Surgery Flashcards

Question

What causes compartment syndrome in the abdomen 2...explain ?

Answer 1

Abdominal compartment syndrome is most commonly due to excessive fluid resuscitation (>5 L in 24 hours) or massive blood transfusion (>10 units in 24 hours). Clinical signs are nonspecific and appear late. Classic findings are of increased airway pressure, decreased urine output, and a tense abdomen.

Answer 2

- is defined as an *abdominal pressure exceeding 20 mm Hg*, with a *decrease in abdominal perfusion pressure and failure of at least one organ.* - The abdominal compartment syndrome is caused by: progressive ascites, swelling of the intestinal wall, bleeding into the peritoneal cavity or distension of the intestinal loop with gas.

Answer 3

Epidural Hematoma The most common vessel damaged is the middle meningeal artery underlying the temporoparietal region of the skull.

Answer 4

venous (sternal vein) hemorrhage.

Answer 5

damage to the middle meningeal artery.

Answer 6

Definition: a non-physiological accumulation of blood between the skull bones and the dura mater.

Answer 7

*Pathomechanism: * damage to the middle meningeal artery, most often due to trauma. *Sequence of events:* trauma => loss of consciousness => bright break (regaining consciousness) => hematoma enlargement => relapse of neurological symptoms (paresis of one half of the body and dilatation of one pupil, lack of its response to light) => increase in ICP => Cushing's reflex ( increase in blood pressure and bradycardia) => death

Answer 8

*Treatment: * surgical, as soon as possible after diagnosis. -It consists in removing part of the skull bone, removing the hematoma, finding a bleeding vessel and stopping the bleeding.

Answer 9

Definition: Pathological accumulation of blood between the dura mater and the spider dura usually results from a severe head injury. It is the most common type of traumatic CNS pathology.

Answer 10

*Pathomechanism:* it is a consequence of tearing of the bridging veins traversing from the brain to the draining dural-venous sinuses, less often - a consequence of arterial bleeding. -It is accompanied by damage and swelling of the underlying brain tissue.

Answer 11

*Symptoms: *loss of consciousness without momentary returns of consciousness, mass effect - brain tissue shift resulting in hemiparesis and pupil dilation Mortality: 60-100%.

Answer 12

- a condition in which the function of the small intestine is suddenly shut down due to a disease causing damage to it or the surgical removal of all or part of the intestine. Short bowel syndrome severely impairs the absorption of nutrients and water.

Answer 13

1. intestinal necrosis of vascular origin (embolism, arterial or venous thrombosis), 2 extensive resections of the small intestine (Crohn's disease, cancer, trauma and others), 3. severe malabsorption disorders (e.g. radiation enteritis or refractory celiac disease) resulting in functional short bowel syndrome, 4. fistulas (external - causing food loss, and internal - causing food to bypass part of the small intestine). It occurs in adults with an active small intestine <150-200 cm, but after a few years the organism may adapt.

Answer 14

is a steroidogenesis inhibitor and cytostatic antineoplastic medication which is used in the treatment of adrenocortical carcinoma and Cushing's syndrome. is used to treat some types of cancer in the adrenal glands. This medicine acts on a part of the body called the adrenal cortex. Mitotane reduces the amount of steroids (cortisone-like hormones) that are produced by the adrenal cortex.

Answer 15

is the most common complication of colon diverticula (5%). It begins in a single diverticulum, then quickly spreads along the colon, leading quite often to microperforation with the symptoms of local peritonitis.

Answer 16

fever, pain in the left iliac region, leukocytosis, palpable tumor, abdominal guarding, Blumberg's sign in the lower left quadrant of the abdomen.

Answer 17

- most commonly used drugs are *ciprofloxacin *and / or *metronidazole* at standard doses, or *3rd generation cephalosporin or aminoglycoside in combination with metronidazole.* Prevention of relapse: compliance with a high-fiber diet, avoiding the use of NSAIDs other than ASA.

Answer 18

is a temporary blockade of pain transmission, used mainly during surgical procedures.

Answer 19

1. topical (application of the drug to the surface of mucous membranes, used in dentistry and endoscopic procedures), 2. infiltrative (lidocaine injection of the operating site during small surgical procedures), 3. peripheral nerve block ( nerve plexus block ), 4. epidural (administration of the drug to the epidural space), 5. spinal (subarachnoid block) (administration of the drug into the subarachnoid space), 6. intravenous regional anesthesia (administration of the drug to a vein located distally from an applied pneumatic tourniquet, useful in fractures of the upper limb bones and hand surgery).

Answer 20

inguinal, femoral, umbilical, parastomal, lumbar.

Answer 21

diaphragmatic hernia pericecal hernia, paraduodenal hernia, hernia of greater omentum.

Answer 22

We calculate the surface of burns according to the rule of nines : head 9%, each of the upper limbs 9%, each of the lower limbs 18%, anterior torso 18%, posterior torso 18%, crotch 1%.

Answer 23

In this case, the surface of the burn is: left lower limb 18% + left upper limb 9% + crotch 1% = 28%. In order to calculate the volume of fluids, we use the Parkland formula : 4ml / kg body weight /% of the body surface area affected by burns . 4 ml x 60 kg x 28% = 6720 ml, i.e. about 7 liters , of which 50% should be administered in the first 8 hours and the remaining 50% -in the next 16 hours.

Answer 24

grade I - erythema, involves only the epidermis. Stage IIa - blister, involves the epidermis and a part of the dermis. Stage IIb - superficial necrosis, includes epidermis and the whole dermis. Grade III - deep necrosis, involves the entire skin. Grade IV - necrosis or charring of deeper tissues.

Answer 25

1. functional (vomiting, diarrhea), 2. mechanical (wounds, food in the airways), 3. metabolic (overhydration, hyperlipidemia).

Answer 26

- acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients. -Acute colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray. -It is a type of megacolon, sometimes referred to as "acute megacolon," to distinguish it from toxic megacolon. (acute pseudo-obstruction of the large intestine) - a specific form of paralytic bowel obstruction, consisting of significant dilatation of the right colon.

Answer 27

The aorto-duodenal fistula is the most common form of fistula between the aorta and the gastrointestinal tract. It is formed as a result of a connection of duodenum lumen with the site of anastomosis between the aortic prosthesis and the aorta, which is usually accompanied by massive gastrointestinal haemorrhage . Moreover, inflammation is often observed there. Such a fistula can be formed after a long time from the treatment of abdominal aortic aneurysm.

Answer 28

increased parameters of inflammation, fever, shock. Abdominal ultrasound and computed tomography may reveal pseudoaneurysm in the area of the vascular prosthesis and inflammatory infiltration, often caused by staphylococci.

Answer 29

Removal of the infected vascular prosthesis as soon as possible. Restoration of proper blood circulation - reconstruction of vessels. Restoration of the continuity of digestive tract.

Answer 30

brainstem contusion

Answer 31

Cerebral contusion is a type of brain damage inflicted in the course of head trauma, usually complicated by a severe disturbance of its function.

Answer 32

*Pathogenesis:* the intracranial pressure increases on the site of impact, while the negative pressure occurs on the opposite side - therefore we can expect injuries on both sides ( contrecoup injury ). Local swelling develops , small petechiae appear, especially visible in the frontal and temporal lobes.

Answer 33

*Symptoms: *immediately after an injury, the symptoms may resemble concussion, but sometimes the patient loses consciousness only a few hours after the event. Possible neurological disturbances: sensory disturbances, hemiparesis (contusion of the frontal lobe) , facial muscle paralysis, homonymous hemianopsia (contusion of the occipital lobe) , aphasia (contusion of the temporal or frontal lobe) , gait impairment and nystagmus (contusion of the cerebellum), accelerated pulse, high blood pressure, breathing disturbances (brainstem contusion).

Answer 34

Diagnosis: computed tomography (oedema and petechial haemorrhages).

Answer 35

Treatment: symptomatic, in some cases decompressive craniectomy.

Answer 36

- collection of three signs (called Whipple's criteria) -symptoms result from *hypoglycaemia* that may indicate insulinoma. - symptoms of hypoglycaemia, low blood plasma glucose concentration - and relief of symptoms when *plasma glucose concentration is increased*.

Answer 37

-is a tumour of the pancreas that is derived from beta cells and secretes insulin. -It is a rare form of a neuroendocrine tumour. -Most insulinomas are benign in that they grow exclusively at their origin within the pancreas, but a minority metastasize. -Insulinomas are one of the functional pancreatic neuroendocrine tumour (PNET) group ("functional" because it increases production of insulin). -In the Medical Subject Headings classification, insulinoma is the only subtype of "islet cell adenoma"

Answer 38

is the occurrence of hypercalcemia as a result of autonomous excessive secretion of PTH in patients with secondary hyperparathyroidism.

Answer 39

-it is a segmental or diffuse acute inflammation of the bile ducts caused by infection due to partial or complete obstruction of the outflow of bile. -The etiological factor is most often Escherichia coli .

Answer 40

*Risk factors:* cholelithiasis, tumors that hinder the outflow of bile, post-inflammatory and iatrogenic obstruction of the bile ducts, primary sclerosing cholangitis, pressure on the bile ducts by the pancreatic cyst or enlarged lymph nodes.

Answer 41

Symptoms (Charcot's triad): 1. severe biliary colic pain in the right hypochondrium or epigastric region, 2. fever with chills, 3. jaundice.

Answer 42

*Reynolds' pentad* = Charcot's triad + 1. symptoms of shock, 2. disturbances of consciousness.

Answer 43

- a syndrome resulting from a mutation in the APC gene, causing formation of polyps in the *large intestine* (usually above 100) and in the* stomach* and *duodenum*. Patients with this genetic syndrome aged > 10 -12 require an annual follow-up colonoscopy and gastroduodenoscopy, because the risk of developing cancer around 35 years of age is almost 100%.

Answer 44

Variations: Gardner syndrome (FAP and osteosarcoma, lesions in the retina and soft tissue cancers), Turcot syndrome (FAP and CNS tumors).

Answer 45

-usually a *prophylactic colectomy *or *proctocolectomy* is performed to form a small intestine reservoir in the 2nd or 3rd decade of life *-pharmacological treatment* is considered as complementary. - best effect can be achieved by using NSAIDs. - The use of COX-2 inhibitors can be included after excluding the presence of factors that increase the risk of cardiac complications. In case of a* rectum-saving surger*y, a follow-up* rectoscopy should be performed every 3-6 months on average .*

Answer 46

1. hepatitis B 2. hepatitis C 3. primary biliary cholangitis 4. poisoning (e.g. Amanita phalloides) 5. car accidents that lead to detachment of the vascular bed of the organ with no possibility of surgical correction 6. alcoholic liver cirrhosis 7. cute liver failure 8. liver cancer (mainly hepatocellular carcinoma (HCC)) - hepatic transplantation is allowed in the case of HCC limited to the liver and meeting certain criteria (Milan criteria - a single cancer lesion with a diameter of up to 5 cm or up to 3 lesions with a diameter of up to 3 cm). 9. primary sclerosing cholangitis 10. metabolic diseases (Wilson's disease, hemochromatosis, amyloidosis) 11. autoimmune hepatitis 12. Budd–Chiari syndrome 13. secondary biliary cirrhosis 14. polycystic liver disease 15. cystic fibrosis

Answer 47

-exposure to ionizing radiation, especially if exposure occurred in childhood,

Answer 48

low availability of iodine in the environment.

