn storen de ye hemoropc Su respirator, armetd lo {evo de ote interven 1) cand starea generale nu permite evalurea complet 5 investigate paralince, se 9 efectos inervenia chirurgie cu crater complet, fave rola diagnasticaren completa cave! sa ean care 00 siblograio 1. rg, NeaguSt,~ Chiru, Volunal 1982 2. prgcudl, Gigoezeu Acre, Cas Lowa, Bucuresti 1984 4 Proc. Tratat de Paologie Charis, vo Medal, fucxes, 44, Proca €. ~ Tratat de patologe chirurseal, volumul 3, Eitura Medals Bocas 1989, {Palace - Chirurgie yolumal sub edu a Al Pic, Eur Didactics 4 Pedapogis, Buare, 19. aMT ECONOMY 8.1 prone pracincs Propites penta operate abla tetera funce de fel boli tal ede evolu, teenie soca stare generis urgensmola se xominares bolnavi treble ncepts eu exsorrea cinta pores etn se putea sbi agnostic de cert tune pleats paral const In xplorarc songsind cares elicean rn 9) Sxamenut tog const in deterninarea oumull de ertroote leocoete,trombocite,precam formu luca are important ‘sognosicu uno bol infcpocte alerge 6) Eramenulbiochimic preceeor® conttati: emoglobine, areea Songvng, gicemio, ionograma. serch (Na RICO, coetera, itrbina tansaminaete omiessle e.In onc de certo se Coreceasddeechilerele huoelecraice: 1 Examenu!bocteriloge,armareste Wenieores geen potogen sins; Teste de sngerorescoagulre; ©) Reacy Bordet: Wassermann {decd este post, este conroineota cersenia chirurgie. 2. plorarca bul agesty se reaizead pi 9) Bxamenulratolop, care este foarte important pent vgn au portant pentru dignost Sndografe ebdoinls snes, pen evden de eth bier tse prone + tamer rede tors, poot eves stro patbgco sofegiand, gastried, duedenols, a intestinulu subtire: + Mooaraf, eer un at colony eas + colectoscoeecsonoorf pe pbroea ciy ire snot 4. txeearf pnt dearest arr proces unre 1) Este enaep ns tei ete eer pet $opseresinvedes romenhtepstape 1 elfen pent cogonere ean ean + fase ofe fore ora stone ses + calonosopa, od informal esupre esanlor pateonce ole ‘elena! + rectosgmoitoscopa, explored sigmoid 1 anuseopa, penta dagrostesrea luni noes prionae; + laporoscpia, este 0 metodé de investigate a. erganelr abdominal, geste 5 genre. 6) copra, flseste uvasuneele a cree releie este fers in funepie de desitotes fest its, Ete tls nexplocaes ior bilare extrahepatic, festul, spine, pancreas, > arc 3 acest, Erplrare eu sotopiradhoasi scmlgrma hepatic, hepatbir’ poreeatic 6} Tomegratia computerizat (CT ade informa mal precise esupra 1. Rezonana mognetoruces (RMN); 9) Oplrin bop fh) Alte export ubojl cuodenal examen de mater fea, proctor analiza sere gases, 9 3. fxplororea cardovoscuors, este necesrd iaintes crite) interven thiurlesl penta se eva aparja Uno cident Serealneae prt 4) Explor redolegice: radografo. towacd, febosrofo guor, Cotcerismul in fleboprefa 3 arenografo member infeeare, ‘ortogafn,etenogap ator orgone; 14) Sprain u autor eventor elecrocarograma (€Ghfonecrsa rome: 1). Ecogroiacoricd; 1) Probe pentru determinarea efciente! crevotortermametia ‘tnotd osciome proba de for spo, $2 ©) Probe cu ztopraioat penta determinareo:tinpull de cea, eu penferce, olumall ongun oct cult. cade 4 ploroea puna, rebue ets a vie bona cia (0) Teste cre opreciazéefcenta vente pulmonore- our eprtar ‘maxim pe secur (VEMS) ptometrapreoperators 1) Bxploran radoleice: radoseope, —rodowrfty pulmonar, bronhograin Explor endoscopice:brohoscope, eevd modifi patologce ale Ate metode ecograf,tomogref,scintarfo:6) Fromeno! bacteria ste ete atl pent bona pulmonar 1) Cevetrea gore a singe: oxieta (etermind 03 in sérgele real ersnmetin deeming dia de carbon), eer oko 5 rplorra ino ya cor arinare se post tect: 8) Rodiog rn radon sipl urge, reteropicogafi cstoraie (exnloreae ect veo rina) 2b) Instrument gr aretrosepe,cstosepe; { Fonchonal pn examen ik chime 3! meoscpi rink obo Ades Hamburger (Geil ulnar pe minty etamerol funcional idvect a! Finch i examinare sénge fol re ura sonavin, rerina, lenogrome ser a) corte: 1) CRN cing, oneriogrf 1) Sromen bate urvet, determine’ clin ind bolle 0 82 Preghtea pic const nears unl regi deprotectiepeir bona cove i aire trates far ae InfuenteseSnegatiy avalon vith Sd lla ete, pelangeasomnaat alo; suprmares senztilor de frre Penta reaizarea aceserobectv, petsonal cre int In contact botnvul webu 3 dea dovad de grfesional si contigs profesional. In Seet sens sunt recomondate dct co Bolan, ies apr operat, Sneseneaspra avantajeor dust de act chr Pacientul ebie 33 ib nereder a tamer pit ncedere vents eo cel care i ates. Efe depuse de dv. Penta realiacea une eat nest, de needed eamarder cu aden vor ade imense benef pe ‘urataboi sal Concomitent ci poterapa, se acinesxd_ yi print trap rmedicarentoasspenty eaizares nul smn Int ante de intern Cimineta operapepaceatul v= minea 5 va sft sil goeash ves linnrs Co 30-6 minute nite da ints sata e opera, olnavli Se v0 8.3, preadties fie obolnavllor cari anerator Intute de trea bona, regia acestora va ferent sat Decechnbu nuvi depinde de ata procsulpatlog de real pe care one leat 9 de vechimes bol, Talburle mtv severe se itlnsc ‘incur crn, ds evolu Indelangat ale procesler patelogc, ce pened Roopwotcnemie, precints.q_anemie, —dezechlibrare hiroeectoli Mgoucmine tc, In sceosth categorie Ind bolnavi cu slenare cgestve Trematn sournaighe) cel eaneeos in general pan cu istl post operator otetres det rote foe pi occa ementar pera eu corte, oud 31 bron®, Dieta we fi eho evan aportelor de ce putin 3000 al 2 + dminstroeadesange integra so plasma ncn i reetate a Soe + Vtaminterepesanaboant { aeotete ge protene, ebumind anand, omincac est) ‘ine pie sine. 2. preaitiee boloaioranemii ‘ema conn in scideren numa de entrocit, a Memoglbiel sa hematocrit suite rermale, Bono, cv excepts caniior ed interven Er urgent, va webu abd iat operatic oH » 10 tun > 30% hemile conics se tateatd pn adminstare de ler x vtarinoterape. nei ate neests nerve chur de urgengs se Wataz prin ans ‘esinge jas esivootars 2) pentru bono esofopien se inoue: ee oectoree duh nutty prs mute parenteral, ‘iteminterapi, gastrostomesovjqunestomie de sient; ‘lgraro net une eri oseptzreo orborli espa Coretoeadefeeneorepotoreale Megoesfegu vf spaat sas; Vor rote fcorele septic oingobucedentore» 8 penta bohavi cy interenti ge stoma, empune on bemragile mos, corecareo oem inceput in seca de (tea intersi 9 fconiuats ints postoperoar + docb sub trotoment medial hemaraga se pret, bonaval ef Imvesigat eventual operat in condi de anemecoretai 0 4+ praia gost est necear8 pentru ooreiereapierdeiey 3 tonto! + fo bolnavi cu perforate, se plies: sonde nar-gastricé, tbiteropie eperopave eS ml ropa: fe bolnav co tenor plore duodenalswieroasd se eectuian Splatrd.gastricd zinc, s0nd8 de. osprape In almineato Imerventet reechiferareahdrelecrotic, corectorea ipooroteiem nem + Ta bena ca stenoed pli neplancd este neces: corctreo hoo potenemil a neni opebiteaple eeput cu 24 ore Inaites opera corertorea ecu ost penta boa ev intereent pe colon re preaiiea mean entre abtne un colon it mtg Paxatve, ame seg okmentar sro res ‘+ pregitven chimich pent