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    52 views266 pages

    शल्यतंत्र भाग 1 डॉ विजय उखलकर हिन्दी

    Uploaded by

    Kristina Babic

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    © All Rights Reserved
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    BRN aA. A ore em, A Rett Ta. A, TR tea TRAGER, ; ech eres atta eahset / ToS Tee sl — BITST Z can ‘www.shantanuprakashan.com _ Bese lantanuprakashan.com Copyrights © 2008 with the Publisher, All he rights reserved. Se eR Cea ene Se aa ey, AMI HLTT, after ergata were Tore fee, welem. 93448, mTATOT aT, 42¢, gues, G- 499.002. Ph. : 020-2445 1053 Cel : 9822085506 Rete, aenng rar, D. wy, Bieta HIB, STEFETR - ¥4¥ 004, 0241 -2321724, 9423176922 shantanu@shantanuprakashan.com www.Shantanuprakashan.com © First edition — August 15, 2008 azaeaia uaa @a fsa saws B.A.M.S. (Premera eden) M.S. (Shalya Tantra - Ayu.) Ph. D. (Scholar) DOEACC a1‘O' level ar ser acters. afterrenan, sieucta rary, mechs ange verre, 18s. areata Rasen areeraran 4 ¢ at Sgr. 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(€o) Herre aor a aor grave Precht (2), Foret SARS (C2), FTA THR (C2), aig TTT TR (62), PRTaUIre THE (63), Fe Sree Ft aunts areTeT (c's), 4) TTT orTT (c's), a) FAT era (C4), Tor ge SET (C), FE AT (G0), JE Tura TAR (So), FE TRH past (40), TOT TAT (32), TET vate (92), gong (92), srPig aero arepett (82), ae arpa Fa eps (42), avTaRy (43), TPH (Se), TUTE (3's), ToTADH (3c), FATA (3.6), RoTeAT sae (33), PARETET (2.08), TTA HEATH (¢0 8), wT Soa ( 02), Arana SIA ( 8.02), ATA TATA ( 203), FT FBR (803), TOA sAEIATA (808), TUTTE (803), TOT PARTE SIEM (202), FETSFATIN (808), GH) GIANAAN (8 08), ETAT AN (205), %) areraOT (208), B) SATAN ($ o), HOTA PURER SHER (20¢), Ulcer (222), Definition (222), Classification (233), Pathological Classification (33), Clinical Classification (# 24), Clinical Examination of Ulcer (#29), Management (£22), Treatment (+22), Differcnces between arterial and venous ulcers (#2), Wound Healing (#22), a7StaT 225), Prat (285), ATgtaOTe seme (296), aT arene Sesh ATT (228), Hee ( 898), AEATETETAT (89c), AMAT PafeaeT (88), AATE Paftrcat (¢2c), fasta Paftrcer (9c), Sinus and Fistula (arétae1) (#0), Causes of persistence of sinus ('s2), Causes of persistence of fistula (#552), Examination witha probe (242), Fistulogram or sinogram (52), ‘Treatment (352) new aetaor SAREE (252), PI AUT (4452), ACTA oh AMT THT (29), Wound (%5<), Definition (¢4¢), Types (25¢), Haha (sig a) Paice (240), Tame (26), THT PafeaaT (26 3), oTPTeGaT era Patter (2ge), Sage aereqaure Pats ( 268), eaUIGTT( #8), 8) ‘Tetanus (28°), Etiology (2&4), Organisms (2&3), Pathology (£68), Clinical features (2&9), Special types of tetanus (2&¢), Prognosis (2&3), ‘Treatment (2198), Syeda (srraras) Phar agate ( 2002), Heer SIA ‘BRUT ( 9), TTA PaPPHSAT (£195), 2) Cellulitis (arr site) (2198), 2) Erysipelas (Pref) (2.09), Pert (207), Rrra emearananet ( ¢c0), Pret Paftscar (260), Premises (22%), 2) Actinomycosis (Tea) (2%), ata (2€2), Definition (2¢2), Causes of Gangrene (£¢3), Signs of Gangrene (<8), Clinical types of Gangrene (2¢#), Specific gangrenes (2¢8), Gas gangrene (24), Pathogenesis (¢.9), Prophylaxis (2¢¢), ‘Treatment (%¢¢) Se ee ee _O ame ATT RAT ( 240), FAteTaTA TATA PafecaT (83%), Shock (fue) (242), Definition (#32), Types of shock (28.2) 880 geszory quar 300 Safar (Burn) (200), BU (Roo), Bary Koa TH g TAT (OO), ARROTGAR ara THR (200), Barat (202), Pataca (oR), wires AT (208), epitrea Pacer (208), Hare HOMETATL TAR a PafaAT (20'S), Burns (208), Types of bums (208), Pathology (20¢), Severity of Bums (208), Rule of nine (2%0), Treatment (222), Parkland formula (22), Bum wound care classification (2¢¢), Complications