ACUTE ABDOMEN IN CHILDREN E:\internet\surgeon.png ILEOCOLIC INTUSSUSCEPTION http://www.drgreene.com/wp-content/uploads/Intussusception.jpg palpable mass in right upper quadrant, pr: stool mixed with blood and mucus C:\Users\21183\Desktop\raspberry.jpg http://www.acvs.org/UploadedImages/HealthConditions/Intruss_Fig_3a.jpg http://www.surgical-tutor.org.uk/pictures/images/hne&p/intussusception.jpg HYDROSTATIC REDUCTION http://www.yoursurgery.com/procedures/intussusception/images/Intussusception.jpg boy (2y), periodic abdominal pain, vomiting ILEOCOLIC INTUSSUSCEPTION •boy (2y), periodic abdominal pain, vomiting • • palpable mass in right upper quadrant, pr: stool mixed with blood and mucus next morning – relapse of abdominal pain C:\Users\21183\Desktop\meckinv.jpg C:\Users\21183\Desktop\scanNPB\invag.jpeg http://3.bp.blogspot.com/_pOK9nKyAFVc/TFP1EC_h6jI/AAAAAAAAABM/uwwDYdi2OUg/s1600/Small+Bowel+2.JPG SURGERY ILEOKOLICKÁ INVAGINACE •boy (2y), periodic abdominal pain, vomiting • palpable mass in right upper quadrant, pr: stool mixed with blood and mucus next morning – relapse of abdominal pain http://3.bp.blogspot.com/_pOK9nKyAFVc/TFP1EC_h6jI/AAAAAAAAABM/uwwDYdi2OUg/s1600/Small+Bowel+2.JPG C:\Users\21183\Desktop\scanNPBupraveno\meckel1.jpg MECKEL‘S DIVERTICLUM RESECTION ILEOCOLIC INTUSUSSCEPTION IS MOSTLY IDIOPATHIC IN THIS AGE BUT IN THIS CASE… C:\Users\21183\Desktop\VVV\Meckel.JPG AFTER REDUCTION LOCALISATION OF INTUSSUSCEPTION ILEOCOLIC ILEOILEAL COLOCOLIC C:\Users\21183\Desktop\pyloro1.jpg •infant (6w), healthy till nowadays • • in the last few days vomiting today projectile vomiting after each feeding irritated; intensive peristalsis, bulk in right upper quadrant D:\ROBIN\NPB\internet\PYL UZ.gif PYLORIC STENOSIS C:\Users\21183\Desktop\pyloro1.jpg •infant (6w), healthy till nowadays • • in the last few days vomiting today projectile vomiting after each feeding irritated; intensive peristalsis, bulk in right upper quadrant D:\ROBIN\NPB\internet\PYL UZ.gif PYLORIC STENOSIS H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ H+ ASTRUP pH 7,47 pCO2 5,3 kPa BE 7 mmol/l Na+ 132 mmol/l Cl- 86 mmol/l K+ 3,1 mmol/l WHICH SURGICAL PROCEDURE? PYLOROPLASTY PYLOROMYOTOMY C:\Users\duch\Desktop\Thom-Hippocrateslg.jpg C:\Users\duch\Desktop\Thom-Hippocrateslg2.jpg boy (12y), progressive permanent pain in RUQ, vomiting fever, tachycardia, tenderness in RUQ, Murphy sign LEU 18 th. BILI 38 ALT 2,4 AST 1,3 CRP 94 http://www.hdi3000ultrasound.com/gallery/hdi3000ultrasound.com/Abdomen.jpg HYDROPS OF GALLBLADDER THICKEND BLADDER WALL ACUTE CHOLECYSTITIS C:\Users\duch\Desktop\Thom-Hippocrateslg.jpg ACUTE CHOLECYSTITIS E:\scanNPB\zlucnik2.png E:\scanNPB\zlucnik3.png E:\scanNPB\zlucnik4.png E:\scanNPB\zlucnik5.png C:\Users\21183\Desktop\nicperos.png C O N S E R V A T I V E T R E A T M E N T LAPAROSCOPIC CHOLECYSTECTOMY TIMING OF SURGERY? ATB ICE SPASMOLYTICS REST ACUTE CHCE DELAYED CHCE 4-40 DAY AFTER OUTSET OF SYMPTOMS •boy (12y) jaundice bili 