redveerea septic (slforide 3 ‘enone forectareohipoprotinem “ntibioterope inept eu 24 ore Inaint de oper ‘ovectren oectunio soca bregdiesbonovlr cardial est erent in once de afecune SIs bolnai cae necesito ntervete chur de urgent pe at forgo sev efectaa ECG 9 un ons interiscipna de meng ‘ern terventichirgial vedas arin pst, by ta bohavl cu aleclun vosulare perferice se. va proceda ferent ste: 1 arrose vor adie voedettoareatogegant, onvbiote; 1 Geleuvaric vor pura bande eesti 2 Coievtrombofeite vor benefice de ratement onticoagunt = Preastieo_bolnovor_pulmonat sive pulmonare_ (ror, ffir spurte) ied mae problemen tinpul opera Snestede cit postoperator.Tatamental reopertor const In Securit pulmonare,inerzeces medlcamentelr cre deprima regdtsa bolnovior hepa! v2 corsa in regi slimentar Fibers, bogat in lucie #peoeie. Se vr administra perc icons, stmuatoare 3) protecoare ale celle hepatic, ‘aminterapl mol es vitamins). regen bolavr renal va ferent, st: + bolnovt cy siferinis renala ocutd neces antbioerapie, feechibrare grosiecroes, ecdoboao 3) cai, \itominaore incon extreme se opeleor a herd + suferin rena ernie poate dtoat fie nel afejun real, {eine ofectun suorenate To oeciuniesubrenaen core mind SHezo se impane dong) wirer sondd veaco), raters corect (in 1500ni/),anbiotrepe: “+ olnavt cu nefrpate ernie impunreeebarecorect ho: lected comboterea —hpoproteiemic, ontbiterapie, trotamental eden sa HPA seenore Pregtrea preoperatorle 0 dabeticor. Terenul dabetc pe care toluene Boal chirurgie’ poate fi compensit,decompensat sn ‘dud [nue recornandsoperaia dct naz de maxim wer 0) Diabet compensa’ neces epi almentor 9) tatarent Imedicamentos,Gleemio nu webule add oblgator to vlor Inomete ere de 150-180 mgX permit imterven chiara, 2b) Diabet decompansa neces corectreo dente xiozeh ‘Covetarea tiburon Ndrnlectrotice. Primordial ete terop10 cuinsiings 6) Bolan shbeci cu urgent chris ou rc foarte mar. 6 orf ot energie pastoperto (det, insaloterape rregdtrea preoperstere @ bolnavilorobes. Sona ober prennt’ particular metaboice deorete.Seeundor obezt el prevints Cobra eeultoiy eepiatrtuneon fen asoiate grave: MTA Steviowelerorh, stestorh hepatic. 1 penn preaspente f bolstirerpse: event, ganereatite ee, bea vor ft explora reoperstor in aminuntime: ungile arsceultrh, respirator, endocrine, gicems, lesterol tetle hepatice ee, Dock bola ‘bez nu neces intervene de agent, v oper na! dup o ‘id de slab. Concomitert vor flcanpensat tuburile metaboce SHleaunie paaoge sso 10. Prepitespreopratorieo bongo vr Sanavi rst sunt ‘nmi zum isuient pulmona, cardiac renal hepate ee De aceea minut de prepite preoperstrie vor cle slate lo fica cz In pate, in plus prints un rite snesteaic 9 operator eosabit dts tren attocerote deshdrtt deminer borate 1 Tonder = potlgie chiral, voli, Casa cdr de sins Ci 2. Vasile By Grigor M— Chie spit inte (manu penta ol sonar poset, EP, Rk Sucre, 1994. 3. Ridleseu'D~ Coet de chiure poste, vol! st, EdMedieats cust 2962 4 Rule Peete de pao 9 tempt cea EOP 94. Conoiaie naratl eoatar opener ests 1. tarngotraheta, ext determinats de ntbata tobe. Cine 3 manifest prin senza de usturne dure la nivel aningeh, voce aR. ase vest 2. Edel gotl Simptomatloledramaties canos, sipnee, con). 3 Aletecteie pulmonard ete cea msi intlnt® complete postopertarie ‘pulmonar. Se produce prin trtre akectlor drum psmn (ma, ob (iovara sau Sepmentiepmentrs. Zona ast! afer este nefunciona Fact foverzanj deri imobilrae tefleé a. base! tore 3) dlaragmuss, pneumopertonedl, imposiitstes tse. simptometologe June trace Sau Jens in ip, feb, spnee, anos, mata, lps ‘murmuri vei, raul creptante. Examenul radiologic evidenars 0 Umbe de ntinderevarabls depasorea medartinssridcare hnataten fdafagmata Tratementl profactie sense, preoperator.lapraa Secretion bron, suprimorea tronhoxpamula, Inercres frat, 2eroso, gate respirators), nraopestor #.pottoperator. Trtamentl ‘ura costa Ia: bonhonspiea,antboterapie, agent mucaliic nor 4 Complicot ifectoose pulmonare(pneumocia, brorhopneumons, abst ical de preverive i costue Inubati, ca and stern corecte 2 materia de ntubsi, 5. Sindromul Mendelzohn (oonhe svelte de sepia) este un acient foarte [ov apt in arma ine conitl sr, Simptomatalogie: depree ‘lant aire. Tretamentupoflact(galtespreaperatore 9 trata fi caratv (nubatle orevaheal, aspirate tahenbrong, crtotraie, ntti). {& Embotia pulmonar22, Complcotite azaratlu cord vascular dem pulmonar acut (PA) ese 0 mantestre dramatic nl decors ‘revator bru, urmat de inundare 9 eller pulmanre, arborel ‘woo a intestiuu pulmonar cu plasms nec, Cine, bln ete famvios, cu spree marcas, apres, expecta crate (pura, fb stu rox), canoe, tus. Tatamentul urgent canst ein: schimbores Poult! bolnavl oti, ongencterapie,flebotone,sigurarea Hoe Clo serine, adminisvarea de tonicardace, dure, broaltstoore, venting mera Boala tromboembolic este o complatle sever postoperatre. Aecunes ae dou apecte: proces! de vombor potentiate embaligen, Tambor ese mai revert ups opera care neces imoblizare. Senptomatolgss ste vara atceleraes progres pull, fers ur de 38° one de tersiune sou campe dureroaee la nivel molt, coer, bolne apt Tratamentl profacve consth dntro. bund pregitie. precperatore si 0 robzae actnd postoperstor. Tratmental curt const dn meddle alcoagulan (Heparing yTrambestop {mbotiepuimonard este cea ma grav complicate 3 tombossor. Ea const Ain grave una emboli insstemal rere pulmonar. Faro favor Sunt: migaren dupa imebiarea prelungh, lor de tase, elt de tefcate in puncte vedere clini oat de mal multe former formal (moarte suit), embola puimonara mast (blnavl ese rece, umes, paid Su danoti, spree. puls form, ifrtil pulmonar res, Forma fast Profiia eonsth in wratamentulcorect al tromborelr, prions emai pulmrare. Tatamentul cuativ este medical vacopesoure in perfil, ‘oncatlae,algenoterapi, anticoagante) chirurgie fembolttomi), Infarct! miocardie act postopeoter proves rise erect la coonstiei, le ent) peste 0 an, Ia dabele. Simptomstolgia: Nootensne, durees ‘Ssonee, cane, siiciune cu wanspaji, caps, antmia. ECG pune ‘agnosis, Progrosteul este summa. ‘Tratamentlongenoterapl, ‘mentinere A, heperinaterapie,tatamentul wburdrrderitm et 93, Comelictile apart cent 1 Rete aeut de win este 0 compliatle elae fecvent, Se ining mai les dup ahianestexe, dupa operat anorectal, prianale 2 alma aud Cure inhipocondr, este aptat are senso de micune, face efor uncte far se surg cites pear La palpore se contté 0 tumors hisogatied reds, regula, noted, renitena, foarte dureroass, mats In peri Tratamentul eons In cateterm (snd) weetrowenea insta extreme, nd ni Se ponte fae sondaj epractispuneia exo war cs roa, late deastr sine pubiene 2. Insfciena renal acuta postoperatorie (IRA po) ete» cmpliaie male intaint, ea reprezntind ayes! rnc dese adapta la agresunee huurlel in puncte vedere cle, oigo-anri este sername, wees rin stad, ceste ueea sanguin retina TRA po. poate: funcional, saith ale complica x adevirts 3} IRA bo. funionals poate = spars donee operate nesompits su Ga compleapie minor qs caracterzasd pin sctemie reset fi olguie. Ea este 0 urmare a dezchibrul hosel Prognostic este bun cing dgnostul este precoce§ atamentl forec..Tetamentul const ih corctres devel, Noo ecole, venta aemintrare de mano. 1) A po. afedatd altel compl este caterminats de sti de sc, lodune itstinals, pertont, infact mesentere, pancreas ac, ‘88 soptcamice sa ator sndroame acute abdominal. Prognoste epinde de atecjunescouats 1) IRA po adevarats reprezintprinpaa complatie po. Tratamental const hemadla, nase de rete bed, canto ane Iaronecoitiee, dminuarea catabelmului"grotsk trope antinfeceass. 