Answer 49

genetic factors (25% of cases due to activating germline mutation of the RET gene).

Answer 50

papillary carcinoma

Answer 51

- progressive anemia and abdominal pain.

Answer 52

- changes in bowel habits (diarrhea with a lot of mucus or constipation), blood in the stool.

Answer 53

- a tumor that can be palpable during digital rectal examination.

Answer 54

- often called* hereditary nonpolyposis colorectal cancer (HNPCC)*, - an inherited disorder that increases the risk of many types of cancer, particularly cancers of the colon (large intestine) and rectum, which are collectively referred to as colorectal cancer.

Answer 55

*Lynch I syndrome* - cancer affects only the large intestine *Lynch II syndrome *- colorectal cancer is accompanied by malignant tumors of the heart, ovary, stomach, small intestine, kidneys, ureters and less often skin, bile ducts and central nervous system

Answer 56

1. occurs at an early age (<50 years of age) 2. it is more often located on the right side or it is multifocal 3. has a lower tendency to metastasis 4. it is usually poorly differentiated 5. it is often resistant to chemotherapy 6. In order to prevent colon cancer, it is recommended to perform partial or subtotal colectomy - the best solution seems to be almost complete excision of the large intestine - this reduces the risk of next tumor foci.

Answer 57

small reservoir where common bile duct and pancreatic duct meet

Answer 58

- enlarged, painless and palpable gall bladder. - It occurs in *tumors located within the cystic duct *and *common hepatic duct junction* or within the *common bile duct.*

Answer 59

-* adenocarcinoma* - *65% of cases* it is located in the *head of the pancrea*s

Answer 60

1. *Whipple procedure* - removal of the pancreatic head, gall bladder, common bile duct, duodenum and pyloric part of the stomach, 2. *Traverso procedure* - as above but with pylorus saved 3.* total* pancreatic resection, 4. *partial* pancreatic resection.

Answer 61

pancreatic head, pyloric part of the stomach, common bile duct, gall bladder, duodenum

Answer 62

internal carotid, radial, ulnar, humeral, femoral popliteal, dorsalis pedis, posterior tibial.

Answer 63

common iliac artery

Answer 64

- aortic stenosis

Answer 65

(reduced left ventricular ejection volume, e.g. in heart failure),

Answer 66

(aortic regurgitation),

Answer 67

(failure of the left ventricle)

Answer 68

(cardiac tamponade)

Answer 69

(atrial fibrillation)

Answer 70

(aortic dissection, atherosclerotic narrowing of the arteries)

Answer 71

- this is a reduction or even disappearance of the pulse on inspiration , which is accompanied by a decrease in systolic blood pressure> 10 mm Hg. - The size of the pulsus paradoxus can be assessed using a sphygmomanometer - it is present when the first tone of Korotkow is heard only during exhalation.

Answer 72

Ia - spurting arterial bleeding (active bleeding). Ib - oozing bleeding IIa - visible non-bleeding vessel (recent bleeding). IIb - adherent clot IIc - black spot in ulcer base III - clean ulcer base (history of non-recent bleeding).

Answer 73

- to assess bleeding during gastroduodenoscopy . - This is the basic diagnostic test for *suspected bleeding to the upper gastrointestinal tract* (above the Treitz ligament)

Answer 74

-The suspensory muscle of duodenum (also known as the ligament of Treitz) -is a thin muscle connecting the junction between the duodenum and jejunum (the small intestine's first and second parts, respectively), as well as the duodenojejunal flexure to connective tissue surrounding the superior mesenteric and coeliac arteries. -The suspensory muscle most often connects to both the third and fourth parts of the duodenum, as well as the duodenojejunal flexure, although the attachment is quite variable.

Answer 75

1. ulcer of the duodenum and stomach, 2. acute hemorrhagic gastritis 3. esophageal and gastric varices, 4. Mallory and Weiss syndrome, inflammation of the mucous membrane of the esophagus or duodenum, 5. cancer, 6. esophageal ulceration, 7. vascular malformations. Up to 80% of patients with GI tract bleeding are bleeding to its upper part.

Answer 76

1. peritoneal signs (peritonitis), 2. air under the diaphragm revealed in chest X-ray (perforation of the gastrointestinal tract), 3. lack of peristalsis in auscultation test (paralytic ileus), 4. unexplained patient deterioration and shock (internal bleeding).

Answer 77

*thoracotomy* procedure is performed urgently

Answer 78

*abbreviated laparotomy* 3 stages: 1. Opening the abdominal cavity and controlling bleeding (ligating vessels, packing parenchymatous organs). - In the situation of an open intestinal wound, a resection of a given intestinal segment is performed and the stumps are ligated without the final reconstruction of the continuity of the gastrointestinal tract. - The abdominal cavity is closed with several temporary stitches. 2. Shock treatment. 3. Re-opening the abdominal cavity and performing a classic definitive operation.

Answer 79

- in abdominal surgery, a procedure involving *temporary clamping of the hepatoduodenal ligament during surgery* (using surgical forceps, tape or fingers), and** thus closing the underlying hepatic artery and portal vein in the ligament.**

Answer 80

resection of liver parenchyma, e.g. due to cancer, liver injuries, bleeding from the cystic artery.

Answer 81

1. In stable patients, conservative treatment may be used, however, frequent imaging of the abdominal cavity (CT) is important. 2. Superficial liver damage can heal spontaneously . 3. In the case of capsular rupture and damage to the liver parenchyma, *laparoscopic drainage* and *peritoneal lavage prevents inflammation* (blood and bile pass into the peritoneal cavity). 4. Liver ruptures are *sutured with an ultrasonic or argon knife *. 5. Extremely *severe damage requires resection of the liver fragment.*

Answer 82

**Insulinoma **(islet cell tumor) -is the *most common pancreatic neuroendocrine tumor* that can occur in any age group, but most often affects adults. -In most cases, it is *benign (75%)* and *origins from pancreatic B-cells.*

Answer 83

*Diagnosis:* determination of the ratio of serum insulin to blood glucose level after starvation.

Answer 84

*Treatment:* surgical enucleation of the tumor or partial pancreatectomy.

Answer 85

*Symptoms* -** Whipple's triad:** 1. Impaired consciousness (memory disorders, periodic loss of consciousness, apathy). 2. Hypoglycemia. 3. Symptoms go away after carbohydrate administration (occur during fasting).

Answer 86

Colon cancer diverticulitis sigmoid volvulus

Answer 87

postoperative adhesions, incarceration of the abdominal hernia, tumors or gallstones of considerable size, intussusception, foreign bodies, inflammatory bowel diseases, e.g. Crohn's disease.

Answer 88

volvulus, neoplastic tumors, diverticulitis, fecal stones, foreign bodies.

Answer 89

parastomal, umbilical, femoral, inguinal, lumbar.

Answer 90

pericecal paraduodenal diaphragmatic omental

Answer 91

Bassini, Halsted, Shouldicev

Answer 92

Lichtenstein, Rutkow, PHS (prolen hernia system).

Answer 93

- is a true diverticulum, i.e. it is *formed by all layers of the intestinal wall. * - It is a remnant of the *fetal omphalomesenteric duct.*

Answer 94

*Epidemiology*: occurs in about 2% of the population (three times more often in men). *Location:* final section of the ileum, about 60 cm from the iliocecal junction, at the iliocecal valve.

Answer 95

Structure: -the diverticulum is usually lined with the mucous membrane of the small intestine, but it can also contain the ectopic focus of the mucous membrane of the stomach, duodenum, pancreas. -It is characterized by various length, usually 5-15 cm, although it can rarely reach up to 50 cm.

Answer 96

-Tis means infiltration of the mucous membrane, -T1 is the infiltration of the submucosa, -T2 means infiltration of the muscular membrane, -T3 is infiltration of pericolon / perianal tissues, -T4 means infiltration of other organs / structures or visceral peritoneum.

Answer 97

- the ratio of the systolic pressure measured on the foot to the systolic pressure on the arm, patient lying on his back. -In normal conditions, the blood pressure is equal to or slightly higher within the ankle. -Values in the range of** 1.0 - 1.4 are the correct values** (borderline values are 0.9 - 1.0). NOTE: - value <0.9 indicates the presence of stenoses (in critical ischemia is usually <0.5) , - value> 1.4 indicates abnormal vascular stiffness (in diabetic patients, chronic kidney disease, in the elderly).

Answer 98

- positive when facial muscles spasm after being tapped with a neurological hammer in the point located right in front of the earlobe.

Answer 99

- is positive if "hand of the obstetrician" occurs, - i.e. hand muscle contractions are detected after maintaining the pressure cuff inflated for 20 mmHg higher than the systolic blood pressure for 3 minutes.

Answer 100

- is based on increased motor nerve excitability - (e.g. facial nerve) to electrical stimulation (galvanic current)

Answer 101

**PTH deficiency (hypoparathyroidism)** These are symptoms that occur in hypocalcemia (low serum calcium <2.25 mmol/l).

Answer 102

1. insufficient dietary calcium intake 2. impaired calcium absorption (malabsorption syndromes) 3. excessive deposition of calcium in the bones (taking bisphosphonates, acute pancreatitis) 4. excessive loss of calcium in the urine (taking loop diuretics) 5. Vitamin D deficiency (celiac disease, chronic kidney disease) 6. PTH deficiency (hypoparathyroidism)(choice E) 7. tissue resistance to PTH (pseudohypoparathyroidism)v

Answer 103

-mesorectum -rectum together with the fascial sheath.