110; conj. b. 86; AST 0,9; ALT 1,1; ALP 7,2; GMT 0,8 , colic pain in RUQ, vomiting C:\Users\21183\Desktop\simps\bart1.jpg C:\Users\21183\Desktop\simps\bart2.jpg C:\Users\21183\Desktop\bez názvu.png C:\Users\21183\Desktop\bez názvu.png , clay-colored stools , 37.3°C, tenderness in RUQ C:\Users\21183\Desktop\simps\bart3.png C:\Users\21183\Desktop\simps\bart5.jpg C:\Users\21183\Desktop\simps\bart4.jpg ? I FEEL SICK C:\Users\21183\Desktop\simps\bart4.jpg TYPES OF ICTERUS PREHEPATAL HEPATOCELLULAR CHOLESTATIC C:\Users\21183\Desktop\simps\bart6.jpg common bile duct gallstone common bile duct dilatation 14mm OBSTRUCTIVE JAUNDICE ERCP C:\Users\21183\Desktop\simps\bart8.png C:\Users\21183\Desktop\žlcesty.jpg IF ERCP FAILS… COMMON BILE DUCT EXPLORATION C:\Users\21183\Desktop\PRÁZDNÁ TABULE.png YELLOW SKIN + YELLOW STOOL -> ERCP YELLOW SKIN + YELLOW STOOL -> ERCP YELLOW SKIN + YELLOW STOOL -> ERCP YELLOW SKIN + YELLOW STOOL -> ERCP YELLOW SKIN + YELLOW STOOL -> ERCP YELLOW SKIN + YELLOW STOOL -> ERC YELLOW SKIN + YELLOW STOOL -> ER YELLOW SKIN + YELLOW STOOL -> E YELLOW SKIN + YELLOW STOOL -> ERC YELLOW SKIN + YELLOW STOOL -> YELLOW SKIN + YELLOW STOOL -> ER YELLOW SKIN + YELLOW STOOL -> ER C:\Users\21183\Desktop\Schiele.jpg C:\Users\21183\Desktop\Schiele.jpg boy (16y), sudden severe sharp pain in epigastric region subsequent shift of pain to the whole abdomen exhaustion, antalgic position and restriction of motion, tachycardia tenderness of whole abdomen, guarding in epigastrium CLINICAL SUSPICION ON GIT PERFORATION ABDOMINAL X-RAY IN UPRIGHT POSITION C:\Users\21183\Desktop\Schiele.jpg C:\Users\21183\Desktop\Schiele.jpg https://medicalforum.files.wordpress.com/2012/04/pneumoperitoneum-patient101.jpg PNEUMOPERITONEUM (GASTRIC BUBBLE) PEPTIC ULCER PERFORATION C:\Users\21183\Desktop\scanNPB\vřed.jpg LAPAROTOMY / LAPAROSCOPY PERFORATED ULCER SUTURE KOCHER MANEUVER TO EXPOSE POSTERIOR WALL OF DUODENUM: 90% OF PEPTIC ULCERS ARE IN DUODENUM C:\Users\21183\Desktop\plavci.png C:\Users\21183\Desktop\plavci3.png gastroenteritis … was visited by … summer training camp of young swimmers in one of the boys symptoms are worse than in the others VOMITING ABDOMINAL PAIN APENDECTOMY SCAR DIFFUSE TENDERNESS OF ABDOMEN INCREASED PERISTALSIS BP 110/70 HR 94 CLINICAL SUSPICION ON ILEUS X-RAY IN UPRIGHT POSITION C:\Users\21183\Desktop\RTG3ILEUS.jpg HYDROAERIC PHENOMENON (LIQUID LEVELS) ILEUS http://www.healthofchildren.com/images/gech_0001_0001_0_img0025.jpg IN SPECIFIC TYPES OF ILEUS CLINICAL SIGNS CORRESPOND WITH THE TYPE - INTRALUMINAL - INTRAMURAL - EXTRAMURAL - PROXIMAL - SMALL BOWEL - DISTAL - VOLVULUS - STRANGULATION - INTUSSUSCEPTION - PARALYTIC - SPASTIC - THROMBOSIS - EMBOLISM C:\Users\21183\Desktop\ileus.png PAIN VOMITING CONSTIPATION C:\Users\21183\Desktop\BILEJ.png SWELLING C:\Users\21183\Desktop\BILEJ.png EG. ACCORDING TO THE HEIGHT OF OBSTRUCION: C:\Users\21183\Desktop\výška ileu.png C:\Users\21183\Desktop\horni ileus.png