2. Ineflengo urinard st datorescégexmeiorpatogei cantonal In apart nar: colibacl, proteus, plrani.Faientupretints polar, die fis. Se efectard urecltura cu antbograma. Teatamentl cones In combstren infec,24. Camplcatite abdominal, i clio postoperotre precoce. Postoperstor se cunote tal forme de Inuerupere a rami nesta evs eomun, ocala Sars oct secant 2) leu postoperater comun afcteas® extremists tubules {stoma colon. Abdomenol este jor meteor da sup nedureros Se erepsgamate hioaence. Se emtespnten sala tatament Bona. 1) clea eivamic are eept cove prezena de sdnge sa bid in cvitten Dertonal, parton, hemo su cella retroperitoneal, Pinta resin cstenste abdominal, vrstur,rervperea anata, absengo {poneteeintestirale Roiografa simp endentiond imagin hirooec. ‘SEimpune tere chiar 1) Octo. mecanid este counatd de aderente oererlat, tues heenfete,obtacle causate de intervene. Trotament cost h Inaepartoren obstacoseechilbroreehdrstect i Peroni pestopertareprecoc ste causa de derurrea anor arastoro%e ‘tgesve,derapares unorIqarun,hematoame supralfetate.Talow. cine ye sevice pertonite.Tratmentl este complex einervertis chirps, ‘ose renjl ath pertoneaerechlorarea oder. Fst postopertori, sur consecins noe deni parte ale anastomo: elo derive Care: bolus anems, poprotec, meoplacl, defects de twin et Acesta impure mur specie de atament general ol 38 thir enterveria cru Hemoropl pstoperaterl re pot -itapesitonese sau digestive. 2) Hemoregilentrapertoneae se prod ca mere a derapai unr ligotu osc, les vseulare su 0 unor vse parerchimatoae. Eola! {ve semate unt aneroeute. Se impunereinterentia chirp pent emoctar reechivorea hematologic. 1b) Hemenagie gestive se produc pin ere de tres, ngorB i tangle de secune gestive Pancreattete ate po spires du interven pe stomac spi ete. Alte comple suport al plgor operator eiscrai sara de dub Sibi 1. Prev ~ Chari EDP Bucees 1985; 2 Proc. ~ Treat de potlogie chivurpcald voli iI, EA Medias 3 PlesaC~ Chrurie gener voll Ed. Aplin ag 1999 se Seca de teri mens (AT este ergata fle pe pt fle in sec pe cae 0, deserves (chtugie, otpedle, gnccoge). In Serv de Terpie ‘Spada de ctre un numa mare decade mad (at de celle stone ale feteil Ais sunt supraveghiote ac funcite” epost restate, rdodreaator, uae sages TAT moderne surovesnetts este efectust cit-un pune cena pantry toy bra cpl Iasistem de cantral Prin momtonzare [moneo= a supaveghea) se inelege determinarea continu a unor parameva funeral Avartaole monitor su > permite datorea cominut « trtomentlel admit lx streo| lagi Bolo > permite depistareo precoce © vnorcompliai #f Worea de mur omplea legate de terapaaainsraa. Principal paramet monitorza sunt 2) Abort crdowoscuar: pul, tersknea atrial, alas ventniors, resumen venoas cenial, ECG 2) Aoortal respirator. ecvena. si mal espa, ampli iigdelor reepiatri 3) porta arin cuba saree: eu debit ear, destaten une ees sanguin ria ‘orate digest strea abdomenutl, tara gusvicd fantate, cate 5) Cara fens 6) Sctemu ners centro £6, prunes ntacraions 27) Probe de coagulore: tng de coagulate, tnpul Howe, pul de protrombins 8} Echbvtaclo-bol pH sangin, PO PCO, 5) sonegrama: Nok Chce 10) Hematocrit emogrome,4 @ 102 Ingen oostnsrotere generals Initerent de ampoarea opera blow benefeiz8. de ing specie Pasty tohow in pat este de repultIn deeubit dorsal upd anumite Inervents, poi poste mati: decubt venta interven pe clon, deci Tote (torent pe ric, pole. Trendelnberg (crete ‘cerebral det}, pane Foner rena ler, aun esprtoi), aimareo drei postaperatr. tentatea drei pstoperatck rman @ turk apeandert ev un maxi fn noapea de up opera, aol mics ropes Mobizoea brow webule nce cS mai epade pent opera ik 5 mili chiar fn sua operates pet cele ample, in fun de stres [enerala 9 Boia, Atel se previn embolic, bronhopreumoni, ‘eae Reloarea aliments se va face in fncie de tpl operat it mal cepede os. La incput 1 se permite Bolnovui#4 bes hide (ap ce pain Indi, apo prose Supa de arava srecarts, sro nora up te Septal its, ape, pre de lege, cane at ie de Alero Yom ies! ete un parame elie postaperstor favorable mod normal a 4-73 oe de a operate ble vo emte eee, a are prima scum Por combaeres pares pestoperto se flees Sestealaoeantseanagnt le de rn sau pa, come oa (Contain state ges fne)sopntcaeemolerte Preece comboterea compli inflorato 7 Complaileplmonae se prevn prin asprarea tecretilo, mastic respirator mas oar, moles, tse sett, anche > Complicate tomes embale se previn prin moblzare precoce dat supavepheats, anticoagulants > Comsicatile rinare se previn prin evtarea sonal vei, mada destimlare a miefunt af beta Bocas) Suproveghereo ek pigs dena. ©. 103. Inarivea postoperatorie o pli chiruralale orice imerenje durugieals se inchele cu suture pig operator Scoaterea fear ave lig consitie atl foal al vndece, care permite ‘verre benawut chirurgie, De a punerea frelor spn a scoaterea le, pigs tec pinto sae de fare. Dae pag evliz fr io problems ele se sctin a Slo operate ‘ic ina 92a operate milo na 10-122 a neopavch visi, dent Pogo wo fi contaat incl vit, Och evolitis este norma, e> este sul, eedurroas, lar pansamenal este cat Ip acest car pansament se ‘chi ta dos se, Pansementl ret cu sete se sch sia dk Secreta ese abundent, se schimbs de mai multe ope x pentru a eva area pel pin stagnarea secretion. Tn cal une evolu nefavorabile 2 plas n 2 ela sau a patra dela opera, spar feb inst de senapa de tesine,duere, wun f vel lg. La ideareapansomentll se constata o2on8 congestion (oi, bomb fu tegurmerte locale cael. Uneor rite fie ve aturge chil seropurlent. ploarea pg se face cu un Stet Sou cu pena, constatingu-seapaiva nel ‘erotty sSnee sav pur, Aaa poll impune scontere felon, debidares BB, solar eu apd oxigenat i coraring eventual efenarea et Seva eclta pratt conduce a complica severe (septier gangrene, evscerai et) gle crerate dn tmpul operati, vor ft conrlate alc penteu 2 uma efectates i cltatea demu, permedbilistea tububi, cantttea Secrefilordrente.Cind secrete Se reeuc tubule vor mobizate, sate 31 fratecu ace de slguant ibografie 2. Baue 3-E ~ Mtiple Organ Failure Patent Cte ant ravetion, Mosby ‘Yea Book, 1990, 3. ConstatngscuM,~ Chua, ature Didi 5 Pedagouc,Bucwes, Manual de anesteie crap intensiv, Etre UM Ch aPit. APENDICTTAACHTA 41.1 Define ster anotomopetaoaie aperots sah est o acne dinuclear orn infrares pend eo ere Ete na enema eo cae deus borin ‘ots lttesins ata duran cea esas rgste crural “Spent aut exe runt bola nee atta