Answer 104

caecum tumor , ascending colon, 1/3 of the transverse colon and the final section of the small intestine),

Answer 105

descending colon tumor, 1/3 of the transverse colon

Answer 106

-derived from *mesenchymal cells* most likely from Cajal "pacemaker" cells of the gastrointestinal tract. -These are the cells that *automatically cause the intestinal muscle to contract, initiating peristalsis.*

Answer 107

epithelial - cancers mesenchymal - sarcomas lymphoid tissue and hematopoietic system - lymphomas and leukemias from the primary germ cell - germ cell tumors

Answer 108

-in the stomach (40-70%) (answer B) -small intestine (20-50%) -in the large intestine (approx. 5%) and esophagus (<5%)

Answer 109

laparoscopic "Right adrenalectomy"

Answer 110

- as the name implies the tumor detected accidentally, during routine tests, not hormonally active, giving no symptoms. - If such a tumor is detected (most often during ultrasound or CT scan), a more detailed diagnostics should be performed: 1. Hormonal teststo exclude 2. Cushing's syndrome 3. Pheochromocytoma 4. Conn syndrome - when hypertension or hypokalemia coexists hyperandrogenaemia *Imaging tests *- CT (if not performed) or MR A fine needle aspiration biopsy is performed only if there is a suspicion of a neoplastic metastasis to the adrenal glands with an unknown primary origin

Answer 111

-cancer of the bile ducts located at the junction of the right and left hepatic ducts -Klatskin tumor is a term given to " Cholnagiocarcinoma" -Cancer of the bile ducts most often occurs in the extrahepatic ducts and takes the form of adenocarcinoma.

Answer 112

-Mechanical jaundice - the first and most common symptom, it is not accompanied by fever or pain -pain under the right costal arch at a later stage of the disease -Courvoisier's symptom (palpable, painless, enlarged gallbladder) if the tumor is located in the common bile duct .

Answer 113

Laboratory tests showed** increased levels of bilirubin, CEA and CA 19-9.** Treatment - radical, surgical removal of the tumor (5-year survival approx. 10%).

Answer 114

-epigastric pain, often appearing at night, -radiating to the left hypochondrium or to the thoracic spine of a "burning" or "pressing" nature. -Changing the position of the body while tilting forward usually reduces the intensity of the pain. -*Mechanical jaundice and Courvoisier's symptom* (palpable through the integuments, enlarged, painless gallbladder) may be the first symptom of a tumor located in the head of the pancreas. -Jaundice is caused by the tumor pressing or infiltrating the common bile duct. -The risk of pancreatic cancer increases with age, and more than 80% of cases are diagnosed after the age of 50, therefore in a 68-year-old patient with painless jaundice, pancreatic head cancer should be ruled out first.

Answer 115

1. Femoral artery - 43% 2. Iliac artery - 18% 3. Aortic bifurcation - 15% 4. Popliteal artery - 15% Typical symptoms are referred to as 5P: a. Pain b. Pulseless c. Paresthesis - disturbance of feeling, numbness d. Pallor - white skin color e. Paralysis - muscle weakness

Answer 116

- *aortoiliac occlusive disease* is a form of central artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries. -a type of chronic ischemia of the lower limbs in which there is narrowing of: - End/Distal segment of the abdominal aorta - Both Common Illiac Arteries - Both External Illiac Arteries

Answer 117

-is a type of colectomy that removes part of the colon and sometimes rectum (proctosigmoidectomy). -The remaining rectum is sealed, creating what is known as Hartmann's pouch. - The remaining colon is redirected to a colostomy. - It can be reversed later.

Answer 118

- (80%) concerns the small intestine. - The most common causes of small intestinal mechanical obstruction are postoperative adhesions, and for large intestine - colorectal cancer.

Answer 119

*Treitz ligament;* -therefore, the *lower GI refers to both the small and large intestine * - which makes *adhesions of the small intestine the most common cause of obstruction! *

Answer 120

-80% refers to the small intestine -occlusion most often concerns the large intestine - colorectal cancer -bowel infarction most often concerns the small intestine postoperative adhesions (the most common cause), hernia incarceration, intestinal torsion, intussusception

Answer 121

-caused by irritating effects of various factors on intestinal nerve plexuses (digestive juices, bacteria, after operations) -reflex (bile and renal colic, spinal and pelvic fractures, injuries and tumors of the CNS, testicular, ovarian torsion) -systemic complication (decompensated diabetes, uremia, water and electrolyte disturbances)

Answer 122

_ also called Sudeck’s atrophy, Sudeck’s disease, *Sudeck’s syndrome*, algodystrophy, reflex neurovascular dystrophy, reflex sympathetic dystrophy, amplified musculoskeletal pain syndrome, shoulder-hand syndrome or causalgia.

Answer 123

-is a painful long-term swelling of periarticular tissues with impaired blood supply and atrophic changes in soft tissues and bones. -It applies to the area of the wrist and ankles. -The factor conducive to the development of the disease state is incorrectly and too tightly fitted dressing, which makes the limb immobilized in the wrong position.

Answer 124

- isolated fracture of the proximal ulna associated with dislocation of the fragments and dislocation of the radial head. - A common complication is damage to the deep branch of the radial nerve, - the symptom of which is impaired straightening of all the fingers and the metacarpus. - the so-called hand drooping. - Surgical treatment is indicated.

Answer 125

**an isolated fracture of the shaft of the radial bone with dislocation of the fragments and dislocation of the ulna head**

Answer 126

partial or incomplete dislocation

Answer 127

- fracture of the distal radius bone as a result of a fall on an extended limb during dorsiflexion of the wrist and forearm conversion

Answer 128

duodenal ulcer disease.

Answer 129

1. haemorrhoids - the most common cause of chronic bleeding 2. colon polyps, 3. diverticular disease, 4. colorectal cancer, 5. Meckel's diverticulum, 6. inflammatory bowel diseases - UC and Crohn's disease, 7. angiodysplasias.

Answer 130

- about 30% of patients with deep vein thrombosis within the lower leg. -It involves the induction of considerable pain within the calf and popliteal fossa during the dorsal flexion of the foot, while maintaining an upright knee. -This is due to painful inflammation in deep veins when tightening them. -The finding of this symptom confirms the diagnosis of deep veins thrombosis of the lower limbs.

Answer 131

**Pancreatic head cancer **- symptoms: *epigastric pain, often appearing at night,* radiating to the left hypochondrium or to the thoracic spine of a "burning" or "pressing" nature. -Changing the position of the body while tilting forward usually reduces the intensity of the pain. -Mechanical jaundice and Courvoisier's symptom (palpable through the integuments, enlarged, painless gallbladder) may be the first symptom of a tumor located in the head of the pancreas. -Jaundice is caused by the tumor pressing or infiltrating the common bile duct. -The risk of pancreatic cancer increases with age, and more than 80% of cases are diagnosed after the age of 50, therefore in a 68-year-old patient with painless jaundice, pancreatic head cancer should be ruled out first.

Answer 132

- increasing pain while lowering the patient's limb (characteristic for the retrocecal position of the appendix)

Answer 133

- pain in the right iliac area while moving the hands along the colon antiperystically

Answer 134

- haracterized by a lack or slightly increased pain during delicate pressure on abdomen, with a characteristic induction of acute, severe pain at the moment of rapid relief of pressure

Answer 135

Meckel diverticulum occurs in: -about 2% of the population, -is about 2 inches in length, -is usually located within 2 feet of the ileocecal valve, -presents before 2 years of ag

Answer 136

-Supracondylar fractures are the most common elbow fracture in children, especially in the first decade of life. -The peak age is from 5-8 years. -The usual mechanism is a fall onto the outstretched hand with hyperextension at the elbow.

Answer 137

is a group of liver disorders in which substances called porphyrins build up in the body, negatively affecting the skin or nervous system.

Answer 138

*acute porphyria*, symptoms are rapid in onset and short in duration. -Symptoms of an attack include abdominal pain, chest pain, vomiting, confusion, constipation, fever, high blood pressure, and high heart rate. The attacks usually last for days to weeks.

Answer 139

-is pain in the legs or arms that occurs while walking or using the arms. -The pain is caused by too little blood flow to the legs or arms. -Claudication is usually a symptom of peripheral artery disease, in which the arteries that supply blood to the arms or legs, usually the legs, are narrowed.

Answer 140

I - asymptomatic IIa - claudication > 200 m - mild claudication IIb - claudication <200 m - moderate / severe claudication III - rest pain IV - ischemic necrosis and ulcers

Answer 141

pancreas head duodenum gallbladder CBD

Answer 142

- the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients -Acute colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray. -It is a type of megacolon, sometimes referred to as "acute megacolon," to distinguish it from toxic megacolon.

Answer 143

- refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. - The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.

Answer 144

1A - phlegmon 1B - diverticulitis with para-colonic abscess 2 - diverticulitis with a limited pelvic abscess 3 - diverticulitis with diffuse purulent peritonitis 4 - diverticulitis with diffuse fecal peritonitis

Answer 145

- acute inflammation of the intra- and / or extra-hepatic biliary ducts caused by infection due to obstruction or blockage of the outflow of bile

Answer 146

1. severe pain resembling biliary colic in the right hypochondrium or middle epigastrium area 2. fever with chills 3. jaundice Note: I f there are *signs of shock and disturbance of consciousness,* then* this state is called the Reynolds pentad.* pain during palpation in the right hypochondrium area increased tension of the stomach muscles

Answer 147

- also known as the *esophagogastric angle*, is the *acute angle created between the cardia at the entrance to the stomach, and the esophagus.* - It helps to *prevent acid reflux of stomach acid into the esophagus*. - It is commonly undeveloped in infants, making acid reflux more common.

Answer 148

-When a patient requires urgent surgery, the action of vitamin K antagonists should be immediately reversed. -Freshly frozen plasma should be administered (recommended dose 15 ml / kg body weight, on average 4-5 units). -An alternative to this is the transfusion of the prothrombin complex concentrate.

Answer 149

-is a deficiency of all macronutrients Types of malnutrition: -chronic protein-caloric malnutrition due to chronic starvation -progressive weight loss -leads to disorders of organ function the albumin concentration is normal for a long time (but sudden illness or injury causes a rapid reduction in albumins) -most often occurs in patients with chronic diseases and cancers -in extreme cases it can lead to emaciation (cachexia) -nutrition via the gastrointestinal tract is recommended

Answer 150

-acute malnutrition most often due to acute illness, trauma, surgery -hypoalbuminemia, edema, water-electrolyte disturbances, disturbances of consciousness occur -can occur in overweight, obese patients when they receive only crystalline liquids without protein supply -very rapid development of malnutrition, without losing weight (weight can even increase by water retention and edema) the patient's condition quickly deteriorates parenteral nutrition is recommended

Answer 151

- an individual excretes too much water without also excreting electrolytes, leaving the fluid that surrounds cells (i.e., extracellular fluid) with a high sodium concentration. - A high concentration of sodium outside a cell will draw water out of the cell, towards the sodium

Answer 152

- dryness of mucous membranes and skin, hypotension, tachycardia, oliguria - signs of dehydration - strong feeling of thirst - a symptom of hypertonia - confusion, hallucinations, hyperthermia - CNS symptoms

Answer 153

respiratory acidosis.