of thermal burn (229), Treatment of Electrical Injury (220), Treatment of chemical burn (222) mez é were ereat feet Tea AAT (RW), HAW (VW), MEAIB AO TAT (VL), PgTeT TT ATT (VIE), TAT AMA AATATAT (2), FTE TST HITT SAT (22), STITT (Removal of foreign body) (228), HITS AAP ETA THE (VY), HT AEA HUA TAA (SF), TYOSA TET HTS STT (238), area Preor ae ae aH (28), FARE AIGA eATELT SAT (232), BUSA WRATST HLT SIT (282), Tae FSA PAPA (RI), cargemqaren Rrgrare Pacer (238), aufeitcerer aren aeTEUT (285), sera PECOT HERA (22) _—) Weezer. zara onto zanarerey 3G Hemorshage (236), Clinical features of hemorthage (238), Treatment of haemorrhage (23¢), Mechanism of Haemostasis (22%), Methods of Haemostasis (2), Congenital Abnormaiities of haemostasis (22), 1) Blood Transfusion (HE) (oe), MPAA THA ATA (2, TS ‘carrera (223), GAH (22), Indication of blood transfusion (28), Blood storage (284), Types of blood transfusion (225), Blood group (228), Advantages of Blood Transfusion (229), Complications of blood transfusion (2¢¢), Blood substitute (22%), I) snpasrenfeqheret (Intravenous fluid infusion) (20), Role of nutrition in surgical patients (249), The effects of malnutrition (4%) Baszoreo _aenera fet 7D ‘aeaanhh (25 0), cea rene anfOr heat (2G 0), RATT AT (Re 2), AARET (REE), rare (26 £), ARTE (2G 2), Hara (EQ, ea (Ie a), TERT (2G2), HBA (Qo), AIMAPIET (Zo), ga (242), gree (22,8), meant a (282), aPHatw Tax HET eH (308), AGENT (30), ever: (320), Terr TAIT (220), ee (244), TTA (222), Surgical Instruments (332) Wezoree aver onfor faferean faehh ar PAR (228), RPreaT Pavia), ereraa aoe Bera UT (30) Hew ez —_ visiterier (Anaesthesia) = Anaesthesia (222), types (282), Preparation for anaesthesia (222), 1) General Anaesthesia (22), Anaesthetic Drugs (382), A) Inhalation Anaesthetic Agent (22¢), B) Intravenous Anaesthetic Agent (240), Muscle relaxants (25%), Equipments required for G.A. (252), Post Anaesthetic Complications (2'5¢),2) Regional Anaesthesia (245%), A) Spinal Anaesthesia (Subarachnoid block) (344), B) Epidural Anaesthesia 7 Extradural block (2'5%), C) Local Anaesthesia (26 ¢), D) Intravenous Regional Anaesthesia (Bier’s Block) (2) oe wernes aufa === sae aureturt Py (2&¢), TORI wor (25c), aR sheet (200), FRU Shavit (3002), sufafr (a9e), starch ant (308), Torsarers are wy (309), Hare arier Pram (aca), dam / at / turdtons (3a), aaa weer (262), Tea ay HAS (2c4), HT AEM TE (C4), TIT ature ate (ac), HERIOT (8¢), srerant eae ataPaE (ace), grea aerate (aco), ae Rea / sramet AUT (2¢\6), Bandage (2¢C), HTCATHH (33,3), TA (342), WHIT (295), Pray (24's), srreteTe art (348) Tezores_afdrdtarereray === seu afOTaPT (39:9), PUTA (23¢), Be, VLA ATM (24¢), aaa STERE (23.¢), afOretraT PER (233), TATE (299), Arenas Feige (200), Sterilization (203), Disinfection (20), Antiseptic solutions (20e) wees fee wel art (ge.2), serra (2 80), Tema TER sera ereteret (2 8c), STEFT creepers SH TE (222), TO (822), TRHAPaRRATA TN (222), Rae Seeger emt (229), HTH Ses sea BOM gah (22e), cease (22), TAT (HM) (82S), aTrerT PAE (22), ae Te a APT (824), PTAA SAT (82a), TT ARTA Fe FSR (22), SAA ‘ae ARTES (29), Slat BIT (2RC), TT MAT TH (92C), east Ta (828), shart amet feraiar (828), eat parca (223), Sat aah ase gor (930), Sra at sips aot (930), Serres (tet we4) (280), a ga (224), Types of skin closure (22), Surgical suture material (222), Suturing Needles (22%), singPrassrecctarrear agian anton rere (#20), Post operative management (#2) meoreg anoat a= Bae earePrenht (2552), are TEE (962), eTTe aOH (242), ATT TAL (852), ‘afererreofter ene arereoerrer ater eure (2s 3), UTetter ere arewoar ae ear wes (853), orf arf eer (952), aftrereofter are Prnfor FART (253), career Prafor Ptr (2's's), Pfr ener ara (ase), WferereoRter arr (25e), aftrereoter erent Arar (2519), BE TMT (BSC), ATTA (VSR), ATT adhe fae (253), ere oem area Fife Eat (V5), ARONA sete I (20), STR Praterfeeht (240), aT HET (260), ATRATATT (988), STREAMS (VEY, AAT STANT (BEI) Hewes _sifvoreet TT attest caren (2&9), aPast tect (2e9), arent sent (eee), afPramnta ware (26's), oi Pramnfersh dee arg (268), a Pat area sare (2a g), safPrarher cree ht (2G), TET RT / THR (2R9), HTT ard (96), aifmrantfaet - qdart (9qc), varat (96%), TrITTHy(283), ara Perfscer gaze (Complications) (2&3) nezrec _ emanarn 00 HUA TANT (VO), LGA LAT (os), HefteTTALT (992), sretrate Tae (202), Tetra SEO Auer sat (gee), GettenreT worth PafcaT (299), THEA (BOC), THAT THR (9c), FATTT anf (9c8), after Sor / cafreraore Pte (eee), THAT aT (gee) Hezor ee jarorenatfater a) awieteratate / aofteatater (2c), aotarett aia Pafeacer (280), =) Resaenftranr eterafftr (290), a) fea ais surafafer (28%), Plastic and Reconstructive Surgery (#82) mezerz0 ‘Radi (ar Rezo) Production of Radiograph (239), Absorption of X - rays (#9), CT or CAT Scan ('0¢), Magnetic Resonance Imaging (MRI) (38), Angiography ('st0), Doppler ('s 2), Interventional Radiology ('5%2) Hqef der 9. areata eae reads scorft opens art eh meer eet EOE see, ater TAT oT. ae ee ARAH aT Ht, ey TT A ARCATA, aT ARATE OT er ROME TET a em a cite I, EN AR aT wat TTA Rt. 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Infections (steqzizef) sarees Seraredt oferacaferensh ‘sigekenh BEE HOT ATS TA: Definition Infection is a disease state produced by lodgement and ‘multiplication of pathogenic micro-organism (parasite) in the tissue of a body (host). Classification ‘The various organisms, which produce infections, are bacteria, fungi, viruses or parasites etc. The common organisms are classified as 2 Bare A) Aerobic and Anaerobic B) Cocci, bacilli, spirochetes, vibrios C) Special strains - actinomyces, acid fast bacilli. Name of organism | Aerobic ‘Anaerobic 1 | Cocei Gram +ve Staphylococci Peptococcus Streptococci Peptostreptococcus Gram -ve Gonococci Veillonella Meningococci 2| Bacit Gram +ve Corynebacterium | Cl. welehii Bacillus anthracis } Cl. tetani Cl. septicum Gram -ve E.coli, salmonella | Bacteroides Shigella. 3| Actinomyces - Actinomyces Israeli 4) AFB © Mycobacterium | -—--- tuberculosis + _M. leprae Types of Infection » i) 20 Primary infection - Initial infection with an organism in a host. Reinfection - Subsequent infection by the same organism in the host. Secondary infection - Infection by a new organism when the host immunity is lowered by a pre existing infection. lv) Focal infection - Generalized effects produced by infection at a localized site. V) Cross infection - Infection from a new host or exogenous source in a patient who is already suffering from a disease. vi) Nosocomial infection - Cross infection occurring in a hospital. ‘The most common organisms are Staphylococci and Pseudomonas. vil) latrogenic infection - Physician induced infection through investigative, therapeutic or other procedures. viii) Inapparent (subctinical) infection - Infection without apparent clinical effects and undetectable by laboratory test. ix) Atypical infection - Infection without the characteristic clinical featues of the particular disease. 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AL, te/Ro axe fr area ere ee TAS rr wit eb aT HT Saree, ae gece er. raat are Rare caer oer ft Fer career safe safeafireetet erarort eect aerocert ferarseafiterer Freie 1 roar eects aro reer Pr er ae pot mieraret ste: rere ren TL. a 4/28 siereare Prete, eared snftr err are da ape Be Stave. 