Topics of practical classes ("Medical business")
Lesson 1. Topography of the antero-lateral abdominal wall. Weakness.
1. Borders of the antero-lateral abdominal wall, division into regions, projection of organs on the anterior abdominal wall (diagram).
2. Layered topography of the antero-lateral abdominal wall. Topography of the neurovascular trunks of the anterolateral abdominal wall.
3. Formation of the vagina of the rectus abdominis muscle above and below the arcuate Douglas line (diagram).
4. Classification of incisions on the abdominal wall (diagram). Requirements for laparotomy.
5. Anatomical and clinical characteristics of weak points of the anterior abdominal wall (white line of the abdomen, umbilical ring, subcostal triangle of Volynsky, tendon bridges of the rectus abdominis muscles, semilunar Spigelius line, inguinal gap, inguinal fossa, inguinal triangle).
6. Internal relief of the antero-lateral wall of the abdomen.
7. Inguinal canal, its walls, contents, inner and outer ring. The structure of the inguinal canal in healthy people and in people with hernia (scheme according To p. A. Kupriyanov)
8. Formation of the inguinal canal in the process of lowering the testicle into the scrotum.
9. Topography of the vascular lacuna. Walls of the femoral canal, the inner and outer ring.
10. Topography of the navel and umbilical ring.
Lesson 2. Surgical anatomy of inguinal, umbilical and femoral hernias. Hernia repair, plastic surgery.
1. Hernias, mechanisms of formation of congenital, sliding, pinched hernias.
2. General rules for hernia sections, stages of operations, anesthesia.
3. hernias of the white line of the abdomen, surgical treatment technique.
4. technique of plastic surgery for umbilical hernias according to Lexer, Mayo, Sapezhko.
5. Inguinal hernias and surgical anatomy of inguinal hernia access
6. Plastic surgery of the anterior wall of the inguinal canal without opening it.
7. Plastic surgery of the anterior wall of the inguinal canal with its opening according to Martynov, Bobrov, Girard, Spasokukotsky, Kimbarovsky suture. Advantages and disadvantages of these methods.
8. Plastic surgery of the back wall of the inguinal canal by Bassini and Kukudzhanov. Advantages and disadvantages of these methods.
9. Features of surgical treatment techniques for congenital inguinal hernia, as well as sliding and pinched hernias. Technique of surgical interventions for femoral hernias by the femoral and inguinal method.
Lesson 3. Topographic anatomy of the upper floor of the abdominal cavity.
1. The Concept of "abdominal cavity", borders, division into floors.
2. Properties of the peritoneum, the ratio of organs to the peritoneum. Course of the peritoneum in the sagittal section (scheme).
3. The Course of the peritoneum in the upper floor of the abdominal cavity (spaces, slits, bags, omentum and their practical significance).
4. The topography of the liver. Syntopia, sellotape, holotape. Features of blood supply and innervation, lymph outflow.
5. Topography of the gallbladder and bile ducts. The triangle of calot (the scheme).
6. Topography of the stomach. Syntopia, sellotape, holotape. Ligamentous apparatus of the blood supply zone, features of innervation, lymph outflow.
7. Topography of the duodenum and pancreas, features of blood supply. Variants of the confluence of the ducts in the duodenum.
8. Topography of the spleen. Syntopia, sellotape, holotape, ligaments, features of blood supply and innervation.
9. Features of the production revision of the abdominal cavity in the top of laparotomy.
Lesson 4. Operations on the organs of the upper floor of the abdominal cavity.
1. Operative access to the stomach, liver, gall bladder, 12-duodenum, spleen, and pancreas.
2. Indications for suturing wounds of the stomach.
3. Application technique of the immersion joints - peritonization. Draw a diagram.
4. Draw a diagram of the albert and Schmieden seam.
5. Features of gastric wound suturing. Possible complications and errors.
6. technique of formation of gastrostomy according to Witzel.
7. The technique of forming the front and rear gastroenteroanastomosis.
8. The technique of gastric resection for B-I and B-II.
9. Indications for splenectomy. Surgical techniques for splenectomy. Technique of treatment of the spleen leg. Suture of the spleen.
10. precautions for dissection of the diaphragmatic-splenic ligament and for dissection of the gastro-splenic ligament.
Lesson 5. Topographic anatomy of the organs of the lower floor of the abdominal cavity. The General principles of imposing of an intestinal seam.
1. Topography of the lower floor of the abdominal cavity (lateral channels, mesenteric sinuses, pockets), practical significance.
2. The difference between the slim and the colon, practical value.
3. Topography of the jejunum and ileum. Features of blood supply, innervation, lymph outflow.
4. Topography of the ileocecal angle and the vermiform process (diagram). Options for the location of the vermiform process, practical significance.