Answer 154

the first examination should be interview, *physical examination and laboratory tests* of blood: - total bilirubin and direct (conjugate), ALT, AST, ALP, PT, GGT, albumin.

Answer 155

- 1. *ultrasound examination of the abdominal cavity* should be performed in the presence of *conjugated hyperbilirubinemia* of the *cholestatic type* in which* **ALP** is greater than or equal to 2x the upper norm*. - 2. **ALT **is *less than or equal to the upper norm*, - 3. and the ratio **ALT to ALP** is *equal to or lower than 2.* | "Duke" has Colorectal cancer

Answer 156

Colorectal cancer - **about 85% are adenocarcinomas**. A - a tumor limited to the intestinal wall B - the tumor exceeds the intestinal wall C - tumor size is irrelevant because there are metastases in the lymph nodes: C1 - pericolic C2 - along the blood vessels D - distant metastases.

Answer 157

Gastric cancer -** 95% is adenocarcinoma**. **Laurenaclassification** - is the most commonly used microscopic classification of *gastric adenocarcinoma.* **Lauren I** - intestinal type - more often endemic, most likely associated with environmental factors, better prognosis **Lauren II **- diffuse type - worse prognosis, genetic predisposition. | "Lauren" has Gastric cancer...L-II others are involved = genetic

Answer 158

The staging of cancer of the **pancreas and hepatocellular carcinoma** is based on the **TNM classification**.

Answer 159

- is a usually benign vascular tumor derived from blood vessel cell types. - The most common form, seen in infants, is an infantile hemangioma, known colloquially as a "strawberry mark", most commonly presenting on the skin at birth or in the first weeks of life

Answer 160

- noncancerous (benign) mass in the liver made up of a tangle of blood vessels. - Also known as *hepatic hemangiomas or cavernous hemangiomas,* these liver masses are common and are estimated to occur in up to 20% of the population. -Liver hemangiomas concern about 3% of the population. -They are usually accidentally detected during imaging tests. In most patients, hepatic haemangiomas do not cause any symptoms. -Rare symptoms are pain in the right hypochondrium and pressure on neighboring organs.

Answer 161

- sudden, rapidly growing pain in the right hypochondrium radiating to the right shoulder and/or scapula; usually nausea, vomiting and abdominal distension also occur

Answer 162

- usually caused by obstruction of the cystic duct, diagnosed in 20% of patients; dull pain over the entire epigastric region, are diffuse, intensifying during inhalation; nausea, vomiting, fever (38-39°C), chills, sometimes jaundice

Answer 163

- a result of mechanical irritation of gallbladder mucosa by gallstones; in 25% leads to bacterial bile infection occurs, symptoms include biliary colic, right upper quadrant (epigastric) pain, burping, nausea, bloating, feeling of fullness after meals

Answer 164

- as a result of blockage of the cystic duct; colic attack, after which you can feel a slightly painful gallbladder

Answer 165

- the formation mechanism is the same as in hydrops, but is accompanied by bacterial inection/inflammation; the symptoms include high fever (39-40°C), chills, peritoneal symptoms, constant severe pain in the right subcostal (hypochondrium) area with radiation to the right scapula

Answer 166

- this is a complication of untreated inflammation (empyema), hydrops or abscess

Answer 167

morphine causing contraction of the **hepato-pancreatic ampulla**

Answer 168

1. diet (elimination or significant reduction of fried products as well as fats, cream, peas, egg yolks and chocolate) 2. supply of analgesics and relaxant (most commonly metamizole, hyoscine and papaverine, it is possible to use nitroglycerin sublingually, which is a strong relaxant; avoid morphine causing contraction of the hepato-pancreatic ampulla) 3. administering choleretic drugs (Cholestol or Raphacholin, but they do not prevent biliary colic attacks) 4. in the case of inflammation or abscess - administration of antibiotics

Answer 169

1. symptomatic gallstones 2. asymptomatic cholelithiasis, but only when it is associated with a high risk of gallbladder cancer, i.e. in people: a. young, especially with multiple gallstones, at risk of acute pancreatitis as a complication b. with a porcelain gallbladder (especially when the calcification of walls is irregular) c. with diabetes d. before extensive cardiac surgeries or organ transplantation e. treated with immunosuppressants or cytostatics f. women planning pregnancy g. with gallbladder polyps (>1 cm or between 6-10 mm, when gallstones are growing and present, or regardless of size in patients with sclerosing cholangitis)

Answer 170

1. small gats - the operation involves reducing the hernia sac and stitching the gates 2. large gates - the operation consists in reducing the sac and closing the gates with the *Mayo method*, which consists in suturing the doubled patches formed by the sheaths of the rectus abdominis muscles

Answer 171

- hypoparathyroidism (3-10%) - the most frequent complication after thyroidectomy, caused by parathyroid dysfunction or accidental excision. It is associated with a decrease in the concentration of parathyroid hormone produced by parathyroid glands, which is manifested by hypocalcaemia and tetany. Most often, the symptoms are transient. Treatment consists in the administration of vitamin D and calcium preparations. - haemorrhage (<1%) - more often during retrosternal, mediastinal and overactive goiter surgery. - unilateral damage to the recurrent laryngeal nerve (1-5%) - this causes phonation disturbances. - bilateral damage to the recurrent laryngeal nerves (0.1%) - there is dyspnea that threatens life, what is an indication for tracheostomy. - thyroid storm - it happens very rarely when the patient was not prepared for the procedure in terms of compensation of thyroid hormones. - recurrent goiter - recurrence of thyroid cancer after incomplete excision of the gland. - keloid - a scar with a thick, red, raised surface, going beyond the original cut line.

Answer 172

- it is a resection of the head of the pancreas and duodenum while preserving stomach

Answer 173

- involves the removal of the head of the pancreas, duodenum and part of the stomach. - Then, anastomoses are made: the pancreas with the end of the intestine, the common bile duct with the side of the intestine, the stomach with the small intestine loop. - An additional anastomosis is decompressive anastomosis, which consists in suturing the small intestine side to side.

Answer 174

- acute, short-lasting abdominal pain, felt at the moment of sudden release of manual skin compression. - Positive in peritonitis. - A positive Blumberg sign and abdominal guarding as symptoms of peritonitis can also occur in the perforation of the large intestine. | "B" Be "Positive" B- for bluberg

Answer 175

- pain in the right iliac fossa, caused by compression of the left half of the abdomen (this causes the displacement of the contents in the colon, which causes the pain while stretching the ceacum). - Characteristic of appendicitis.

Answer 176

- the patient lying on his back raises the lower leg straightened in the knee joint. The examiner compresses the right hip, instructing the subject to gradually lower the limb. - The sign is positive when the patient feels pain while lowering the limb. - The sign is evidence of retrocaecal appendicitis.

Answer 177

-appendicitis. -Appendicitis is usually accompanied by *peritonitis*

Answer 178

hospitalization, antibiotic therapy and a liquid diet

Answer 179

-so called bubonocele - hernia is limited in the inguinal canal

Answer 180

- exceeds the canal; the hernia passed through the superficial inguinal ring

Answer 181

- hernia in the scrotum

Answer 182

- hernia near the labia majora

Answer 183

- partially intraperitoneal organ pulled to the hernia

Answer 184

- always acquired, rarer than indirect inguinal hernia, - does not descend into the scrotum, gates are formed by medial inguinal fossa. - The hernia manifests itself with a bulge above the inguinal ligament, close to the pubic symphysis

Answer 185

- the hernia sac enters the femoral ring through the femoral canal. It is an acquired hernia, more common in women. - The symptom is a bulge in the medial part, below the inguinal ligament. - The only treatment is surgery.

Answer 186

-between the left branch of the central colic artery (branch of superior mesenteric artery) and the ascending branch of the left colic artery (branch of the inferior mesenteric artery).

Answer 187

- also known as aortic arch syndrome, nonspecific aortoarteritis, and pulseless disease, - is a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing, - most commonly affecting young or middle-aged women of Asian descent, though anyone can be affected. - It mainly affects the aorta and its branches, and pulmonary arteries. - Females are about 8–9 times more likely to be affected than males.

Answer 188

- **thromboangiitis obliterans**, is an inflammation of all layers of the vessel, which leads to thrombus formation and obliteration of its lumen. - It most often occurs in the lower extremities and affects both small arteries and veins.

Answer 189

feeling of cold, numbed toes, excessive foot sweating, intermittent claudication - foot pain while walking, over time, foot pain at rest and necrotic changes.

Answer 190

Deep vein thrombosis (DVT)

Answer 191

1. Homans's sign - pain within the calf and popliteal fossa during dorsal flexion of the foot 2. Mozes sign - increased tension and stiffness of calf muscles 3. Payr sign - painfulness of the medial edge of the foot

Answer 192

- (protein-losing hypertrophic gastropathy) - is the idiopathic proliferation of gastric mucosal folds usually located in the gastric fundus and body - is a rare premalignant hyperproliferative gastropathy characterized by massive overgrowth of foveolar cells in the gastric lining, resulting in large gastric folds, and manifesting with epigastric pain, nausea, vomiting, peripheral edema and, less commonly, anorexia and weight loss.

Answer 193

- belongs to precancerous conditions, necessary endoscopic monitoring every 1-2 years more often occurs in men, usually around 55 years of age - *the most common symptoms:* abdominal pain, weakness, lack of appetite, weight loss, diarrhea -* diagnostics:* a. *gastroscopy:* oversized> 1 cm stomach folds in typical places (see above), and hist-pat . b. *examinatio*n: disappearance of the glandular ducts c. *treatment: *from eradication of H.pylori (some allow full recovery), PPI to cetuximab or partial resection of the stomach.

Answer 194

with the **CMV virus** and **after the detection of the disease, ganciclovir is used.**

Answer 195

1) BMI ≥40 kg / m2 without comorbidities: 2) BMI 35-40 kg / m2 with a coexisting disease, the course of which may be improved after bariatric surgery. ( hypertension, type 2 diabetes or dyslipidemia.)

Answer 196

diarrhea, abdominal pain, weight loss, weakness, perianal changes, anal fissures, abscesses, fistulas, tumors in the abdomen.

Answer 197

-the most common are within the osteoarticular system - joint inflammation in the course of inflammatory bowel diseases, * -additionally: *suttona aphta, erythema nodosum and gangrenous dermatitis, urolithiasis, cholelithiasis, primary sclerosing cholangitis (PSC). * Skin disorders ( erythema nodosum and gangrenous dermatitis ) E ye inflammation (inflammation of the iris, cornea, sclera) A rthritis (arthritis) L iver or gallbladder disease (primary sclerosing cholangitis (PSC). K idney disorders (urolithiasis)

Answer 198

-condition after excision or exclusion from the intestinal passage of some or all of the small intestine, -which leads to a reduction in absorption to such a large extent that nutrition exclusively by the digestive tract is not sufficient to maintain health. -SBS can occur when the length of the active small intestine is less than 150-200 cm or when 50% of the intestine is switched off.