Fecenfel eucae se ineineste n aceast pv 2 vei (1020 an, corespuncnd eu petioads de trav eevee star ate Anatom spenele poate prezenta diverse poi fa de et 9 al frecvent find cea In fos ik dent Mot poate leat subhepatic so Imevotetic pe, fsb sng et I acest pool unl pacen, est ‘iets cagnosicares, “Avotomopatologe pendcee pacurge ma mule fx Papen edematoor (eter), cd apare proces inflate 5 penta egmonoosd, cond process ‘nomotor aptrare msciar ocoat a ive fos! Mace ep: > iperesteteeetnat acd 0 senate excesvd tegument Jose ace “mptomele generate sun provost de toxnfeca pleat de la apensice > greats vest oom sou dre. ores sein evsteno une compl Jed nspree mere (nda 290) chr poate pst bard Pulemovoceerat Teucootona ext op/epe totaeounaprezent > tesa deseimemtorea hematite (Siete reset 4113. volutes! complent Apert asta ponte eveuaasimptomate sau ea un mii de spome core mui fac pe paint sa se adreveze unui servic de urgent, sa de a sme futere isl adminsresrs ano, antinamator, et. In aeare staat se Format tumor amatore infor aca deapla ce posts rum de plston pendiulr Nedagnosta ating, sauamanatsoperatia duce acomplia > Penionto aperdea load. AV be oftreo prowesd 0 sti (ereroe curb fn paver evcoosende eco > ertenta generlaors poate pore: primar pin propogero infec ‘su scindor pin prforarea agence > Abcese regional soloists; > Trombopetita vee porte: Compleat incon pleuropulmonare Tratamentul spent acute este nama hieugialde urgent, 30 regi Spell atubul digest Tn forma. septcemles, trtamentl ex antbjotice ebule ieeput sreoperaor va contma postoperatr eu anbotce precate prin antblogama Inparae sev elect eecilbrarea hironectrobe 9 lem. ‘Avencecomia are. ch. tinpl operator anestena (local, spina, eriuralt su general, nl, exlrarea Og ecotarea de probe, hgaturares FH secionarea meroul igtura eu catgut) setonarea pends le baz, infundaree btu spendelr In bursa cecal stura tegumentars In prs trenajltrebuie vu 0 aitudine elects, im apendetee neperiorate derail ‘te inl Inulin tmp 38 practeaapendeacorl aproscpia, intrvetie {ace dminun oy mt din simplomatelopa derasa postopestore, st permite ‘meres paces 3 ile postoperatr volute postoperette este un stun cin feb sede in prime ie, poi se mormalrens, onal testunal sea, sea leucotora stares enerlsse ameorears, iogrtie 1 ArgelescuN— att depatoogie chip Ed MudcaBuurest 200% 2 Caloghera€— Tra ce chirurgie de urgent, E8ANTIB Taos, 2003; eATT 121. etn stelsteore ler gastroduodenal este o leune caracteriats pin perdre de Substana nll mucoseigastie sau duadenae Ete mde itt a vrte Ulcer gstoddanalevoluat lin 90% dn cz in pseu ace, pe fondul unor peat de rersne ci Girth ‘vmiabal frares sco Derlodatats). In ulm timp o¢ consats 0 reducre 3 frecvene ular ‘luna! dar mentineeainaeleay lite acer gastie Dey ulcer garni es duodenal suo patolegie certs apart eae este final reall detechilbrlt dn factor de arene 9 de prove Ulcer dtrage progres” stat eu tat pertale gato suodensl, pectin in peitoneu, organ cantare au penetear in vscereleparenchimatase bin pnt de vedere evo se dsting dus forme de ulcer ease: >” der seu de imensunt de obi il [ec em} incon de ‘dem > eer eon care de obcl depiseste 2Sem dames iar lca fdemofa este lat de 0 bozé care in imp sudearsstomacul de ‘etal vein Facto de agresianeasupra barrel celular gastice pot > bipersere acto pep > mnpersecrepa gosrine 2 Tutrd ole mati gostricefetorea evs) > Refi uodenopat; > welcobacte ptr Facto exogen contain, Famatl leool 122 laanosictn sLporanie Semele ie se bol contain > "atenanya pusece cate eu cele ernie (mare s mio peridetatl > ree localaat in eigestu sub forme de crampe Sau de tse fvocerbat® de ingest de olmente 31 camo de vor sou de ‘evacuorea cangutul gos; > greg versa: > aru (procs postorondie sant oe, le ot precede dureree seu SOfieodatcu00 Dlgnostiparadinisestableste dupa efectucea urdtoarelor anal > examen radiologe barat sableste posts nigel, dmensunes profunsmes ek Localiatsodesea pe mies carburd ex ents vac din roflin oor contra gore > Endorcopia digesta superoara permite examinarea_ diests (avalzare) Tenant, easement permite prelevarea de probe (tiop ace posts explores in ntregine 2 stomacoll ei 3 pilot ay bulbul duodenal. Este sigura metods are poate oer Sulelente date pnt agnosticl eel avrg ponte sab dock ‘te o lesan benign sau mand > examenul secrete gastric este de interes minor in dagnosteare deoaree lsu guste na este pute seretant, 123, Teatomen In eel gastric misure stetie pind components alimenteor 3 frecvnts messlor sunt importante, in scum Ia ulcer duodenal rep Almentar nua dove a aen un elect beet evident, Cea mal coe atudine terapeuts const in institutes una watament smedcamenta cau lcera qasre necomplst 3 veiest endoscope. Oecd ins) reutatele explorer converg ctr o lesune dbioas, vansformats sou ‘har malig se stableste iceapa opera. Tatamental medicaments se Instuie pe © peiosaa de 4-6 sigtamani rmirestecreserea estes rmucoesl la apesunea acidopeptcd In carul weer astie 3! iahiboea Iperseceii gate ncaa ucerki dude. acest scp sunt fooste "Antacid, cave nevrolaeaz ecsdotey gas > togonis of receptor Hy histominerge (rantina, cinetsing 5a): >» ntzoinerete (trpin dein sine > Indore nbc cornice, > mesicamente core mire péraree muccose (ueoet, comput coi emt2 anoog' a prostgiontintr monroe) > Sumaten a sett! mucasul gat corbenoraona: Regn almertar ars cof ooo tater Trtamentulchirwpeel se aplick la bono cv ulcer perfor tenors tosenopiorc, hemorape dgesiv rpetiv, cancer gasve Su ulcer reractar latrtamentl mada. Localzare xu cross est determinant fh lgetea care cheure 3 Spl de torent agotomie reece gardai = 6 set. sibgrafie 4 Radulescu P.~ Elemente de pateloge si tropeutcs chro, EOP Bucarest 1980 2, Rarequ Chirurgie generl, Reps, 2008 3. sirbu ¥.— Urgente chiurgeale abdominae, EAMedeals. Sucre, 6 Be3. OCLUZIAINTESTINALA 121. Define siosiicone (Ochca intestinal este caractereats de open complet pesstents ‘ranstull intestinal, determints deo aur8 mecaics su namie, ce ae ort onsets apriia nor tuburmetabolee cu expresie Ia nivel nue gan ‘Ocha Intetnalé este una din cele mal frecvente afectun curate reprezenind 0% dn total cazuror de abdomen aul (teres ce iil din punt de vedere rac impart ecu 1 Ocunt meconce, care sunt concn opin transl intestinal set pes ud otc tar espa ees Saini intralumena, compres estere seu wich depose 8 Incstinll her vos, escrah vapnai: > Oca anomie su fanctionae, la cre ops reat intestinal se datorattunor ulburi in dna nesta, Di punet de vedere atc ale po a intestinal sues inate (ung ein} sa joase (gs eon nites aon in funce de eter evolu actus ptf acute (staat brse 4 lui rapids grav, sebaete [ev evolu mat lent) ernie (cu nts Tens evolu naelungat) Dops tpul obstruct elute pot fr blterae simp [rb sfectre vascular srangulre cu aectare vas) ans inchs la ombelecpete 413.2. lognosti cline si poretnic iagosticl de aclu intstinal trebule tbl urgent pentose putea acionain imp ul pert Eristena celui poate tbl cine pe ba: 0} ancmerel in ured cu balan 1) sernetor cnc: duere