5. Topography of various parts of the colon, especially blood supply, innervation, lymph flow.
6. Revision of the abdominal organs. Features of revision in middle laparotomy. Gubarev's Method.
7. Determination of the adductor and diverting loops of the small intestine by the Williams-Gubarev method.
8. Intestinal sutures. Requirements for intestinal sutures.
9. The Difference in suturing: manual - a) single-row, b) double-row, C) three-row (on the large intestine). Mechanical.
10. Intestinal sutures of Lambert, Schmiden, albert, Cherni, Pirogov-Bira, Mateshchuk-Lamber, Kirpatovsky.
11. Technique of suturing wounds of the small and large intestine.
12. The Technique of applying anastomoses "end to end", "end to side", "side to side" with and without opening.
Lesson 6. Operations on the abdominal organs
1. List access to the abdominal organs. To know them layer-by-layer topography.
2. The technique of puncture of the abdominal cavity.
3. To give a definition of intestinal suture.
4. List the main requirements for the intestinal suture. Know the different types of seams.
5. Options for the location of the Appendix. Signs of its location.
6. Typical and atypical appendectomy.
7. Indications for intestinal resection.
8. Technique of mobilization of the colon.
9. The types of intestinal anastomoses. Technique of formation of anastomoses with and without opening the lumen of the organ.
10. Indications and techniques for applying an unnatural anus.
11. Technique of resection of the colon (operations). Methods of mobilization of the colon.
12. The technique of formation of anastomosis “end to end”, “end-to-side”,“side by side”.
13. Appendectomy. Accesses for appendectomy (according to Volkovich-Diakonov and Lennander). Features of retrograde appendectomy.
14. Technique of colon resection.
15. Operation of applying fecal fistula and unnatural anus.
Lesson 7. Topography of the lumbar region and retroperitoneal space. The technique of surgical interventions on the organs of the retroperitoneal space.
1. Lumbar region, Weak points of the lateral part of the lumbar region.
2. The boundaries of the triangle of Petit and Lesgaft-Grunfeld of, their contents and value.
3. Ways of spreading inflammation from the lumbar region and their practical significance.
4. Retroperitoneal space: blood vessels and nerves, fascia and cellular layers.
5. Scheme of the layered structure of the retroperitoneal space according to G. Stromberg.
5. Paranephral blockade according to A.V. Vishnevsky, method of implementation, possible complications.
7. Topography of the kidneys, adrenal glands, and ureters (holo -, skeletostomy, and syntopia).
8. Vessels of the retroperitoneal space. Diagram of branches of the abdominal aorta, formation of the inferior Vena cava. Formation of the thoracic lymphatic duct. Operative accesses for operations on the kidneys and ureters. Their comparative characteristics.
10. Nephrectomy. Sequence of processing elements of the” leg " of the kidney.
11. Nephropexy. Different types nephropexy.
12. Pelotonia and pyelolithotomy.
13. Decapsulation of the kidney.
14. Basics of kidney transplantation.
15. The seam of the ureter.
16. Ways of infection spread.
Lesson 8. Topographic anatomy of the pelvis and perineum.
1. The concept of “basin” boundaries, the division into big and small pelvis.
2. The Course of the peritoneum in the male and female pelvis. Abdominal folds, pockets. The relationship of the pelvic organs and peritoneum.
3. Clinical significance of communication between the abdominal pelvis and the abdominal cavity. Opening and drainage of Douglas space abscesses.
4. Topography of pelvic organs in men. Blood supply, lymph outflow, innervation.
5. Topography of pelvic organs in women. Blood supply, lymph outflow, innervation.
6. Cellular spaces of the pelvis. The path of propagation of the urinary and purulent streaks. Incisions for drainage of abscesses of the pelvis.
7. Topography of the urogenital diaphragm. Pelvic floor. Their value in fixing the pelvic organs. Sciatico-rectal fossa. Incisions for opening the abscess.
8. Topography of the Alcock canal.
9. Topography of the pelvic ureters. Practical significance of their relationship with the iliac vessels and uterine arteries during operations. Risk of damage to the ureters during operations on the pelvic organs. Access to the pelvic ureters.
Lesson 9. Operations on the pelvic and perineal organs.
1. Topography of the urethra in men.
2. Topography of the urethra in women.
3. Topography of the rectum. Features of arterial blood supply and venous outflow, lymph outflow. The importance of rectal bends in the diagnosis of its diseases.
4. Indications and techniques for performing cystotomy, cystostomy.
5. Indications and techniques for performing prostatectomy.
6. Surgery for ectopic pregnancy.
7. Blockade of Shkolnikov-Selivanov-Tsodyks.
Lesson 10. Independent development of practical skills.
Lesson 11. Practical skill
Lesson 12, 13. Independent preparation for the exam.
Lesson 14. Exam