Answer 199

-upper mesenteric artery thrombus/embolism

Answer 200

Crohn's disease (Pl. Leśniowski-Crohn's disease) volvulus abdominal injury tumor

Answer 201

-leukocytosis, high concentration of CRP, -increase of: lipase in the blood (the highest sensitivity and specificity in the diagnosis of AP), amylase in blood and urine, -urea increase, hypocalcaemia - hyperbilirubinemia, ALT, AST, ALP, and GGTP increase suggest a biliary ethiology of AP.

Answer 202

In ultrasonography : enlargement of the pancreas, obliteration of its borders, reduced and inhomogeneous echogenicity of the parenchyma, plus the widening of the bile ducts again suggests biliary etiology.

Answer 203

- removing bile duct deposits (ERCP) , - and then after the symptoms disappear, it is recommended to plan the gall bladder removal to reduce the risk of relapse.

Answer 204

unequal pupil sizes

Answer 205

GCS 13-15 - mild GCS 9-12 - moderate GCS 6-8 - unconscious - INTUBATION GCS 5 - decortication - INTUBACTION GCS 4 - decerebration - INTUBATION GCS 3 - brain death - INTUBATION

Answer 206

-is a type of surgical procedure performed to remove a fibrous tissue that has abnormally formed on the surface of the lung, chest wall or diaphragm. -through full thoracotomy is a major surgical procedure - A five or six-inch incision is made on the chest wall, through which the pleural peel is accessed and the infection is removed. - Drainage tubes are placed to drain blood, which are retained for 4-7 days.

Answer 207

- one-third of the distance from the anterior superior iliac spine to the umbilicus, place of attachment of the appendix to the cecum. - This is the most painful place when examining a patient with appendicitis.

Answer 208

situated on a line connecting the two anterior superior iliac spines one third of the distance from the right spine

Answer 209

fracture of the distal head of the radius bone. This type of fracture is the most common within the distal base of the bone.

Answer 210

-men are twice as likely to get this disease, so we will see them more often with complications 1. sudden stabbing pain in the epigastrium 2. symptoms of peritonitis: strong stomach ache nausea, vomiting gas and stool retention tension of the abdominal wall, i.e. a hard, tight stomach ("like a board") urinary retention pale and sweaty skin

Answer 211

- in the case of perforation of the digestive tract, the X-ray shows free gas under the dome of the diaphragm in the shape of a sickle. - Western countries usually use abdominal CT, when ulcer perforation is suspected.

Answer 212

** most common cause of gastrointestinal perforation is perforation of duodenal and gastric ulcers, therefore urgent surgical intervention should be performed, followed by analgesic therapy, PPIs and antibiotic**

Answer 213

- is a local dilatation of aorta by more than 50% of the norm. - The diameter of the abdominal aorta is about 2 cm, which means that we can speak of an aneurysm when the diameter is ≥ 3 cm

Answer 214

- gastrointestinal tumor, - most often located in the *appendix* : 90% according to Noszczyk, - usually *less than 2 cm*, too small to give metastases to the liver -* other location:* small intestine (terminal ileum - much more often metastasizes to the liver), esophagus, stomach, large intestine, bronchi - *neuroendocrine tumor:* it secretes mainly serotonin- a type of slow-growing cancer that can arise in several places throughout your body.

Answer 215

- *Frequency:* 1-2 / 100,000. They are more common in women and older people. - associated with the secretion of serotonin into the blood *symptoms:* (attacks in the carcinoid syndrome may appear under the influence of certain stimuli, such as stress, physical activity, alcohol, meal, some medicines (especially antidepressants): - acceleration of the heart rhythm - paroxysmal redness of the face and neck - dizziness - hypertension - excessive sweating - diarrhea - stomach pain - weight loss symptoms of bronchospasm, such as dyspnoea, wheezing

Answer 216

1. hypothermia - below 34 degrees 2. coagulopathy PT> 19 sec, APTT> 60 sec. 3. acidosis - pH <7.2 - Hypothermia inhibits the coagulation cascade, which causes symptoms of hemorrhagic diathesis. - This promotes further blood loss. As a result of hypovolaemia, metabolic acidosis develops depressing the heart, causing further deterioration of peripheral perfusion and consequently death. - Any serious injury or shock, by triggering inflammation factors, may cause damage to the blood-air barrier and, as a result, acute respiratory distress syndrome (ARDS).

Answer 217

acute inflammatory disease of the skin of streptococcal etiology ( S.pyogenes, beta-hemolytic group A streptococcus)

Answer 218

streptococcus infection spreads through skin, it can also spread via the lymphatic pathways - migrating erysipelas

Answer 219

- acute start, quick progress - general symptoms - fever ( > 40 ° C ) - local symptoms - swelling and redness of the skin clear margins, usually located on the lower limbs or face, may be present with necrosis and gangrene

Answer 220

benzyl penicillin or antibiotic treatment

Answer 221

- is a widely used term for* Brinton's disease* (also known as** leather bottle stomach**), a morphological variant of diffuse (or infiltrating) stomach cancer (adenocarcinoma) . - In some texts, the term is also used to describe the condition of a *rigid, non-distensible stomach *which may be caused by a non-malignant condition such as a caustic injury to the stomach - is a special form of gastric cancer (adenocarcinoma), causing diffuse thickening of the wall, which causes its stiffness and resistance to stretching. - This form gives early metastases to the lymph nodes.

Answer 222

- collagen disorders (frequently genetic background), frequent, significant increases in intra-abdominal pressure (COPD, constipation, prostate hypertrophy, physical exercise, etc.), systemic diseases that aggravate tissue endurance (diabetes, malnutrition)

Answer 223

Bassini Halsted Shouldice

Answer 224

Lichtenstein Rutkow PHS (prolen hernia system)

Answer 225

internal outlet - deep inguinal ring external outlet - superficial inguinal ring upper wall - edges of the internal oblique m. and transverse abdominal m. together with their fasciae lower wall - inguinal ligament front wall - inclination of oblique ext.m. posterior wall - peritoneum and transverse fascia

Answer 226

Grade I covers only the epidermis (erythema) Grade IIa covers the epidermis and part of the dermis (blister) Grade IIb covers the epidermis and dermis (superficial necrosis) Grade III necrosis is subject to the entire thickness of the skin (deep necrosis) Grade IV necrosis or charring of deeper tissues

Answer 227

- 2nd degree burns >25% of body surface area in adults and >20% of body surface area in children - 3rd degree burns >10% of body surface regardless of age - 3rd degree burns on hands, face, neck, feet, hands, groin, circular - inhalation, electric and chemical burns - burns complicated by other severe injuries or comorbidities

Answer 228

- *severe protein deficiency* in a high-carbohydrate diet. - there is no weight loss observed. It may even increase due to edema and water retention inside the body. - Parenteral nutrition is recommended as treatment. - The WHO recommends that malnutrition should be suspected in patients with a BMI <18.5 kg/m2. Other types of malnutrition: *Marasmus* - caused by protein and caloric deficiencies due to starvation *Mixed malnutrition* | The WHO recommends that malnutrition should be suspected in patients wit

Answer 229

- (thromboembolic vasculitis) is a disease of the small to medium-sized arteries and the veins in the limbs, which causes blood clots and vascular overgrowth. - The disease usually *affects young smoking men aged about 20-30 years*, and the *disease after 50 years is rare*. - Initially manifested by migrating thrombophlebitis followed by intermittent claudication or pain at rest in the feet and hands, accompanied by numbness, a feeling of cold and excessive sweating. - The characteristic feature is the lack of a pulse around the wrist and ankle with its simultaneous presence in the popliteal and brachial arteries.

Answer 230

anticoagulants, painkillers and vasodilators, and quitting smoking is key. Surgical treatment consists of a lumbar sympathectomy or the injection of ethyl alcohol into the ganglia, which results in the expansion of arterioles, and thus better blood supply to the limbs.

Answer 231

stomach cancer

Answer 232

- small interpectoral lymph nodes located between the pectoralis major and pectoralis minor muscles. - They receive lymphatic fluid from the muscles and the mammary gland, and deliver lymphatic fluid to the axillary lymphatic plexus. - These lymph nodes are susceptible to breast cancer, as the cancer sometimes spreads (metastasizes) to the interpectoral lymph nodes

Answer 233

History of breast cancer Family history of breast cancer The presence of other tumors Consuming alcohol Obesity Hormonal factors and estrogen intake

Answer 234

**hepatoduodenal ligament** The hepatic-duodenal ligament contains: Hepatic artery Portal vein Common bile duct

Answer 235

ultrasound

Answer 236

rebound tenderness

Answer 237

pancreas head duodenum gallbladder CBD pylorus

Answer 238

pancreas head duodenum gallbladder CBD

Answer 239

- acute colonic pseudoobstruction - colonic blockage without obturation manifests itself by a significant distension of the right part of the colon without obstacle in the large intestine

Answer 240

-The digestive tract (Stomach) is the most common extranodal location of lymphoma. -Most of them are non-Hodgkin's lymphomas (NHL)

Answer 241

The **Fontaine scale** is used to assess the degree of* limb ischemia,* which determines the choice of treatment.

Answer 242

Bassini's operation Halsted surgery Shouldice's operation

Answer 243

1. Lichtenstein's method 2. Rutkow's method 3. PHS (prolen hernia system)

Answer 244

- in recurrent hernias. - They can be performed both from transabdominal and peritoneal access.

Answer 245

1. sliding hernia (most often *Nissen's surgery* ) 2. paraesophageal hernia 3. mixed hernia

Answer 246

There are 2 ways of operating: 1. *access from the thigh* 2. *access over the inguinal ligament*

Answer 247

1. small gates 2. large gates- **Mayo method**

Answer 248

- **gastrointestinal tumor** - most often located in the **appendix : 90%** - usually** less than 2 cm** - too small to give metastases to the liver | Carcinoid is annoyed with my apendix

Answer 249

- Cullen sign is *not a classic clinical feature of acute appendicitis* - Instead, it is a *rare sign of acute pancreatitis describing the foci of subcutaneous tissue necrosis* in the *form of brown patches found in the umbilical region*.

Answer 250

- when there is a rapid increase in pressure in the abdominal cavity and the pressure measured in the **urinary bladder is> 25 mmHg**

Answer 251

1. Endoscopic examination with biopsy 2. Contrast barium enema of the colon 3. Imaging techniques 4. Endoscopic Ultrasound

Answer 252

1. Neurological disturbances associated with fasting: dizziness, confusion, coma, convulsions, 2. Rapid improvement after glucose administrations, 3. Concomitant hypoglycemia (<40 mg/dl).