ura, perombilea virtue ‘onaeu cestnat seme fee: meteor abdominal, mij perstlice accentuate tsiografe abdominals pe gol evisentaeSdstensa gozoasd «une! ‘ons intestine 3 matte moain avonence, > Ingoarafatobepte sel dbstucye cle; 5 slografa ev aostroroin ini sel obstructs Sr se rcomands uma cava foarte fle: > atzebockimic: hemogram, protinemi,lnogrema sangeind ‘nord, -s Sonoui, lozem@araazi germ 0 evalua ma recs 4133. elute! comic volta boli ete consti dn rel tape: > oebuat poate ruse sau insides. Aesea el este dramatic brut Durerea bominals poate vie ruse, leans spare progres > Penooda de store, cand se adauga virsiture lar duterle se scertiae, FPS Hatament chirurgie, evolils ae fee ive fara terminal > Faro termina ind virile devin (esos, abdomen snge a dstense exter, 28 migedri perstale,apar sere generate de Inroncati (oeh funda In rite, Tacs se sdhmbs, respaia devine superials, pull sob, burle se lanes, prabuse ‘ersional lige ure, Complicate ce pot apr sunt 7} "inundatia vaneorbronicd (pneumonia de aspirate) cu chide de arstrd, ‘lectzies previ; Desharatare tern tubule echt acdo‘bave; Insert Peston prin wansudat 5 nero pereteluintstinl Secockrona Tratamenl ochuieh intestine este complex medico-chirupeal Intervenis chiraiala de urgent, care vzeard insepsitea occas bstacluis qi evacuren conta Intestinal, imine gertl teapeutic Trtamentul mesa ae drop sop 2 corectareatlburirior hurler (se face pi peur soutie Faolegied 7 slcors), reechitvarea volemcd 3) octane fo ‘acdoze metaboled se adminitreez solyie de bicarbonat de No 13% [arinaleslozemetobolS odmintrorea de lest sei > asprotenaro-gosiiee; > nigenoteropio pentru o reduce hipoxemio si a combate dstensis ‘hdomins, > ntbvoterapa cu specu lrg este Wi mai oes in octile cu tronulore Tratamental ebro este st terapetie fundamental are ae dou ‘bietvemajore: ndepdtrea sau ocala bstaoll i evacuare cout Invests a Fett peroneal Jn azul ocuior grin obtuare,pevioada de pregitie pate dra pn Ia iat. 24 re, dar in elute prin songulare ea ru poate +8 depseascd 2-6 oe Moment operator optim este aun cand boat event sta hemodinamic (oul, TA}, sea telus duress fu dipirut semnele de for (hpotensiunes, ‘asoconsrcia,hpotrmi. ea mal converablaanesteae est cea ganerald pin intuboye oxo ‘waheali, anc cal ma dest este cea mesa are confers posbitates ‘une une explora eau petonesle. Intervent se poate eect 3p ele Taparoscople, Trtamentu postperator vo cprinde > srt nazogosied,crese vo mentne pan a etuare onal > reecivorea valerie, electole 9a acide bones: > oniticteropeeuspecry lr > ratomentsimptometi:> rotomentucompcatior(puimonre,corao-sasclae,pertoneale Insifisenshepate,infc urine.) dod acest ep Cehwtte ainamice ou lo ls itrersperea tana Intestinal torts Plerdrs canst de popula conus curate uno bur Funetionate ese ntnese ma pot fh > Oalu intestinal spstice (enter lo nevropot ter > Ociu imestnole protic, Inflate ral des dct precedente 2 Alatorese une! tpi pertnede retroperitoneal sou nor tbr ‘osculre emboli s0 romboeovoslr meant) sibograie 2 Proea €, ~ Tratat de potlogie chiurgcalolL $M, Ea. Medals bucwest 2. Pigs C ~ Chirurgie reroll £4 Apoona as 19 GLa a GE 1M. Define sicsiieare Paneestta south reprennth un sion scat de outodisugere paneeaic) sl peripanceates dedongat prin acttatea Invaglandaré 9 famelor ro ezine fndamentale cin panceatta sets sunt inflata ters, hemor ecroea. Combinareaaestr lec toppraa exter lr sunt fenton de variate facind se dsting rei orme prnapale de ponte cis Jorma edemoase, cnsderts poor poten ers cre ‘ons ininflomajio acta intersivaledemotoas8. Panera ete ‘mart evalu uy indurat, cv een glotines lable evident > Jorma necronice-temoraged, dnd hemaragile marci 0 fonnored hemotoameorinto- 3) peripancreatic. Poncreasl este ment de volum eu pete sov trove emeroaie negrcoase sew zanenecrotce Conus so volaee, de consstents moat x foabie Forma netics fete coracterizota de prezenfa-necozel glandlere saltore, ford ito: 2“ Consumul de ao (60% din ax >is irs ele in veel bara in cle ilar principal) cre etrmindabsruti paagee prin eminaeacaleulior din duoden: > lavogens, cre suvine In cal admins uner medicaments Iso. urtce, costae, tetraine, estrogen ups investiga dagnostice (ponte pancreatic, endoscopl, colgigre) = In ‘sl alimenta el poenterae cy exces de emus ipa, Traumates, care spare duns trsumatime abdominal cnt pl) {al metabo Ingeripem {ol endocrine hperparatroii; Intec va ops 4542. bioanosictinksLparctinc Praxentarea clined 2 pancreaitel acute are mule variants ine dout fetreme: forma cu dsconort abdominal wor form sever, dramatic. ca oe Datent st hipoxemieDebut lin este bata fan pant cv atecadente bare, consumstor de aoc urine Ia 1-4 ore dup mass bogs In grin su dup consum ‘raprat de alcool. Siptomee cine st: °F dutere abdominal in Bor 90% din cazun, de more intense > greturis vsti > Sonstpai dotont evs prot; Jed moder, onsetate, aire respatle iflo; In formele severe poems este optat,corfar zou omates,preznth item facil dspneeexatiformd senate oc Nipervotemi Diagnose pareve stables pn Ponatee halapce:omloramia 3! anaezura (ese de 3-4 peste Calorie ormote tm pimele 2-207), Iporemio (ae peste 20:30 or ‘ane normale > Ccoorafa tomegrafia computerzat (TC) sau Ril st metode cu ‘curate mare ‘eografia abdominal pe 90, ete 0 inate de rutin’ petro se ‘ica perforotie viscera oie intestinal; > riograpa forced poote endenie colecta pleural, infitvotele ‘heolare £2 > Colangioponcreatografe endescopk retrogrod et insat o48-72 te de la debut ptr tratomentl panreateloracte pin obstruct 1 laporescopia ognostis entra viuazareo leur Diagnostic postal pancesttel acute bareazS pe sndromul cine sugesty, croboret cu eeyeren nerifeatvs 2 amfaxemi, ipzemiel si cu “astenje meodiielnior panceatce evdenite magic, laparstope su 483, plates comolicati ancreatits acu (PA reo evlue carious. 8% dite pacencu PA maton fc forme reise For prococe este dominatS de isuficenta multiple 2 ssemalor i cergenclor MODS) suff respratce renal, leste de stes, enetlopate Complicate care ot apices in Past Sechestral penereatie semis deintreanecovele gland cet pertoneale na dou siptémina de bool. Diagnose se sugaresé ce 9 5e fonts agit Preudochistl pancreatic ete 0 coe exra Se nrapancteais sia fark perete prope, contnind ens pancreatic sl detitsut recone Diagnostica! ete sugerat_de Taboo! lite Ia 23 siptiméni se to sebetul pancrestite nerotis Abcessle pancreatice unt cols purulent feist, sedi intra anduar,penponereatic su retropertonea. Manfstirte cliice par 13.6 ptimini deta aout PA ‘te complet 3 PA car srvin ma rar emorap ponereatie,trombore| nscale seni, portale, mesenteric), necrors or bla, stl pancreatic, ‘sul digestive, stenore duodenal. 