C:\Users\21183\Desktop\tenký.png C:\Users\21183\Desktop\Intestine.png PROXIMAL OBSTRUCTION SMALL BOWEL DISTAL OBSTRUCTION OBSTRUCTION C:\Users\21183\Desktop\ileus.png C:\Users\21183\Desktop\ileus.png C:\Users\21183\Desktop\ileus.png C:\Users\21183\Desktop\BILEJ.png C:\Users\21183\Desktop\BILEJ.png C:\Users\21183\Desktop\plavci.png C:\Users\21183\Desktop\plavci3.png VOMITING ABDOMINAL PAIN APPENDECTOMY SCAR DIFFUSE TENDERNESS OF ABDOMEN INCREASED PERISTALSIS BP 110/70 HR 94 C:\Users\21183\Desktop\RTG3ILEUS.jpg HYDROAERIC PHENOMENON (LIQUID LEVELS) ILEUS CONSERVATIVE TREATMENT CONSERVATIVE TREATMENT OF ILEUS C:\Users\21183\Desktop\appe\rozp1.jpg C:\Users\21183\Desktop\appe\rozp1.jpg K+ SYNTOSTIGMIN Na+ Cl- DISSOLVE IONS AND MEDICAMENTS EFFUSE INFUSE LIQUID INTO VENOUS SYSTEM ADMIT, THAT CONSERVATIVE TREATMENT MAY NOT BE SUFFICIENT ACCUMULATED LIQUID C:\Users\21183\Desktop\plavci.png C:\Users\21183\Desktop\plavci3.png VOMITING ABDOMINAL PAIN APPENDECTOMY SCAR DIFFUSE TENDERNESS OF ABDOMEN INCREASED PERISTALSIS TK 110/70 P 94 C:\Users\21183\Desktop\RTG3ILEUS.jpg ILEUS 3 HOURS LATER 100/50 P 112 NO PERISTALSIS SWELLING, GUARDING C:\Users\21183\Desktop\RTG4ILEUS.png LAPAROTOMY IS INDICATED DUE TO THE WORSENING OF THE COURSE OF THE DISEASE http://4.bp.blogspot.com/-pV1dhIbdW7w/UF9NDrRTWxI/AAAAAAAABR0/sw2AbTeOOY0/s1600/2012-08-01+14.21.57 .jpg E:\internet\ileus.png C:\Users\21183\Desktop\anast2.jpg STRANGULAČNÍ ILEUS BOWEL NECROSIS RESECTION AND ANASTOMOSIS CONSTRUCTION ADHESIOLYSIS ABDOMINAL PAIN + VOMITING + LAPAROTOMY SCAR TO SEE A SURGEON TO EXCLUDE STRANGULATION ILEUS C:\Users\21183\Desktop\black.jpg C:\Users\21183\Desktop\HEMATEMEZA.jpg boy (7y), black stool) , weakness, breathlessness pale, sweaty, HR 112/min, abdomen without clinical signs, pr: black tarry stool past medical history: umbilical vein cannulation during doctor¨s consideration the patient starts to vomit blood CAUSES OF FAKE BLEEDING C:\Users\21183\Desktop\BILEJ.png LOWER GI BLEEDING HEMATOCHEZIA UPPER GI BLEEDING HEMATEMESIS MELENA MOSTLY LESS SEVERE MOSTLY MORE SEVERE BASIC TYPES OF BLEEDING INTO GIT C:\Users\21183\Desktop\black.jpg C:\Users\21183\Desktop\HEMATEMEZA.jpg C:\Users\21183\Desktop\HEMATEMEZA.jpg SIGNS OF SEVERE BLEEDING INTO GIT BASIC MANAGEMENT OF SEVERE BLEEDING: IN HOSPITAL NASOGASTRIC TUBE ICE-COLD IRRIGATION Leu Hb Hct (NOT WAITING FOR THE RESULTS) DICYNONE (ETAMSYLAT) KANAVIT PAMBA (PARAAMINOBEN. A.) HELICID (OMEPRAZOL) REMESTYP (TERLIPRESIN) BLOOD TRANSFUSION FRESH FROZEN PLASMA PLATELET CONCENTRATE FIBRINOGEN NOVOSEVEN (FACTOR VII)VII) OXYGENOTHERAPY CAUSES OF BLEEDING INTO UPPER GIT ESOPHAGEAL VARICES PEPTIC ULCER TUMOR EROSIVE GASTRITIS REFLUX ESOPHAGITIS HEMOBILIA MALLORY-WEISS ZOLLINGER-ELLISON • C:\Users\21183\Desktop\black.jpg C:\Users\21183\Desktop\HEMATEMEZA.jpg AFTER INITIAL STABILISATION THERE IS PLACE FOR GASTROSCOPY C:\Users\21183\Desktop\JV.jpg C:\Users\21183\Desktop\SKLEROTIZACE.jpg C:\Users\21183\Desktop\LIGACE.jpg ESOPHAGEAL VARICES