4) stores rer itor raed ier fester, rere (avereored ee), arena at STH HT (3) OT er reer a ata ear ge arent see str area. 2) sitoreara sent sttearaarrea endkeraaaiore® rere sere Be, SATEEN aT strane seafer Stam, aréerar ant weed, soo sen, Aer anf Pra seo aa. 3) sitorerareh serch stoeramret wat, mie, He, seme onfor eae as are sour erga citrate area sre gape er ara a aoe wet Fart Pattscer Boch are ae strcroaraarsh erat ont erafetach sirverare meh ere Sra See aA TEA et 2 2.2m sme aftorsiort ferftscer 2 Raed omaa a finenfttefedctereraa| eer ae qt BR 06/38 eter for sey stereo roregen Fer avatar rere Pacer aed, storrarear atures aon aes Seo AT ora erg carr Patra as a, We ag eererdhoret rat a EAS a ea srr art ater ery 2 EAL Bo/ ty eaarard fear, Strstravies enor streetcar (itsianét) wera aurea arr, so TEA, BRE Sterear stirrer tetemroret erate Reet Gey, goer a Beet Immunity Definition _ Immunity is the ability of the body to resist the injury caused by micro-organisms and their products. This is mainly by antibodies and white blood cells. It may be innate immunity (nonspecific or specific) or acquired immunity (active or passive). Immune Response ‘Immune response to an antigen can be of two types. 24 2. cam after A) Humoral immunity Itacts by antibodies secreted by plasma cells or B - lymphocytes against extracellular bacteria and viruses. It takes part in some hypersensitivity and autoimmune reactions. B) Cellular Immunity It is sensitized by T - lymphocytes. These activated. T - lymphocytes produces lymphokines which activates macrophages and other mononuclear cells resulting in destruction of the micro- organism. Immuno Suppressive Agents ‘They inhibit immune reactions and thus help in situations like ‘organ transplantation i) Radiation - No antibody production after 24 hrs. of irradiation. i) Corticosteroids - Causes lymphocytic depletion, inhibits histamine release and inflammation. i) Antimetabotites ~ Inhibits synthesis of DNA and RNA and suppress cell division and differentiation. Hence above agents act as an immuno suppressive agents. The Acquired Jmmuno Deficiency Syndrome (AIDS) and surgical patient Definition AIDS is the manifestation of chronic, retroviral infection that selectively affects the function of CD4+ and T cells caused by Human iramunodeficiency virus. The spectrum of disease varies with the degree of immunosuppression. The occurrence of certain opportunistic infectious diseases and malignancies is directly related to the degree of immunosuppression and the CD4+ count of the patient. At present, 25 2, came feeore time required from the initial HIV seroconversion to progression of the disease (0 AUDS is usually longer than 10 years. Asymptomatic patients infected with HIV should be treated by using guidelines similar to those for uninfected patients. Most of opportunistic infectious complications are medically managed. However, some of them may requires surgical intervention. e.g. Appendicitis, small bowel obstruction etc. Patient with AIDS have the potential for long term survival, and this should be considered before operative intervention. Initial Evaluation Some important factors must be thoroughly evaluated before decision of surgical treatment A) History A careful history should include questioning for risk factors for HIV infections e.g. Sexual activity like homosexual lifestyle, Intravenous drug abuse, Hemophilia patient treated with factor VIIT, Blood and blood products transfusion history. * History of dyspnoea, tachypnea, weight loss, constant diarrhoea associated with fever is suggestive of underlying pulmonary or gastrointestinal infection, * History of prior oppormnistic infections should be noted as well as the prior CD4+ count, B) Physical Examination The presence of cachexia, diffuse lymphadenopathy, active Pulmonary or systemic infections should be noted, Sometimes i immunosuppressed patients, the signs and symptoms of ongoing infections may be obscured. 