144 otament rere na ante urgenfle majre. Tratamentl este compos neces indivduaiare sit adaptore continus Ia pariclartie line, fropatologcesevolsve, Terapia primar a tutor frmelor este conservator, pace cu forme severe (scr Ranson peste 3) trebuee Intrmalila teape Intens ‘Tratomente medicaments apa umareste algae 1 anagesle, avand in vedere severtatea suet, Sunt deste: procana| > ‘efacerea 9 mentnereovolemiei se face pin canta) mal de solu frstalede, smiistate prin eateter vos su ental PVC Selderea hematocl 9 hipoalbuminemil ream adminstare de albumin, ‘asa antl de singe > Innaficientsresprtarie se waeaz3 prin ovgenoterapie zal sub > Insufcento renal ocutd se trateatd prin subsite voli ‘adeciats,aeBugnddopamina in peruse > Profane ucereor de ses se reaizeaa prin adminstvare penta (elon ai veceptorior 2, > Tratamentsldereglirior metebaice cupindereecibrorea> Punereo in rep0os a pancresuii se reaizaass prin abstane Blimantar pn spate nagar contin. Almentatia oa a fi reuaa ex orden (regen hole pope) nme! dup > nha secrete) poreeotce eocrine 19 ponte obtine px _miisare de antiolinerie (roping, robot; > Tratament omensimoiserealaea2 Tras 95 Gordox ‘Tatamental rural este rt cle dou pu rip de PA 1) PA prin itn blr, end intervnia de ugenté este amt Inerventia fect laparoscopic va crest acuttetea gosta parmitind eitares Toparotomie! care are un potent sravat.E2 cont Gi coecstectomic, colanpigrae, dena] eoledoconcutub Kehr cots, cind_ se interne chrrglet doar ia fora compliatio. Intecenti cont in copsstomi, dena pancreatic netretom Biograte izes. ~ Chui gener, e4Requ 2004 Srbu. Vo = Urgenfechrwiale abdomnae, EAMedals Buco, Toader C = Poologte chirurgie, vl , Casa ri de sin cu Napoce, 2008. rE NETS 154. Define siclosticre Coedsta acu const in inlsmatia outs vesicle bias. Ea este ompicaja cea mai ecrenta 2 Iazel veda (pete 25% din cacu] 9 se Inenepteadeseaa vse ma avast 50-70 on). ‘Obsucia acst a stele aun eal dav deerind in pri foed oncntrare itn ken print proces de resort aapel, congntl devine bogs mn plang stu iar, ctl de cols produc oe chia ‘mucoselrerltindo infamy epi C2 urmare se secret mucus in canta Ire, presune crste noe ar vei bila serves forme anatome patloglce de cols act > edematoase (cater), ind cole ete desing, de euoare rox no violet, cy pares edemapat: > Fegmoneass, ci miroabeese In gfosinea perteui excl, supra cect devine sed unr depose free, > Gangreneasi, care dd aspecul de unc! vestedd a unr pt in peetelevesclrcretuenes oe perforate cu pertontad 4152. plounosti clin st goractnie Dlagnosticul webu 53 eferenize clecsttaacuts de o simp cles bila sou deo compeate de tip spurt ini A se marist pri drat cu carecter colcoty i hipocondeaarept (MD), eu tadire Chow ce rest progres in intense, sretursvrstar [eri dr me seams fiom; ‘spirore soy contractra meld ‘atic, ogi sun serine de gravtate ale Ct: pobre bisnd8 in HO poote conde 0 ree in soir (enna a rome) Diagnostic pares tables prin 3) anal bce: leucotrs eset1b) ecopai fornineans dat de certain supa presents ian & Indi cleo, colcstlal 1 CBP si a gFosimi pereteit cia eae cpt aspect de sandwich 161. Defines! clastere 153 volutes totament Pertnita acu este o reac nfamatoni 2 pertonel, dun, deobiee de orgie septic. Germend ining ant streptoeoeu, preumococl, (cate ra {onococu sau al geen fo este una in mare were abdominal. Sa watarent conservator maorttea CA pot aves o evolu fara in cedorea fenomenelar sate ilametori. La 2/3 din Bolnal inst books ‘oluaed pe complica cae st mie 2desa fare grave, pit core + Pesoratile, care pot + lecoltate ica cd bees subfreie abies subhepatie sou boc beets > nmorea cotate peritoaald core condue loo peritont bird ‘generaoticuetoitate de peste 30%: > itl bio cigs, cleisto-dvdeate sou cole, conse @ anor theese coves deschid sendin lumen dies 1 Gangrena colecstulssrine a 18% sntrepacens ups cals de pitrundere a germenols pertnitele po 7" pritive(epontane), su surs8 de eontaminare extapeitoneas iar ‘anspartl agentllpatogen este pe cle Seuatre; > secandae, datorat contamina iapetoncle ‘upd evolu pot up intinderea esa pet 1 ancretitle deere tensa nsjesecea 7% in CA ati: tier BP este ratte. 20% dn can. > localize Tratamentul cles! acute, avin vedere «8 nu se poate prevedes ‘ups arpectal xsd pot voli ebul fect ins 2» seroase, rtomentulconservter ar ensue ons dn > toroase: 2 Sandd de orale ocogesticd per decamprmareastomocui > purulent perce ca slo slne pert rehirata boa > Gnvolgie x antpostice pen comboteea der Casficarea stiopatogenich derenjand partoitele ia: prime > ontiiterape scundare, eae sees inrapertoneste. 2) ertontele primare sunt infeeyi faze pertoneale core pistreacd ineprtatea tut digesty 9a ganar anexe; ncaa de watament, lo bolas dagnostiat co CA, este aro chirurgie devine tld tune ind exis perforate sa pert bir Imurvenga chirurgie conta In coleesecoml, Colecstectomia ae poate ‘recta pe cle se [Secs pe cal lparoscapth (care esteacuaente foarte reptndt datos educritraume operston 1) Pritontlesecundore gretits solute de continutate la nvll recut Ggestv Cauce or perforata stomscul 3 duodencieantaminaea bar, pertonta apendclrs; petonita din. pancrestta acts sire Peitentie “de eine Eenitosrnas;pertontlepostoperatorh 3. langsotcu Nh — Trott de poole chirurgie, Ed Medias Bucuresti, Dostraumatie perforate tes 2. Caoghere Trott de hire de urgent, ELAN Tino, 2003 76 n6) Peitontele teiare sunt cae Ia core agentl tant mu poate locale Cole prions door Sspunsul sa al rgaismalt t)Abceslerapertoneoe sunt nec peritoneal, 162 planet tine sLporcin Manifest cline le pertonit aeate aes: >” Dureres debut bse ar debutl poate lent. Sell dur ete a Tocul perforate sub forma ltr de pura", duerea ste > Vitetnle ant Inconstante | afar mal tru: Inia ahimentare, biloase sar fesioe > Oprres "wun intestate incon: int tdbuk homes pret necator rn anaes neler » Stominonson > empower ens 3839 > Tenses sternal ap sce > te ene spe 2 Senseo are area, thie; 2 peat coy de po > Come unt concn donna, shen een > (Sfegeciesanomens no epi epee col ie rr 5 USpuaate-toe dosent imate ronal 2 adage ceapum sbsmin porelini se stables pe seams: 2 ale de aborstr ‘© levcogrme pune In event eucoctor cu linfopeni relat; een este moderates, examen! erin ne evden semne de sofia nel: © gheema~lo linia supercars > adigrafa abdominal pe gol pune in evident: peumopstoneul strsa mest sbi arse dataec prezen de ae ei 2 Ecopatia pane inevden coer inrapertneal: > Computer tomapatia RMN reprerint un exes petra care ‘ind agnostic! Fos sab > Punctia lv pertonel: 163, Trotment ‘Tratamentl este dirueal in marea mona a calor (cu exceia pertontlorprnitve) Ca ce urgent chur, perontele neces un ‘ratament medical peoperta, care Webule se sur efient Preoperatr se urmirt:reecilbraves hide’, oxienoterase, sntbioterapi,combaterea dura febre suport renal venltr# ascot rm, Circa se impune: elininarea suet de contaminate, seduceea contamina (spl, dena), wataes infection exduae prin split Deoneale coniruiopostoperator, abdomen eschs (Isparosora) dena Psitonel cu tubu de den In pericads de reaimare se continu rechlores hdrelecrote, exgensterapia,sondd de aspraie nazoastics, watamentul ‘dslnei de orga, andboterapiacucealesporne, gentamicin, metoniaral sibogafie 1 Prgcul.