과제

[sunrise]

 

<trauma>

1.Spleen injury scale

Class1: Nonexpanding subcapsular hematoma <10% surface area.

Nonbleeding capsular laceration with<1cm. Deep parenchymal involvement

Class2: Nonexpanding subcapsular hematoma 10~50% surface area.

Nonexpanding intraparenchymal hematoma < 2cm in diameter

Bleeding capsurlar tear or parenchymal laceration 1~3cm. Deep without trabecular vessel involvement

Class3:expanding subcapsular hematoma or intraparenchymal hematoma

    Bleeding subcapsurlar hematoma  or subcapsurlar hematoma >50% suface area intraparenchymal hematoma >2cm in diameter

    parenchymal laceration>3cm deep or involvung trabercular vessels

class4: Ruoturedintraparenchymal hematoma with active bleeding

     Laceration  involvung segmental or hilar vessels producing major(>25% splenic volume) devascularization.

Class5: Completely shattered or avulsed spleen.

           Hilar laceration that devascularized entire spleen.

2.췌장 손상

type 1:contusion &laceration without duct injury        tx:external drainage

type 2:distal transection &/or parenchymal injury        distal pancreatectomy

         with duct injury

type 3 :proximal transection or parenchymal injury     distal pancreatectomy or

         with proable duct injury                                   Roux-en-Y                                                                                                      pancreaticojejunostomy 

type4: combined pancreatic and duodenal injury

         ampulla /blood supply intact

        massive injury:ampulla destoryed ;devasculation

<기타>

1.intestinal obstruction이 원인과 치료

 원인:1>기계적 폐쇄

       1)intestinal lumen obstruction:

        tumor .intussusception,large gallstone,feces meconium

       2)intrinsic bowel lesion

        comgenital:atresia,stenosis,duplication

       stricture:neoplasm.inflammation.iatrogenic

     3)lesion extrinsic to the bowel

       adhesion,hernia,volvulus

2>paralytic illeus

     <- 장관운동을 저하시키는 reflex,장기의 확장, spinal fracture,

         외상,전해질 불균형,복막염        

치료

1>보존적 치료

 -fluid&전해질 치료

 -bowel decompression

 -pain control

 -항생제

2>수술적치료

 early op:strangulation 의심시,fever,tachycardia,localized tenderness,RT,leukocytosis

 delayed op:pyloric obstraction,illocecal intussusception

2.복막층 9개층

 skin

 camper's fascia

 scapa's fascia

 ext.oblique m

 int.oblique m

 transverse abdominal m

 transversalis fascia

 endoabdomial fat

 parietal peritoneum