SCLEROTISATION LIGATION BLEEDING SUCCESFULLY STOPPED 6 HOURS LATER HEMATEMESIS AGAIN SENGSTAKEN – BLAKEMORE (INTERIM MEASURE) SENGSTAKEN – BLAKEMORE (INTERIM MEASURE) SENGSTAKEN – BLAKEMORE (INTERIM MEASURE) SENGSTAKEN – BLAKEMORE (INTERIM MEASURE) • C:\Users\21183\Desktop\black.jpg C:\Users\21183\Desktop\HEMATEMEZA.jpg OTHER TREATMENT POSSIBILITIES (EXCEPTIONALLY) C:\Users\21183\Desktop\TIPS.jpg C:\Users\21183\Desktop\TRANSEKCE.jpg TIPSS WARREN PROCEDURE ESOPHAGEAL TRANSECTION C:\Users\21183\Desktop\nobel.jpg ACUTE APPENDICITIS WHAT IS THE TYPICAL COURSE OF APPENDICITIS? C:\Users\duch\Desktop\ruka1.png DULL PAIN IN EPIGASTRIUM VOMITING (NAUSEA) SHIFT OF PAIN TO RLQ C:\Users\duch\Desktop\ruka2.png E:\appe3.png C:\Users\duch\Desktop\srdce.png GENERAL APPEARANCE: ABDOMINAL PHYSICAL EXAMINATION: C:\Users\duch\Desktop\palp.png TENDERNESS IN RIGHT LOWER QUADRANT McBURNEY LANZ IN SEVERE INFLAMMATION: C:\Users\duch\Desktop\palp.png C:\Users\duch\Desktop\PALP2.png C:\Users\duch\Desktop\palp.png C:\Users\duch\Desktop\PALP2.png BLUMBERG-ŠČOTKIN ROVSING PLENIÉS PARACLINICAL TESTS: LEU CRP SONO E:\vrátnyý.png TYPICAL APP. COULD BE DIAGNOSED BY DOORMAN E:\vrátnyý.png HALF OF APPENDICES DON‘T READ SURGERY TEXTBOOKS C:\Users\21183\Desktop\polohy2.png C:\Users\21183\Desktop\nonrotace.png C:\Users\21183\Desktop\nonrot.jpg C:\Users\21183\Desktop\věk.jpg ANALGESICS CORTICOIDS ATB CAUSES OF ATYPICAL COURSE: C:\Users\21183\Desktop\HOUSE.gif IT COULD BE DIFFICULT EVEN FOR A SKILLED DIAGNOSTICIAN C:\Users\21183\Desktop\nobel.jpg ACUTE APPENDICITIS E:\appe3.png WHAT COULD YOU CONFUSE APPENDICITIS WITH? GASTROENTERITIS OVARIAN TORSION MESENTERIAL LYMPHADENITIS INTUSSUSCEPTION MECKEL‘S DIVERTICULUM CROHN‘S DISEASE PANCREATITIS TUMOR PYELONEPHRITIS TESTICULAR TORSION ORCHITIS SALPINGITIS PNEUMONIA CARDIAC FAILURE HENOCH-SCHONLEIN PURPURA HEMOPHILIA DIABETES TRAUMA WHAT IS THE MOST OFTEN CAUSE OF CONFUSION? C:\Users\21183\Desktop\Mesenteric-Adenitis.jpg C:\Users\21183\Desktop\MINUS.jpg MESENTERIC LYMPHADENITIS GASTROENTERITIS RUDOLPH VALENTINO (1895-1926) Hollywood actor laparotomy for abdominal pain catarrhal apendicitis 8. postoperative day passing away section: duodenal ulcer perforation DO YOU NEED TO KNOW THE APPENDECTOMY PROCEDURE? C:\Users\21183\Desktop\appe\rogozin1.jpg C:\Users\21183\Desktop\appe\rogozin2.jpg C:\Users\21183\Desktop\scanNPB\appe1.jpg C:\Users\21183\Desktop\scanNPB\appe2.jpg C:\Users\21183\Desktop\scanNPB\appe3.jpg C:\Users\21183\Desktop\scanNPB\appe4.jpg C:\Users\21183\Desktop\scanNPB\appe5.jpg LEONID ROGOZOV (1934-2000) in May 1961 as the only doctor in an antarctic station diagnosed his own appendicitis and later on performed appendectomy on himself C:\Users\21183\Desktop\nobel.jpg AND WHO IS THIS GENTLEMAN? ALFRED NOBEL WAITING, WHEN YOU DISCOVER RELIABLE METHOD OF APPENDICITIS DIAGNOSING • C:\Users\21183\Desktop\happy.jpg C:\Users\21183\Desktop\appe\bart2.tif THE SUN SHOULD NOT BOTH RISE AND SET ON ACUTE ABDOMEN THANKS