Answer 253

1. low fasting blood glucose 2. high levels of insulin in the blood 3. fasting test 4. USG, CT, MRI

Answer 254

- pain in the right hypochondrium after "slapping" this area. - This is a common sign of cholecystolithiasis.

Answer 255

- refers to a** longitudinal tear or laceration in gastric mucosa** at the location where the abdominal part of the esophagus and the cardia meet - the **gastroesophageal junction** -The typical clinical symptom is vomiting, characterized by coffee-ground or bloody content.

Answer 256

macroscopical advanced gastric cancer during endoscopy

Answer 257

Type 1 polypoid - single exophytic tumor (usually without ulceration) - Type 2 fungating - sharply demarcated tumor with elevated margins Type 3 ulcerative - ulceration with indefinite margins Type 4 diffuse - infiltrating (linitis plastica, leather bottle stomach) tumor infiltrates uniformly through gastric wall

Answer 258

-adhesions: most common cause -entrapment of a hernia -Meckel's diverticulum -gallstone: who got out of the gallbladder in a person suffering from cholelithiasis -cancer -internal hernias

Answer 259

-colorectal cancer: most common cause -torsion of the intestine -diverticulitis -adhesions -residual fecal masses -inflammatory bowel disease

Answer 260

-previous abdominal surgery -metabolic disorders: porphyria ketoacidosis: resulting from diabetes -renal colic -atherosclerosis -intra-abdominal infections -medicines: anticholinergic anti-Parkinson opioids

Answer 261

is led by the sympathetic and parasympathetic fibers of the autonomic nerves it's difficult to locate it exactly it is more often a projected pain than that experienced at the source of the pain the pain is deep and diffuse it can be permanent or colic the patient cannot find a position in which the pain would be less severe

Answer 262

is caused by an organic disease (such as obstruction, Crohn's disease, etc.)

Answer 263

is due to the irritation of the spinal nerve endings that innervate the peritoneal wall is precisely located, radiates in specific directions it is accompanied by muscle defense and increased tension

Answer 264

pain appears in the area of innervation of the nerve e.g. trigeminal neuralgia often paroxysmal

Answer 265

-discomfort is felt in the place of the amputated body part -it is unrelated to the effects of pain stimuli -the pain may be dull, burning or spasmodic

Answer 266

Littré hernia

Answer 267

special form of hernia containing a peripheral fragment of the intestinal wall

Answer 268

- also known as thromboangiitis obliterans, which is an inflammation of the walls of the vessels of small arteries that most often affects the lower extremities. - Young men under 40 are affected, and smoking is one of the most important factors involved in the pathogenesis of the disease. - Smoking cessation is able to stop the progression of the disease.

Answer 269

-As a result of vasculitis, vascular lumen decreases, resulting in: lower limb ischemia and the resulting intermittent claudication -numbness of the fingers -bruising and coldness of the skin of the feet -↑ sweating of the feet

Answer 270

- is obstruction or narrowing of the end section of the abdominal aorta or iliac arteries. - It mostly affects older men. - As with Buerger's disease, symptoms of Leriche's syndrome include ischaemia of the lower extremities and intermittent claudication, as well as necrotic skin changes resulting from ischemia. - An additional symptom of the syndrome is erectile dysfunction. - Another similarity is that smoking is a risk factor for the disease. - Leriche syndrome is *associated with atherosclerosis.*

Answer 271

- i.e. giant cell arteritis, - most often affects the aorta and / or its branches. - Women are sick 2-3 times more often than men. - Most often, the disease begins in the 7th decade of life.

Answer 272

-clearly delimited fluid reservoirs filled with pancreatic secretions. They can be located anywhere on the pancreas or outside it. -They are usually the result of chronic pancreatitis

Answer 273

-they are much more common than true cysts, they account for up to 80% of all cysts -they are usually the result of acute pancreatitis -simply finding a pseudocyst is not an indication for surgery

Answer 274

-unlike pseudocysts, they are** lined with epithelium** -they are usually the **result of cancer** or **existing pancreatic malformations**

Answer 275

- painless jaundice and an enlarged, painless gallbladder that can be felt through the abdominal wall. - It is most often associated with a tumor of the pancreatic-duodenal area, which, by infiltrating the common bile duct, causes impaired bile flow from the liver to the intestine, which leads to mechanical jaundice and distension of the gallbladder.

Answer 276

-vascular endothelial injury -slow blood flow -may occur, among others as a result of prolonged immobilization or cancer -change in blood composition which causes hypercoagulation: antithrombin III deficiency protein C, protein S deficiency thrombocythemia disturbances in the balance between pro-coagulant and anti-coagulant factors -the most important factors in the pathogenesis of blood clots

Answer 277

Tis - infiltration of the mucosa, T1 - infiltration of the submucosa, T2 - muscle membrane infiltration, T3 - infiltration of periocecal / perianal tissues, T4 - infiltration of adjacent organs / structures or visceral peritoneum.

Answer 278

transverse colon tumors sigmoid tumors

Answer 279

caecum tumors ascending colon tumors

Answer 280

descending colon tumors sigmoid tumors

Answer 281

-tumors of the left half of the large intestine (including sigmoid colon). -In some cases (tumor histologically well differentiated, diameter <3 cm), local resection is allowed. This method of treatment should be combined with radiation therapy.

Answer 282

1. the area of the liver and the right kidney are assessed, which reveal the hepatorenal recess (the so-called Morrison recess) 2. the right costo-diaphragm angle. This allows for the preliminary exclusion of haemothorax, as the blood initially locates in the lowest parts of the lungs, ie in the costal-diaphragmatic angles. 3. The same applies to the other side of the abdominal cavity → the splenorenal recess, called the Keller recess, 4. the left costo-diaphragmatic angle.

Answer 283

1. *Coagulopathy* - due to a dilution effect (deficiencies of plasma clotting factors and platelets (*Thrombocytopena *) 2. hypothermia - (one RBC unit stored at 4oC can lower body temperature by 0.25C) 3. metabolic disorders (*hyperkalemi*a is caused by the release of potassium ions from aging erythrocytes during storage 4. *metabolic alkalosis *and* hypokalemia* associated with the transfusion of large amounts of citrate 5. *hypocalcaemia* and *hypomagnesaemia* associated with the toxic effects of citrate, especially in patients with hepatic failure and congestive heart failure 6. an *air embolism* may occur and symptoms of cardiovascular overload may appear, especially in people with heart failure

Answer 284

- is a disease from the group of inflammatory bowel diseases, which is most often diagnosed between the ages of 20 and 40. - The clinical picture of the disease is dominated by diarrhea with blood and abdominal pain

Answer 285

-Jaundice (yellowing of the skin and whites of the eyes) -Itching -Pain in the right upper part of the abdomen -Fever, chills -Unexplained weight loss -Fatigue

Answer 286

-is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts, which normally allow bile to drain from the gallbladder. -The bile duct scarring that occurs in PSC narrows the ducts of the biliary tree and impedes the flow of bile to the intestines. -Eventually, it can lead to cirrhosis of the liver and liver failure. -PSC increases the risk of various cancers, including liver cancer, gallbladder carcinoma, colorectal cancer, and cholangiocarcinoma

Answer 287

restorative proctocolectomy

Answer 288

1. *Conservative treatment* → patients with UC should use non-pharmacological treatment (avoiding stress, oral antibiotics, and other exacerbation factors). - Additionally used pharmacological treatment (sulfasalazine, GCS, immunosuppressants) 2.* Surgical treatment *→ target treatment for ulcerative colitis due to the high risk of developing cancer. Depending on the patient's condition, operations performed in UC are divided into:

Answer 289

- the body responds to bacteria or uninfected body fluid entering the peritoneal cavity. Bacteria can enter the peritoneal cavity in many ways: -*Gastrointestinal perforation* → Most common cause -Displacement of bacteria without perforation of the intraperitoneal organ (in the course of enteritis, obstruction) -Rupture of an abscess into the peritoneal cavity -Entry of bacteria from an exogenous infection

Answer 290

coli and streptococci.

Answer 291

are extensions of the venous plexuses around the anus, usually in the form of easily bleeding nodules.

Answer 292

Constipation Weakening of the connective tissue Pregnancy and natural birth Lifting heavy objects Chronic cough Low-residue diet, too abundant, with lots of fats Alcoholism Sedentary lifestyle

Answer 293

Grade I → the nodules do not extend beyond the anus, they can be visualized on endoscopy Grade II → nodule prolapse with pressure and spontaneous reduction into the anal canal after defecation Grade III → the protruding nodules do not reduce spontaneously after defecation, but can be reduced using the finger Grade IV → the protruding nodules cannot be reduced

Answer 294

- a benign adenoma of the glomerular layer of the adrenal gland → it is a disease caused by excessive secretion of aldosterone, most often by a hormonally active adenocortical adenoma. --It is derived from the glomerular layer of the adrenal gland, which is responsible for the secretion of mineralocorticosteroids, including aldosterone.

Answer 295

1. Hematological diseases (spherocytosis, chronic thrombocytopenia, splenomegaly) 2. Extensive injuries, ruptures 3. Abscesses 4. Cysts more than 10 cm in diameter 5. Tumors 6. Portal hypertension 7. Aneurysm of the splenic artery> 2.5 cm, if it causes compression symptoms, otherwise a stent-graph can be inserted and the spleen preserved

Answer 296

1. from the upper-front side - inguinal ligament 2. medially - lacunar ligament 3. from the lower-posterior side - upper branch (ramus) of the pubis, or rather the pubic crest 4. laterally - femoral vein

Answer 297

- the hernial sac moves through the femoral canal from the deep femoral ring to the hiatus of the saphenous vein. - The femoral ring is the gateway to the femoral canal.

Answer 298

- is an autosomal dominant genetic disorder (APC gene) (A) leading to the presence of numerous polyps in the large intestine, and sometimes in the stomach and duodenum. - In such patients there is a significant increase in the risk of developing colorectal cancer compared to the general population, therefore these patients require: Once a year → check-up colonoscopy every 1-2 years → check-up gastroduodenoscopy

Answer 299

- enveloped bacteria, especially pneumococci, meningococci and Haemophilus influenzae type b (Hib), therefore vaccination against these pathogens is particularly recommended in this group of patients.

Answer 300

**Pneumococcal vaccine** - Due to the increased risk of Invasive Pneumococcal Disease, the PCV-13 conjugate vaccine (Prevenar 13) is recommended. **Meningococci vaccine** - Due to the increased risk of Invasive Meningococcal Disease, based on epidemiological data in Poland, a group B meningococcal vaccine (e.g. Bexero) is recommended first, followed by a 4-valent group A, C vaccine, W, Y (e.g. Nimenrix) or against group C (e.g. Neisvac) **Vaccination against Hib** - it is registered only up to the age of 5, therefore its administration to older children and adults is an off-label procedure.

