General Surgery General Surgery

Áiáëiîòåêà ñòóäåíòà-ìåäèêà Medical Student’s Library GENERAL SURGERY GENERAL SURGERY ОДЕСЬКИЙ МЕДУНІВЕРСИТЕТ ОДЕСЬКИЙ ДЕРЖАВНИЙ МЕДИЧНИЙ УНІВЕРСИТЕТ THE ODESSA STATE MEDICAL UNIVERSITY Áiáëiîòåêà ñòóäåíòà-ìåäèêà Medical Student’s Library Започатковано 1999 р. на честь 100-річчя Одеського державного медичного університету (1900–2000 рр.) Initiated in 1999 to mark the Centenary of the Odessa State Medical University (1900–2000) GENERAL SURGERY Selected lectures Edited by prof. V. V. Mishchenko Recommended by the Central Methodical Committee for Higher Medical Education of the Ministry of Health of Ukraine as a manual for students of higher medical educational establishments of the IV level of accreditation using English Odessa The Odessa State Medical University 2009 BBC 54.5я73 UDC 617(075.8) Authors: V. Ye. Vansovych, N. D. Voloshenkova, D. M. Davydov, B. I. Dmytriyev , O. I. Zhuravok, V. S. Kadochnikov, V. V. Mishchenko, V. I. Savvov, Yu. I. Stepanov, A. M. Torbynsky Reviewers: M. D. Zheliba, professor, the head of the General Surgery Department of the Vinnitsa National Medical University named after M. I. Pyrogov, MD V. O. Shidlovsky, professor, the head of the Department of General Surgery and Operative Surgery with Topographic Anatomy, Traumatology and Orthopaedics of the Ternopil State Medical University named after I. Ya. Gorbachevsky, MD The textbooks on general surgery course published the previous years have lost their actuality on some problems. The curriculum organization on the credit-module system basis according to the new syllabus requires new educational-methodical supplies. This manual presents in English the lecture course taking into account the achievements of surgery. The manual is made up by the Odesa State Medical University General Surgery Department’s staff. Рекомендовано Центральним методичним кабінетом з вищої медичної освіти МОЗ України як навчальний посібник для студентів вищих медичних навчальних закладів ІV рівня акредитації, які опановують навчальну дисципліну англійською мовою. Лист ЦМК з ВМО МОЗ № 23-01-25/6 від 25.01.2007. © Колектив авторів, 2009. ISBN 978-966-7733-47-6 (серія) © Одеський державний ISBN 978-966-443-007-1 медичний університет, 2009. 4 FOREWORD The lecturers of the General Surgery Department of the Odessa State Medical University, who wrote this book, made an attempt to unite all the topics of the lecture course according to the new curriculum on the general surgery on the basis of credit-module system in organization of the educational process for English-speaking students. It gives students who are trained in the higher medical institutions of Ukraine in English, a full notion of the general surgery course. The main issues presented in the course are based on the scientific and practical achievements of the last years. The authors aimed at expanding students’ knowledge on history of the development of surgery as a discipline. Significant additions were in- cluded in the following parts: care of patients, haemotransfusion, surgical infection, anaesthesia and others which have been changed in accordance with the newest scientific and practical achievements. The parts which will be studied by students the next years are given briefly. We hope that this manual will provide students with sufficient information on general surgery and they will use it in future prac- tice. We admit that we did not manage to avoid some drawbacks. The authors would accept any critical remarks and recommenda- tions with gratitude and will take them into account in the following editions. 5 Lecture I INTRODUCTION Dear young colleagues! It is a joyful day today both in your life and in the life of the department. After you learnt the bases of anatomy, histology and some other disciplines, the clinical life begins. We are glad to greet you in the General Surgery Department and to share our experience and skills with you. We sincerely congratulate you on this day — the beginning of clinical disciplines studying. The students work in the clinic and direct contact with patients, as well as the work in operating, dressing and other rooms of the surgical hospital, has features to which students should pay atten- tion from the first day of study at the surgical clinic. Some of them are following: 1. The students for the first time come into professional contact with patients, get acquainted with various diseases and psychology of a sick person. It is necessary to remember, that not every patient with readiness will agree to be an object of study, and in many cases patients reject that students carry out dressings or any other medical and surgical manipulations. This is connected with distrust to the quality of student’s knowledge and care of health. Therefore, it is very important that students, as soon as possible, acquire theo- retical and practical skills, have a professional appearance and de- served the patient’s trust. 