26 . 2, cane frame C) Laboratory tests Following laboratory investigations should be carried out. + CD4+ count + HDSAg © Platlet count © Viral load « Hematocrit * Urine analysis * Chest radiograph Liver function test * Total feucocyte count D) Imaging studies Patients with pain in abdomen with doubtful diagnosis benefits from non-invasive modem imaging studies. e.g. Ultrasound, CT scan and MRI. These modalities may demonstrate presence of any focal mass, intestinal wall thickening, intra-abdominal lymphadenopathy, abscesses etc. Assessment of risk Patients with AIDS are at higher risk for complications than asymptomatic HIV infected infected individuals. It is predicted that \creased post-operative complication risk associates with the following factors 1) Lack of appropriate management of the AIDS related disease 2) _ Failure in the prevention of ongoing opportunistic infections 3) Hypoalbuminemia Emergency surgical intervention are associated with an increased intra and post operative risk compared with elective surgery. ‘An overall poor prognosis is associated with some surgical disorders e.g. AIDS related lymphoma,. Visceral Kaposi Sarcoma, mycobacterium avium intracellular (MAI) infection. The extent of risk to the surgeon depends upon number of procedures and length of procedures carried by him. 27 2. came afer Source of infection ‘The principle route of occupationally acquired HIV infection in health workers is by 1) Skin perforation with a hollow needle containing HIV infected blood. Although, infection has been reported after solid needle skin prick also. 2) Extensive splashing of mucous membrane and skin by HIV infected mediae.g, blood, amniotic fluid contamination through unprotected eyes and mouth during labour. Precautions AAI patients were assumed (0 be infections and 10 be handled with appropriate precautions. The risk of contamination to the persons in the operative field shall be reduced by universal precautions e.g. Wearing double gloves, Eye wears, Mask, Gown, Boots. These garments should be disposable and impermeable to large quant of blood or splashes. ies ‘Techniques that minimize percutaneous injury . Careful handling and disposal of sharp objects are essential © Surgical assistants should be kept to a minimum and instructed that not to move during operative procedure. © Good lighting and a carefully organized operative field minimized accidental exposures. * The operation should proceed in a slow and methodical manner with meticulous attention to hemostasis. Unnecessary personnel’s in the operating room should be minimized. + Inexperienced operators. should not be permitted to perform an POSE prone procedures. 2. ca ferene EE Post exposure prophylaxis » Asurgeon also has been contaminated with HIV infected blood should immediately clean the contaminated area by washing under running water. «+ Antiretroviral therapy should be started as early as possible Eg. Zidovudine 250 mg b.id., Lamivudine 150 mg b.id., Indinavir 800 mg tabs. for t month ¢ HVtest should then be repeated approximately 12 weeks after contamination to determine seroconversion has occured. 29 3. rather anor Fee 3. arora mfr Fert mez 3 aureitp anfer faseft avrenter qayauiteadta qaeaarear “aawuity” sneered aurgiraretatehy er ahs erat sre. BH, 80/3 © gated | afer airareetare, ‘array’ grat 1 ae: aeieer, Prat &ft Rrameeerit ar, oa aureiemeargn tae aa | reefer ary tor, gp? Acree ari TeT ‘arena | dteciarer get cane gatehgat ar dravort sere areata: dar sag |

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