Answer 301

- is haemolytic anemia resulting from genetically conditioned disturbances in the *quantitative synthesis of protein globin chain*s. - Splenectomy is indicated in some patients with the most severe form of the disease (thalassemia major) where it helps to reduce the destruction of abnormal red blood cells.

Answer 302

- is a qualitative hemoglobinopathy in which hemoglobin has an abnormal structure (hemoglobin S) and altered physicochemical properties (including lower oxygen affinity), and red blood cells take on a sickle shape and have a shorter survival time. - As in the above diseases, splenectomy is indicated in patients with the most severe course of the disease - it allows to extend the survival time of red blood cells and reduce the number of hemolytic breakthroughs.

Answer 303

- is an autoimmune disease in which the presence of antiplatelet autoantibodies causes their excessive destruction and reduced production of platelets in the bone marrow. - Platelets coated with antibodies are phagocytosed by macrophages and prematurely destroyed in the spleen. - * Splenectomy* allows to limit this process, but it is indicated only in patients without improvement after> 12 months of treatment with glucocorticoids and second-line drugs.

Answer 304

- also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid - It frequently results in and is the most common cause of hyperthyroidism. - It also often results in an enlarged thyroid - Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea and unintentional weight loss. - Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves' ophthalmopathy.

Answer 305

- head of the pancreas; - segment of the duodenum adjacent to the pancreas; - gallbladder; - gastric pylorus.

Answer 306

- head of the pancreas; - segment of the duodenum adjacent to the pancreas; - gallbladder; - gastric pylorus.

Answer 307

1. the common bile duct and the loop of the small intestine (ducto-intestinal); 2. small intestine with the pancreatic body (duodenal-pancreatic); 3. small intestine and stomach stump (gastrointestinal).

Answer 308

1. **Courvoisier's symptom **- enlarged, painless gallbladder - a symptom also present in cancer of the bile ducts, duodenum and Vater's papilla; 2. **migratory superficial thrombophlebitis**, which may be its first symptom in approximately 15% of patients.

Answer 309

- Traverso method. - pylorus is preserved. - partial peripheral pancreatectomy (also with spleen excision), or complete pancreatectomy with duodenum.

Answer 310

- a blockage in the outflow of bile and an ongoing inflammatory process. - Progressive infection causes thickening of the follicle wall and then gangrene with a subsequent risk of perforation and biliary peritonitis. - Alveolar-intestinal fistula is one of the less common complications.

Answer 311

- are polyps with the structure of branching coils. - They are the most common adenomatous polyps.

Answer 312

They are the rarest of adenomas, but have the greatest ability to be malignant.

Answer 313

- are infiltrates and inflammatory granules left over from the normal mucosa. - - They *appear in the course of ulcerative colitis and Crohn's disease.*

Answer 314

- polyps caused by the thickening of the mucosa. - They are not atypical and account for about 90% of colon polyps. - Most prevelant colon polyps - Single ones may not cause any symptoms. - When symptoms appear: bleeding is most common, and there may also be pressure on the stools, mucus in the stools or diarrhea. - Polyps are detected by endoscopic examination

Answer 315

1. SGA (subjective global assessment of nutritional status) 2. NRS (Nutritional Risk Score), which allows to estimate the risk associated with malnutrition.

Answer 316

1. loss of 10% of body weight in the 3 months prior to admission to hospital 2. anthropometric measurements: BMI (body mass index) value <18.5 is underweight assessment of the thickness of the skin fold over the triceps muscle of the non-dominant arm, biochemical research: albumin (<3.5 g / dl) and prealbumin, transferrin (due to the short half-life of 8 days, it is used to monitor rapid changes in malnutrition) total lymphocyte count (CLL =% lymphocytes x lymphocyte count / 100) - a value of <800 indicates immunodeficiency and impaired nutritional status. nitrogen balance (a negative nitrogen balance may indicate insufficient energy supply)

Answer 317

1. pain localized in the gallbladder projection, under the right costal arch, 2. pain increases with breathing and pressure, 3. radiates to the right shoulder blade, 4 nausea, vomiting, loss of appetite 5. tachycardia, increased body temperature, 6. leukocytosis, 7. muscle tension, 8. positive Murphy symptom,

Answer 318

1. peptic ulcer perforation, 2. acute upper abdominal appendicitis, 3. acute pancreatitis 4. myocardial infarction 5. basal pneumonia.

Answer 319

- inflammation of the tissues surrounding the nail. It is caused mainly by staphylococci that have entered the body through damage to the skin. - The inflammatory process causes a sub-epidermal abscess that can penetrate under the nail plate. - Paronychia is manifested by throbbing pain in the limb that increases as patient leaves the limb. - In addition, there is redness and swelling of the tissues around the nail. - Treatment consists of incision of the abscess, and if the inflammation also affects the tissue under the nail, removal of the nail.

Answer 320

- an inflammation that develops on the palmar side of the hand and fingers. Its etiology is also mainly staphylococcal. - In the case of a felon, the inflammatory process may be local - limited to the skin, or also include subcutaneous tissue, tendons, bones, and joints. - We distinguish the felon: skin; subcutaneous - swelling may also appear on the dorsal side of the finger; tendinous; bony; joint. - The symptoms of a felon, depending on its type, are pain, swelling, limited mobility, and even fever and chills in the tendon, bone and joint felon. - Treatment consists of incision of the skin and removal of pus, and in more severe cases, antibiotic therapy and immobilization of the hand.

Answer 321

- is a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. - This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis

Answer 322

abdominal CT 1. it is a thorough examination that *allows the assessment of both infiltration and the presence of metastases. * 2. It allows for the* assessment of the clinical advancement of the tumor.*

Answer 323

1. carcinoembryonic antigen (CEA) test measures the level of CEA in the blood. 2. CEA is a protein normally found in the tissue of a developing baby in the womb. 3. The blood level of this protein disappears or becomes very low after birth. In adults, an abnormal level of CEA may be a sign of cancer. 4. Anything greater than 10 ng/mL suggests extensive disease, and levels greater than 20 ng/mL suggest the cancer may be spreading. 5. carcinoembryonic antigen (CEA) test is used to check how well treatment is working in certain types of cancer, particularly bowel cancer. 6. Carcinoembryonic antigens are proteins produced by some types of cancer. In response to the antigens, the body produces antibodies to help fight them.

Answer 324

- PET-CT is a more precise examination than CT, and it also covers the entire body. - it is possible to assess whether the metastases have appeared in other places than those we examined in CT or colonoscopy.

Answer 325

excessive thirst.

Answer 326

- dopamine, norepinephrine, and epinephrine. Epinephrine is also known as adrenaline.

Answer 327

All catecholamines are synthesized from the amino acid l-tyrosine according to the following sequence: tyrosine → dopa (dihydroxyphenylalanine) → dopamine → norepinephrine (noradrenaline) → epinephrine (adrenaline).

Answer 328

- Neuroendocrine chromaffin cells, responsible for the biosynthesis of catecholamines, are located throughout the brain and in the adrenal glands. - The highest density of chromaffin cells is located within the adrenal medulla, the most functionally significant area of catecholamine production

Answer 329

- are noncancerous growths that occur in the connective tissue. - most often occur in the abdomen, arms and legs. - Another term for desmoid tumors is *aggressive fibromatosis*. - Some desmoid tumors are slow growing and don't require immediate treatmen - associated with a mutation of the* CTNNB1 gene*, and many of these appear during or after pregnancy. - Some desmoid tumors are linked to previous injuries. - In rare instances, desmoid tumors are associated with familial adenomatous polyposis (FAP), a genetic condition that's linked to colon cancer.

Answer 330

- always an acquired hernia (it is worth noting that the patient in the question suffers from COPD - a chronic, intense cough may predispose to hernia formation). - Its gate is the medial inguinal fossa (Hesselbach's triangle). - In a simple inguinal hernia, the inferior epigastric vessels visible in USG lie laterally from the hernial sac - as is the case with the patient in the question. - This hernia is less common than the oblique inguinal hernia, has a short canal, and never goes down to the scrotum

Answer 331

USG - first-line examination in the diagnosis of cholesthetic jaundice; CT - allows you to determine the degree of advancement and resectability; MR - a key test for suspected cholangiocarcinoma; MRCP - visualizes narrowing and widening of the bile ducts; EUS - assessment of extrahepatic bile ducts, gallbladder, hilum, regional lymph nodes and vessels; ERCP - allows you to take specimens for histopathological examination and brush swab;

Answer 332

- first-line examination in the diagnosis of cholesthetic jaundice;

Answer 333

- allows you to determine the degree of advancement and resectability;

Answer 334

- a key test for suspected cholangiocarcinoma;

Answer 335

- *magnetic resonance cholangiopancreatography (MRCP)* is an imaging test to examine pancreatic and biliary (bile duct) systems. - test uses a dye, infused into your veins through an intravenous (IV) line. - visualizes narrowing and widening of the bile ducts;

Answer 336

- assessment of extrahepatic bile ducts, gallbladder, hilum, regional lymph nodes and vessels; - An *endoscopic ultrasound (EUS)* procedure examines the inside of your digestive tract. - can detect pancreatic cancer, colon cancer, as well as cancer that's spread to other parts of your body. - EUS can also detect inflammatory bowel disease (IBD), pancreatitis and other causes of abdominal pain.

Answer 337

1. endoscopic polypectomy or ampulectomy; 2. local excision of the lesion by duodenotomy; 3. ; 4. papillotomy with drainage of the bile ducts - palliative treatment.

Answer 338

1. endoscopic polypectomy or ampulectomy; 2. local excision of the lesion by duodenotomy; 3. pancreatoduodenectomy 4. papillotomy with drainage of the bile ducts - palliative treatment.

Answer 339

-** papillary carcinoma**, - which originates in **follicular cells,** - while the proliferation of C cells, also known as perivveolar cells, results in an outbreak of medullary thyroid cancer, which only occurs in 5% of cases.

Answer 340

- Identification of homogeneous groups in the population requiring special medical care. - In occupational medicine it is e.g. *a group of workers exposed to permanent effects of a specific factor harmful to health at the workplace.*

Answer 341

-it is conducted by sympathetic and parasympathetic fibers of the autonomic nerves -it is difficult to locate it exactly -more often it is referred pain than felt at the source of pain -the pain is deep and diffuse -may be permanent or colic -it is characteristic that the patient cannot find a position in which the pain would be less severe

Answer 342

is caused by an organic disease (such as obstruction, Crohn's disease, etc.)