2. In each surgical clinic there are always some severily ill patients with various pathologies. Some patients are nervous, expect- ing for operation; others are already recovering from surgical intervention and demand, naturally, intensive therapy, rest, and care. Therefore, silent conversation gets special significance in surgical clinic, it is impossible to laugh, joke, and behave thoughtlessly, it is necessary to observe order while moving as groups of students 6 through the corridors and chambers, from one to another floor. It is no less significant to know that training is being carried out at the same time with correct and sensitive approach to the patient; 3. Features of surgical methods of treatment and threat of wounds infection demand to stick to specific actions, which directed to pre- serving sterility of dressing and instruments, surgeon’s and operation sister’s clothes, protection of postoperative wound against infection. At the operation block, dressing and manipulation rooms, special rules of behavior and certain habits, which students will gradually seize, have been developed. We shall acquaint you with them during lectures and practical classes, during the time of night duty in the clinic, during practical training, lessons in the circle of student’s scientific organization (SSO). Today it is important that you carry out all of these requirements, which are directed towards the protection of the patient against infection. It is necessary to remember that a student should always have a tidy appearance, clean lab coat, medical mask, change of shoes. 4. Despite of achievements of surgery, surgical methods of treatment still now are aggressive and cause the negative emotions in people which are not used to that. Changing a dressing is mostly painful and surgical intervention is frequently accompanied by significant haemorrhage and suppuration. Experience testifies that during the first attendance of these work sites students feel bad, lose consciousness while observing surgical operations or manipulations. It is necessary to remember this, and at the first displays of feeling bad students should immediately inform the teacher. HISTORY OF SURGERY DEVELOPMENT Surgery is a section of medicine, which because of different so- cial and economic periods developed extremely irregularly. After the period of prosperity in some ancient countries (2–4 thousand years BС) the period of its almost full degradation came in the mid- dle ages when the church domination hindered sharply the development of medicine and surgery. At last, from ХІХ–ХХ century up to the present time, the period of most intensive and rapid surgery development has proceeded. Information about surgery is received from archeological exca- vations of old burials, old manuscripts, papyruses and books, pic- tures on rocks, vases, antique sculptures and even from national 7 eposes and legends, proverbs, sayings, etc. Early people struggled with the forces of nature, trusted in evil and kind spirits, and used elementary means of treatment. There is no doubt that the most ancient medical tools were used in case of traumatic damages (while hunting, at war) and in wound complications, in the case of bleed- ing during birth and other diseases. Through the person’s importence to the forces of nature ani- malism and fetishism, shamanism and sorcery got wide spread- ing. All natural phenomena (fire, water, air, ground) and all ill- nesses of a person were connected with evil spirits (fever, shakes, swelling, etc.), which should be gotten rid of, expelled from the body of a patient or deceived (dance with noisy effects, masks, terrible clothes of shaman). Gradually people who had “contact” with these spirits singled out into separate castes of pagan priest and sorcerers. Such “skilled craftsmen” were mostly concentrated in the temples, churches, imperial palaces, empirically accumulating experience for treating diseases and mixing this experience with demon- isms and mysticism. So, gradually being separated, two qualitative- ly different directions were developed in medicine: temple medicine, which was more perfect and scientific, and folk medicine, which was primitive and developed empirically, without any claims for scientific character of knowledge. “Surgery” (from Greek cheіr — hand, еrgon — action) means “hand action”. This name occurred in the ancient times and was also used for contraposition of surgery as a trade to internal medicine, which was not investigated enough yet, complex and myste- rious science. People who had full training in temples or in special medical schools were

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