— Chuo 0° Bosra, 1985; 2. roca E:~ Trott de pottoge chiwgio volt l, EA Medals Bucuresti 2. lesa. chirurgie eneralvo fd Apllona a, 1995,171. petniesteoue emarle deesivs supercar HOS) ete o uence reorezetat rn ire sngl in sepertl oper se uh gest ele ‘oma dues cre se poate extrorasaunupen ematere sau een + Hematemeth = vet cu singe > Mlnd = rdorea de singe pen defecai. count ete negro aes eapaain. caucele HOS pot fete igentive su entrees. ‘Aen dgestve: 1 Eulaiene + varie esofsiene at; tumorle mela tena; ee esofgion: cfogte erie: Troumotine prin corp! stl Sov lotrogene. (explore) endoscope, ops da) + Srdromul Motor wes: 2 eral + lor gastric tumor mene serine: duel eve hemoroice, tke, couric, medicomentonse: beri tale sitagene ‘ngs core sted, bonng gost > bodenae ler duodenal 3 ierteat ume 1 empuorvoerion telenglector,plpze: + trogene > caibiare: + toumatime hpanes, tumor helices CBP 1 rene epic, fori BP. _Aecie extredigasive 2 leer de srs (sumtime sri oe iP evox boa singel (hipocoaguabitte boll sstemie: amide, milo, senor, intent eal Infci grave, suena cardacs,practazes 4372. Blagnosticline st poraclnks > “Hematerners meld nu hemstochetie (singe roast chigur pe date recta}, > fete dep, vei arene, hatin 2 antecedents patelopce personae: hepatica, bol hematologic, relat (asprin, tromboop; > Gxvemiare tonsa tegemente pie sac TA, rest A Invest gatile pordinc vor cusinde: 3)" Beamenul delaboratr pin care sea stab hemoglobins, hematocrit teste de conguae, wee; 2% investigaiafuncjel hepatic: wansaminace, Strbina, > Investigah real: ve, ceatinsionograme Cciteite de gioiate sunt date de) AVE100, THIOD; Hoe Ht vce; bres At 1) Exameneiagitice Fendoropin, metods cea mal sgurd (peste 95% dlagnosice ferecel > adopters cu substan de contrast; > sraograte selec; ‘Trtamentl emocaiel digestive superioare tebule fecuatruana, In funcie de grvtates cau Tn princpis cupringe dus categork de mast ‘obligato: esuscave,desusinere a func vials! de opie ohemeroge 3 festa se adnug8 une atom paolo a bol fond odaltleterapeutce sunt: mele chirurgie> Reschiltar, in hemor grave ostionarea bol! in decobit dona, cu eembree Infesoore wjor riot Tender Imonitorizoreaconstentelor itl (PAV in spot; atetezerea 8 12 ve, pe core $2 realea: grap sa Fn He tombocte,erroct, teste de cagulre, et ugenaterope = Sond nosopesrd: ‘monitorsorea deze: reechloror voles repaos digest absolut > coracare cogil, se face ca: plasms proaspth stamina X, clea urone, masa woman womboctopen > ace, mai lesin HOS ules in paste hemeagie > Prostglanaine 5A sunt puri inhibtora seat gastric; > Vasopresina este un vasceanstitor puternice optete HOS in 75% > Somatostatna,provoacs vasoconstricleslanics sade presknea porta, > ipotermiagastrs (va gastric user flog rece 2 Propanaoal are rl in prevenies hemoragife prin varicecupte sau ust rca > herostnd endoscopic 2 hemosttsanloeaic prin erbolae, injectate de vasopresing 2 Sone de compres cu dub balona, nvaries exofagene rte -rosna 30% dn co de HOS preston medi 10% incontinence de rena atament crural Tinamentl cht! ese ca neon car hereraie catcsmch hero so is ot ch porno, hemo ore nu se core hate Ustamernat med Remorge ere repo ops ce ime sn pele cn eae re Want uc 0 gure Sree Trocedcl hg ete etn uniede caus hemor Biograic 1. ules P. ~ Elemente de pateloge si terapeuicd crural, EOP Bucuresti 880, 2, Rbteu. ~ Cura merle, c&.tsequ, 2008 42 Sibu. Urgente crupcle abdominal, £4 Medcal8Bucuey 3989 2 Colle sont dures cractersice rgsnlor caviar cu musculature nected 381 Calica bitors Cola iro regula debuteazs in mod bse, de bie a dvd et ore ups masa e seo. Este resimits ca 0 cramp sau esi’ Im epg, co iat in spate (pre vu mopltulu sau numa erent. ln tmput colt Bolawl este agi, thea, sublebi i freevent recint manifest gestive retire asodae visita iiose seu aree ind nu srvin compat, cole estar de eg brine, Cin colle se elungeste si nu cedeazi a calmantele obit, supers irs decoder su folecstts acit Penta elu eaur cobel bla ste necesar eplrara i ioe prin: ecograi,radografie simple de Npocondrs dept, clactograte orl, fclanio safe ete Tatamentl canst in amiitrarea de antalgie (goal), anispstice (Scobu, Popaverin,atemetie(Metoclopram Colca renal CR ete o dere lamba pacts, craters pent feces, De ebicl apare bru ae sed lamb cu exacero, Aetesmining bolnavlu 6 tare de agape in cbutrea une pont tle Durereawadlah in jos etre Mpogastu, spre organele gentle au reghnes ings CR, de obi nu est ingots de fer, mums in xz de retentie Septic baits apres febra. Papares repinibonaveexacerbeacd dere Lneor se onstat contactur,Preupalmbel devises dutere ie ern Giordano examen bdomenull se costal meteosm plieapia floc a dure const deters ruse a bacinetelor sa ‘alr dat spas ureter aera rigne post i un cle angjt pe ‘wetere un chig sau un depot mucopuraont pe ureter, eu tata palin. Paracini vor efectuste exarmenul une racgraia sgl, ogra. 8Jn CR, durtilevolente neceststratament de urgent antspaice IPapavernd,antalgee unl (Algor, Baa cals ave o actune antspastck bund Inco arena cedead ls ratamentul aint se poate fos mrt ar umyaitnaseiepe cuum antspastc yt mura ups ce diagnostic este ce. 183, Coleone Col inetd ene consecins detent ites 1 2 wk receptor acs ach ia aes so aug 5) © ste 8 Iretntrl ures devin puter. ats nestle curt cies rs men tein prin bra wos vga in colea prods pin obstocha ines Aeekaedarees et rors ua etl eave pores sre ra de corte inl everett’ pe mtr ce dap prope de aaa sath dap cease epete ca pomete © nud wn Fen temorr const inate anaes ontage mal, tarde ee al mateo pert idepnarencbstcld #¢ pune ies charge 4184, Cole slpnaand acai sping rere extelcalia in pops: abdomen este suru Beamer genital eadenars.un slpne mare fare sero ogre PR. — ott de pte ciara 5, EAMeBs sucurest ee 2. lege Chie genera, Ed Apollonia 1, 199: 3B Ridley D- coer de chrurgie proctcs, vol! 9 i, f4Medis cure 2992; CS i 191. Hemi define scompotiie enotome-pateoaicd Hernia cepraints enerorares anvl organ din cavtates abdomina ‘rina zn slabs pret adomenla eu integrtatcutanats, Factor fovorzanti si hemilor sunt repreentali de eft mi tepatate, dn brontelecronieconstpatile one, efortsle de mice se teinavior cu obstacolsubverca, obentatee i sarcinle repetate ga Prine {actor predsporant aint rou eredkat, conte de iment, cone de media side munch (ured fled fea) starea muscu peretlo Sdominak gen. Factor exenil este isd efor depus I periada’ cea mal {eivd a viel, de ae majontat olnallr sont barb inte 18 950 an fort poste func bra sau mal miedo repetat,canducd ast! a apriia herr {rpunctte concede vedtent3 mai mie ale perelelt abdominal pln, ure zonelor hemi, trite sa tetris anatomice bine delat, de reastens tna) mich Fee punet sau 20nd hemiar3-a peretluabdomine-pelin ‘orespunde ovrietatetopogratics de hee Clasesea hero se poate fae dupa diverse citer > dup modal de prosucere, deovabin: het congenital 9 her > dup sed, pot fs nore suentere; ‘dp contin (ove gan abdominal co exepia pancreas > dupa evolite, ptf simple (educa reduce (nacorte 5 Srangult) > Gaps oporatie, pot 4), Hei vente, la ove pare venta at abdomen, te spi: Herat des tite: herile Inghinale, femurle 5 mbit; {teri foarte rare: eri nie! pepe ceo obturator 