2. Acute intestinal obstruction

3. Actuality http://medicalplanet.su/xirurgia/157.htmlhttp://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html

4. http://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html Actuality

5. http://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html http://medicalplanet.su/xirurgia/157.html Great attention to the study of acute intestinal obstruction is given by Soviet surgeons, as evidenced by the monograph IM Perelman (1937), PN Maslow (1953), DP Fedorov (1954), PL Seltsovsky (1954), DP Chuhrienko (1955) KS Simonyan (1961) A. Altshul (1962) Actuality

6. Acute intestinal obstruction disease that is characterized by partial or total disruption of moving the contents of the gastro - intestinal tract. The most frequent intestinal obstruction Nye occurs between the ages of 40-60 years. Acute intestinal obstruction increases in summer and autumn months, which is associated with a greater load on the gut of plant food that contains high amounts of fiber. Acute intestinal obstruction

7. Frequency of occurrence of Acute intestinal obstruction   - 3.8% of acute abdominal diseases   The Republic of Uzbekistan - 4-5 cases per 100 thousand.   man: female = 4:1

8. Classification А.Г. Соловьев (1983) dynamic obstruction Mechanic obstruction Mixed obstruction AIO ParalyticSpastic StrangulationObstructive

9. Mixed intestinal obstruction (Obstructive + strangulation) Intussuscep- tion tion Adhesive bowel obstruction Acute intestinal obstruction due to malformations MalrotationDuplication Meckel's diverticulum

10. The causes of paralytic ileus The causes of paralytic ileus Pyoperitonitis Pancreatitis Hepaticcolic Choleperitonitis Omentumvolvulus Terminal ileitis Hemoperitoneum Postoperative intestinal paresis intestinal paresis

11. Causes of spastic ileus Hepatic colic Ascariasis Renal colic Stress Hypoproteinemia Uremia Beriberi Acidosis

12. Causes of mechanical obstruction Strangulation ileus Adhesions Node formation Intussusception Gut volvulus

13. Mechanical obstruction Obstructive i.obstruction Foreign Bodies Gallstones Gallstones Cicatricial stricture A ball of Ascaris A ball of Ascaris

14. Mechanical obstruction Obstructive ileus Tuberculosis of the intestine of the intestine Compression of the intestine from the outside Tumors of other organs Intestinaltumor

15. Square of symptoms nausea and vomiting Inflation of abdomen Delayed FECES and gas pain General symptomatology, diagnosis of acute intestinal obstruction.

16. The frequency of symptoms - abdominal pain 99,6% 100% 83%

17. Pain Delayed FECES and gas

18. The frequency of symptomatic Delayed FECES and gas 64,7% 80% 65%

19. Delayed FECES and gas есть нет

20. The frequency of symptomatic nausea and vomiting 73% 60% 80%

21. Vomiting нет есть время

22. The frequency of symptoms - bloating 80% 75% 82,5%

23. Квадрат симптомов Боль Задержка стула и газов Тошнота и рвота Вздутие живота Flatulence Adhesive Obstructive disease. NoGeneral flatulence Local asymmetry

24. Diagnostic algorithm А. Anamnesis B. General examination 1. General examination 1. General examination 2. Examination of abdomen 2. Examination of abdomen а) ad oculus а) ad oculus б) examination of hernial gates б) examination of hernial gates в) Palpation в) Palpation г) Percussion г) Percussion д) Auscultation д) Auscultation е) Obstructive sympyoms е) Obstructive sympyoms ж) per rectum ж) per rectum C. Instrumental D. Laboratory

25. Diagnostic algorithm  А. History taking  B. An objective examination of the patient  1. General examination  2. An objective examination of the abdomen  a) ad oculus  b) examination of hernial rings  c) palpation  g) percussion  d) auscultation  e) symptoms typical of IPOs  g) per rectum  V. Instrumental studies  G. Laboratory studies

26.   Symptom of Anshyuttsa (Bouveret) - swelling of the cecum in the localization of the reasons for the level of distal colon. Shlangs’s Symptom - visible intestinal peristalsis.

27. Symptom of Val Visibleperistalsis Hightympanitis Visibleasymmetry Palpable E. bulge

28. Palpation  Adhesive conglomerate  Fecal lumps  Tumors  Intussusceptum, intestinal knot Mandors symptom - severe rigidity of the abdominal wall, reminiscent of consistency of an inflated ball.

29. Symptom of Sklyarov (1923) - with a light concussion lateral abdominal wall auscultated "splashing"

30. Kivuls Symptom - percussion sound with a clear metallic tint Percussion

31. Auscultation  Symptom or dead silence  Silent abdomen -  subsided and the disappearance of peristaltic noises Symptom Loteysen*s (Bailey) - hearing heart sounds and breath sounds. Symptom Spasokukotsky - noise falling drop

32. Per rectum Simptoms of Girfprung Symptom Obukhov Hospital or Hogenega

33. The volume of research. It is mandatory cito: - News and Media analysis of blood - Urinalysis - Biochemistry of blood - Blood group and rhesus accessory - Survey radiography of the abdomen II. According to the testimony: - Abdominal ultrasound - Chest X-ray - Passage of barium gastrointestinal - Irrigography - Consulting physician and resuscitation

34. General analysis of blood Increase the number of erythrocytes - Increased hematocrit - Leukocytosis with left shift - Increased ESR

35. Urinalysis Special shifts are not observed, but in later stages can occur: proteinuria, indikanuriya, cylindruria, the presence of blood cells, up to oliguria anuria.

36. Biochemistry of blood Fall chloride, protein, calcium The increase in residual nitrogen: urea, indican Increased blood sugar, prothrombin index first- alkalosis then acidosis Electrolyte imbalance - potassium, sodium

37. X-ray examination required in all patients with IPOs. Running Review R-spectroscopy or R-graph is given to "standing up" in front projection: If it is impossible to make a study in a standing position in severe condition of the patient, it is permissible lateroposition (lateral decubitus)

38. The presence of the X-ray thickets Kloyberg- horizontal layers of fluids with a dome- Coated

39. And kerkringovs folds (positive symptom Casey or "fish skeleton") is certain radiographic signs of IPOs

40. In the earlier stages of the CL can be determined radiographically accumulation of gas (no liquid level) in a loop of intestine, respectively, determined by the clinical symptom Valea symptom Ginttse (Hintze)

41. Flatulence in an arch - a symptom of Shtirlins:

42. Contrast studies -Irrigoscopy Half a cup of barium- Schwartz’s test

43. Ultrasound examinations

44. Differential diagnosis of Differential diagnosis of Acute intestinal obstruction MYOCARDIAL INFARCTION Basal Pleuropneumonia Renal colic INFECTIOUS DISEASES Acute appendicitis Acute cholecystitis Acute pancreatitis Perforated ulcer Torsion CYSTS of OVARIAN Peritonitis THROMBOSIS Mesenteric VESSELS

45. Р ез.Сахибоев Д.П. Рук.Суннатов Р.Ж. conservative measures for acute intestinal obstruction

46. The volume of conservative measures AIO Strangulation ileus obstruction Obstructive ileus obstruction Dinamic ileus obstruction Non differentiated ileus obstruction Enema events are held, only a short-term Preoperative training The total volume of EE, but not more than 2 hours EE purely up to 3 days EE is not more than 2 hours

47. Contraindications to the EE All kinds of IBO, when there are at least slightest signs of intoxication in the body - tachycardia, cyanosis, blood pressure below 110 mm Hg, signs of dehydration - dry tongue, sunken eyes All running instances of the presence of fecal vomiting All cases with signs of peritonitis

48. The main direction of conservative measures Emptying the digestive tract Impact on the autonomic nervous system

49. Emptying the digestive tract Emptying the distal digestive tract Emptying the proximal digestive tract Siphon enema Cleansin g enema finger removing fecal stones Gastric lavage with a thick nasal tip or gastric tube Intubatio n of the intestine with long tube

50. Enemas are contraindicated in all types of IBOs in the 2 and 3 stages of the disease, when there are degenerative changes in the intestinal wall. This increases the pressure in the lumen of the intestine that can cause it to rupture

51. Impact on the autonomic nervous system perirenal novocaine blockade by Wisniewski Application the ganglion blocking of funds anticholinesterase funds the use of means of exciting peristalsis epidural anesthesia electrical stimulation of the intestine

52. Treatment of patients with IBOs consists of three phases: After operation management Preoperative preparation. Surgeon treatment

53. Tasks in postoperative period Evaluation state of the patient. Determining the degree of operational risk. Determining the degree of operational risk. Correction of the disturbed functions of the body. Correction of the disturbed functions of the body. Reduction of secretory function of the gastrointestinal tract. Reduction of secretory function of the gastrointestinal tract. Creating a medical background (premedication). Creating a medical background (premedication).

54. Cleansing enema

55. Siphons enema

57. 2. The correction is carried out in violation of the protein / albumin in the introduction of 100-200 ml, 200-300 ml of FFP, poliglyukin, reopoligljukin, gemodeziz and zhelatinol

58. Palliative surgery for acute intestinal obstruction

59. Palliative operations - the kinds of operations that do not address the underlying causes of disease and creates conditions for the temporary relief of the patient.

60. - Severe diffuse peritonitis. - A serious condition of the patient. - Inoperable cancer. - Local adhesions exciting third the total length of small bowel (solid conglomerate). - Massive infiltration of the mesentery tumor tissue. Indications for use of palliative operations for IBOs

61. -Ileostomy - Bypass anastomosis. - Operation Noble (enteroptissiya) Palliative operations are used in thin intestinal obstruction

62. The imposition of such a lips fistula

63. Suspension enterostomy

64. Bypass anastomosis (by Brown)

65. Metod of Nobble

66. Palliative surgery for colonic AIO (iliotransverzostomy) Anastomosis side to sideAnastomosis end to side

67. Palliative surgery for colonic AIO (transverzosigmostomy)

68. Tubular bowel fistula

69. Lips fistula of the colon

70. Mesosigmoplication (By Hagen- Torn)

71. Permanent preternatural anus (the way by Lambro)

72. Postoperative complications and mortality in acute intestinal obstruction

73. Complications of the anterior abdominal wall Festering wound Abdominal wall abscess The separation stoma of the abdominal wall

74. Abscesses of Abdominal cavity Inadequate drainage of abdominal cavity Accumulation dialysate in abdominal cavity Defective washing of abdominal cavity Inadequate antibiotic therapy

75. Abscesses of the Abdominal cavity

76. Insufficiency of the anastomosis Excessive ligation vessels Fistulization to knowingly or not viable gut Highly virulent micro flora Significant tension walls Violation exchange substances

77. After operation peritonitis The failure of welds anastomoses Separation of the stoma From anterior abdominal wall Inadequate sanitation of the abdominal cavity in intraoperative period Insufficient drainage Breakthrough emerging abscesses

78. Eventration

79. Intestinal fistulas

80. mortality Intestinal Paresis Gross violations of homeostasis Toxic shock Depletion patient Intoxication The growing phenomenon of peritonitis

81. Causes of death from non- specific complications Myocardial infarction Pulmonary edema Cardiogenic shock Acute cardio-vascular insufficiency Acute respiratory failure ICE syndrome Hypostatic pneumonia Exudative pleurisy OPPN Sepsis