2) eri dora a nivel pete dort al abdomen: her3) Heri prin, a ivell lange peta 4) Heri ltragmatie, ave pret superar al abdomen Hermite nghinae, femoral st omblcale repress 95% din tot erin Indterent inde, poricartagie tush de ernie, coneite de Tecsearea sou de contin eer tate hari rest caratere generale ‘Antonia potolgicé a herilor este constuté din rei elements teletl prea soca er ivelgurl sale # connate! sae Taicl parietal punt sau soné de rensten® ciinuatd 2 pereell abdominal este reprezenatprintrun simp orf ina musle-sponeweti theta epgsstic sou um onal ona tan oii ronda item, Un trletInaporital gun fy superca sau exter, stat sibeuanat (era inghinadebes eterna). Socul hernie este format din pestoneul eae, impins. de vsceree atdominle mobile, se argajast nivel Warecukh parietal tepat se Sangeyte aluneed pe misuse hernia Se moje Forma sac este veri, Infante de topos desta evolt, [a fra globuloass a forma ‘Sind sae pflorms, Saul herr poate Hips total (a Heil ombiicale ‘mbvonat) su paral (end heriars un organ retroperitoneal = ven, cet. ivelgurle exerne ale scahh sont formate din afer planut anatomice Drift nal mst sau mal pun odate onyjnutl scat hernarvaria8 in functie de toporaia erie. Se consata eb tote vbeerele cots pentoneae supertoneale pot Heri, cu ‘Seep paneessl In maptaten eazy, is, conhmutl sac heir ete ‘eprerentat de estnlsubtie, eppon sl uneor de coon 192, Hermie —semne clin 1 Semple unetionse locale apa ia mers, n rtostatsm prune elt si se cosctoricarl prin seneatia de ereutte, uneor jn ders locas Fcmem ne local se face nartstate gin deco, efor (use, mes) 30 pus ova ee floc sb opr (a 3 = marcos 0 here spontan eaux pin {TeubtUa plpore apres constens care, In fone de conn, poate f CGosterentenaintestin) sau mosle psoas, necegulats leppon), wer 6 ae intestinului subtire. . * Evolutls her exten gone tnt progres, vluml Su manny se euinpl a poate bine suportat an de le ol ales atone ind continu "iu nu ese reperenat de intesn. Unser, a nouase, hemile mi ombeale "chiar hari nga se po vides spontan, ene ce juste studies de fexpectativa Trebuin at In vedere isa ck heli, In general cle cu conjnut intestinal, sunt pasibile de complet, nee care cea ma gad este heris stranquat Stranguarea hemi este realiats prin consticia bral, srisd 31 permagants a una sal) mltor “cere in ino soul eriar Stonglarea herni,poste f urate oui Intestinal in cru grave, de Decora wcherch a contnitulanerr gi pertonta herr 193, Testament hemilor ‘ous metode sunt pase In tratamentulhenitor: banda etpes “Tratamentl ortopede const in utara unor bande centur eae se pun enters soc beri 8 conn. (aad soln bates, trtmento onopece nu este inst dec in eazul cind stavea general a boinavutina permit watarental enrurge “atamontulchiurgial_are_drept_scop_reintepravea abdominals 2 “errs si err 3 eles partes son 4 os i serine ce, tact Everio tosis pin ce wceele abdomen pnd sb segment pntan eet mao poneote stat ener Thun po congetae, eatete (ponte) pomtounatie ‘eatriciale (dups laparotomii. a In cat eventatior, beneresvserlor abdominal se face La vel unor delecte mustuloaponevotce abgominale care I majortatea cantor Dreced intrvetile crops, Eventraja postoperatve mel este cosas 3)sub numele de hernie pottoperstarie. Tuburinie funetonle 3} anatome atlas ree dete eu cle prods cava a unel eri srangute Cling stanguiarea ve caracterizard pin apariia dures sa seni! de ‘racns bold format psuserureate pens ab, e psfpeasd defctl panel Tratamentl conservator cone in banal esti bominal gies redial seere ponder. Tetametul crural cons de obi! n erecta Healt de evemvate,reinegraren vicerelr abdominal, eacerea pret ‘ucloaponcwrote Th cond eventaiior mati se apelearh Ia plate: de Consolare itive sau de subst 195, cert defini, dascre, factor fveriant, visceral reprints ent patolgie carecterzte prin estes nor viscere abdominle. i afra cut pertoneale pinto bres complet entonce meseuleaponevrtcategamentar say Fre tegument. Eviceraia ri sieare ‘apd natura eautl generators a bree parietal, se dtng dou tip de escerti wore postoperators. Pamele my pun probleme deosebite sub ‘Spec terapeute # pean de bie! un proghoste favorabl Esceratile ‘Sestoperatn avinscimb, «evolu ail so mertaltate ns rica te fancied stature peetlulintererte in complica, deosebi tei tin de ecerati F Sibeutanatd fcompet, sarin in pina sptimnd postoperator bin deschdere lanutlor peritonen-usuaro-aponenotce; > Suprotegumentord er complet) care const in desfcere Uuror retry pest $1 ageraren arsoorintestinale cessor gh person te pl cel a ra de euscerapie sunne de oben mete pd opera, dated se ma! es defector de teh enced peratore sou copter baste a presi ntraabdominale; > Monfesta advent (boctd) care iteresens toate state, dar Contador hn loeat ound pg ra enterina Facto favrzaniinproducerea evenratilor sunt de dou cater 1) Factor genera cu sunt nefvorbi supra citric gtr: Parte Inte, mute defstors, cu —hpopoteinenie. si Ipovitomingse, ‘nome, abectot, abet, comer mature, cartcoterapa wurde coogulore au Frnt > Facto core cres preshnea mvoabdominal:efecun respirator, prostate, leas dinamie, sfart de Wdeore precee, onesta rnecoresponaétoare in pune! de vedere leon 52 2) Factor lait spol de ince, sehnica de sits, infects pg, hemateame ssarename ae ph 196 deri —semne nie stotoment Fviscoraiasupretegumentara ber survine prim, tn perioade estat postopettoie dott cesterbuste a presun intaabdominale 9 defector fe tehned chrurgals. Cellate doud tpur spar mal tru, lb 7-10 ale Dostoperator, precedste de sere minote: einige, dur ciel! pei, Ietorsm,varstur alten se instaleard bras o Saree abundent sefass, Serosanguinlen sau purulent vel lg sine duce vie percepe o senzaie de upturn nivel pigs Se const ehscenta pig cu ance vale sau aoperte de pal. tn evceatia adres ‘ocans, buzela pig apar atone, cu fale de sutra relate co see purulent a funds ‘ratamentu poate 1} Proc care constr 2» cavectreopreaperotorie defer protic, ichiiene# vtamince > inuanosatar $¢ v0 oplia 0 tehned chrugicald igri, pun traumatic csp evr, ohemostzs gi onepe nice, > pastopraar orice plogd suspect va i sustinaté cu bondofe sans, ‘in meterot netens, core 50 depdsensc la dstond marge Bligh se v0 calme lsee, se v0 menfine @. vous, veseat ermanent prin sod 82) Conservator, a fol, se adreseand a ales evsceraioraderente fonts Ins apropierea_peretor pp cu bena de leueopast S80 fee Paste gua lcldguroass 2) chiara, insted urgentin can evisceratitrsprategumentare bere 2 essceratilraderente cui mare de substan. Anesenia de breferat tabuie sf fe genelé 53 ofore o bund relanare muses Interveniachiurpialé proprivsss cuprinde dol tml tales pl so pertoneai 3 refaceres peretelu abdominal Dups operate 52 or ‘Sarina mevicamete cares ete sea vomismentee ibograie 1. Angeleseu 1. ~ Tota de patlie chris, Ee. Madeals Bice, 20; 2. CeloghereC.~ Trova decir de argent ANTS Tigra, 200% 3. praca £ — Trtat de patoogle chr, velumul 3, Edtura Medias Boss 1989. 44. Rpande Chirurg ~ vluml | seb redaeya Ia AL Psu. tra Cidactic yi Padagope, Boars 1992