Answer 343

-results from irritation of the pain endings of the spinal nerves that innervate the parietal peritoneum -it is precisely located, it radiates in certain directions -it is accompanied by muscular defense and increased eyelid tension

Answer 344

-pain occurs in the area of innervation of a given nerve -its example is, for example, trigeminal neuralgia is often violent

Answer 345

-discomfort is felt at the site of the amputated part of the body it is unrelated to the action of pain stimuli -the pain may be dull , burning or cramping

Answer 346

Bennett's fracture.

Answer 347

isolated fracture of the shaft of the ulna with displaced fragments and dislocation of the radial head.

Answer 348

isolated fracture of the radial shaft with displaced fragments and dislocation of the head of the ulna.

Answer 349

fracture of the distal epiphysis of the radius with volar displacement of the fragments (conversely, not Colles' fracture) - occurs as a result of a fall on an outstretched limb in the palmar flexion of the wrist joint

Answer 350

- is a fracture of the distal epiphysis ( loco typico ) of the radius. This type of fracture is the most common within the distal epiphysis of this bone. Cause: fall on an outstretched limb with dorsiflexion in the radiocarpal joint and simultaneous setting of the forearm in the reversal position. Symptoms: upward bending and dorsal displacement of the distal radius. Significant swelling of the wrist and deformation of the axis of the forearm are visible. Treatment: setting and immobilization for 4-6 weeks . In the case of an unstable fracture, Kirschner wires are used to fix the fractures and a plaster cast is used.

Answer 351

-flexion contracture of the fingers of the hand -most often affects children between 4 and 8 years of age -is most often caused by a supracondylar fracture of the humerus - symptoms - evolution: -forearm pain => loss of feeling in the forearm, pale and blue fingers => swelling of the hand increases => fibrosis of the forearm muscles => the hand takes on a clawed appearance

Answer 352

- appearance of pain in the calf and popliteal fossa during dorsiflexion of the foot, may be useful in the diagnosis. - The cause is increased tension and stiffness of the calf muscles. - The presence of this symptom confirms the diagnosis of deep vein thrombosis of the lower limbs, although it is not a necessary symptom to make a diagnosis and does not always occur.

Answer 353

is the formation of a blood clot in the deep veins of the lower limbs, less often the upper limbs.

Answer 354

-slowing down blood flow (e.g. due to immobilization of a limb) -damage to the vessel wall (e.g. as a result of trauma) -predominance of prothrombotic factors over coagulation inhibitors and fibrinolytic factors (inherited and acquired thrombophilias)

Answer 355

prolonged immobilization past venous thrombosis Cancer surgery bone injuries and fractures pregnancy and puerperium thrombocythemia thrombophilias

Answer 356

( thromboangiitis obliterans) is a disease of small and medium-sized arteries and veins of the limbs, which leads to the formation of blood clots and vascular overgrowth. The disease usually affects young, smoking men aged about 20-30 years, and cases after the age of 50 are rare.

Answer 357

The Fontaine scale is used to assess the degree of limb ischemia, which determines the choice of treatment method

Answer 358

-I degree - a patient asymptomatic or with non-specific symptoms such as numbness and freezing of the fingers -II degree - a patient with intermittent claudication -III degree - the patient feels pain in the limb at rest -IV degree - the patient's limb is covered with necrosis

Answer 359

1. First generation antihistamines (dimenhydrinate, promethazine) 2 Phenothiazine derivatives (chlorpromazine, thiethylperazine, levomepromazine, prochlorperazine) 3. Haloperidol (induced emesis and metabolic disorders) 4. Prokinetic drugs (metoclopramide, itopride) 5. Serotonin 5-HT3 receptor antagonists (ondansetron, palonosetron) 6. Corticosteroids (dexamethasone, methylprednisolone) 7. NK1 receptor antagonists (aprepitant)

Answer 360

-dehydration, -electrolyte imbalance ( hypokalaemia, hypochloremia ), -metabolic alkalosis , -aspiration and aspiration pneumonia, -rupture of the wall of the esophagus (Boerhaave's syndrome) -inear ruptures of the mucosa in the region of the gastroesophageal junction (Mallory-Weiss syndrome), -malnutrition

Answer 361

- a syndrome caused by a mutation in the APC gene , causing the formation of polyps in the large intestine (usually more than 100) and in the stomach and duodenum. Patients with this genetic syndrome from 10-12 years of age r _ require annual follow-up colonoscopy and gastroduodenoscopy, as the risk of developing cancer around the age of 35 is almost 100%.

Answer 362

1. Gardner's syndrome (FAP and osteomas, retinal changes and soft tissue tumours), 2. Turcot's syndrome (FAP and CNS tumours).

Answer 363

- prophylactic colectomy or proctolectomy with the creation of a pouch from the small intestine are usually used in the 2nd or 3rd decade of life, while pharmacological treatment is treated as complementary. - The best effect can be achieved with NSAIDs. - The use of COX-2 inhibitors may be initiated after exclusion of the presence of factors that increase the risk of cardiac complications. In the case of rectal-sparing surgery, an average rectal examination should be performed every 3-6 months .

Answer 364

- a linear tear in the mucosa of the ventral esophagus and gastric cardia. - - TRUE. They are usually located on the posterior wall of the stomach , and the coexistence of a sliding hiatal hernia may be observed. They are caused by conditions that can cause increased pressure in the region of the cardia, e.g. intense vomiting, coughing. This is a syndrome seen more often in people who abuse alcohol. Its symptoms are vomiting, characteristic coffee grounds or bloody content.

Answer 365

- is characterized by longitudinal mucosal lacerations (intramural dissection) in the distal esophagus and proximal stomach, which are usually associated with forceful or prolonged vomiting or retching. - The lacerations often lead to bleeding from submucosal arteries.

Answer 366

- the group of inflammatory bowel diseases, which is most often diagnosed between the ages of 20 and 40 . - The clinical picture of the disease is dominated mainly by diarrhea with an admixture of blood and abdominal pain. - patient reports symptoms that do not result directly from inflammation of the intestine. persistent itching of the skin chronic fatigue weakness All these symptoms are similar to those associated with cholestasis . Of the given distractors, the listed conditions that can cause bile blockage are:

Answer 367

→ occurs most often in the complication of gallstones, typically pain and fever symptoms resulting from inflammation in this area predominate. -Ulcerative colitis is also not a disease that predisposes to gallstones, which is the cause of inflammation. -Typically, urolithiasis occurs mainly inobese women over 40 years of age.

Answer 368

→ chronic pancreatitis as a result of inflammation of the pancreatic parenchyma, formation of inflammatory cysts may lead to compression of the bile ducts. -In this case, however, the key to the diagnosis would be the presence of symptoms in this patient such as strong, enveloping upper abdominal pain and risk factors for CP (mainly alcoholism

Answer 369

-it is a disease often coexisting with inflammatory bowel diseases, mainly ulcerative colitis. -In addition, it occurs mainly in males (as in the patient described in the question). -The disease is more common in men (70–75%) - The coexistence of inflammatory bowel disease is very characteristic of PSC. Such a coincidence is observed in more than 75% of patients with PSC and most often it is UC . - This disease is characterized by a chronic inflammatory process with subsequent fibrosis of the bile ducts causing obstruction to the formation and flow of bile, i.e. cholestasis

Answer 370

-of painless jaundice and an enlarged, painless gallbladder palpable through the abdomen. -It is most often associated with a tumor of the pancreaticoduodenal area, which, by infiltrating the common bile duct, causes impaired bile flow from the liver to the intestine, which leads to mechanical jaundice and gallbladder distension

Answer 371

"death triad": -hypothermia - below 34 degrees -coagulopathy PT >19 sec, APTT >60 sec. -acidosis - pH <7.2

Answer 372

- gastrointestinal cancer, - most often located in the appendix : 90% according to Noszczyk, usually less than 2 cm, too small to metastasize to the liver - other location: shadow intestine (terminal ileum - metastases from here to the liver much more often), esophagus, stomach, large intestine, bronchi - neuroendocrine tumor: secretes mainly serotonin

Answer 373

- incidence: 1–2/100,000. - They are more common in women and the elderly - associated with the release of serotonin into the blood

Answer 374

- Symptoms: (seizures in carcinoid syndrome may occur under the influence of certain stimuli, such as stress, physical exertion , alcohol , meal , certain medications (especially antidepressants): acceleration of heart rate - paroxysmal redness of the skin of the face and neck dizziness hypertension excessive sweating diarrhea stomach pain

Answer 375

**algodystrophy**, is a painful, long-lasting swelling of periarticular tissues with blood supply disorders and atrophic changes in soft tissues and bones. -Most commonly, the wrist is affected , less often the knee, foot, ankle, sometimes the whole limb (shoulder-hand or hip-foot syndrome), occasionally the face or trunk. A factor conducive to the development of the disease is too tightly applied immobilizing dressing or placing the limb in a forced position.

Answer 376

thin, cool and moist skin brittle nails contracture in joints located peripherally from the fracture muscle wasting

Answer 377

rehabilitation physical therapy pharmacological treatment to improve circulation and bone calcification.

Answer 378

- consists in the appearance of paleness, bruising and then reddening of the skin of the fingers and/or toes when exposed to cold. - This symptom arises as a result of a rapid contraction and then relaxation of small arterioles in the fingers and toes

Answer 379

- is the most common childhood arthropathy . - The diagnosis of JIA must meet the criteria of the International League Against -Rheumatism (ILAR): onset before the age of 16, at least 6 weeks of clinical symptoms, exclusion of other causes of arthritis.

Answer 380

Leriche's syndrome is an obstruction or stenosis of the distal abdominal aorta or iliac arteries. It most often affects older men . - As in Buerger's disease, the symptoms of Leriche's syndrome include ischemia of the lower limbs and intermittent claudication, as well as skin necrosis resulting from ischemia . An additional symptom of the syndrome is erectile dysfunction . - Another similarity is that smoking is a risk factor for the disease. - Unlike Buerger's disease, Leriche's syndrome is associated with atherosclerosis.

Answer 381

or giant cell arteritis, most commonly affects the aorta and/or its branches. - Women are affected 2-3 times more often than men . - Most often, the disease begins in the 7th decade of life.

Answer 382

** thromboangiitis obliterans**, - is an inflammation of the walls (all layers of the vessels) of the vessels of small arteries, which leads to the formation of blood clots and overgrowth of its lumen. - It is most common on the lower extremities and affects both small arteries and veins. - The disease usually affects young men, below 40 years of age, and one of the most important factors involved in the pathogenesis of the disease is smoking. - Stopping smoking can stop the progression of the disease. - As a result of vasculitis, their lumen becomes overgrown, which results in: lower limb ischemia and resulting intermittent claudication numbness of the fingers blueness and coldness of the skin of the feet ↑ foot sweating Symptoms of Buerger's disease do not result from the presence of atherosclerosis.

Answer 383

** chronic lower limb ischemia** - It is a condition in which the supply of oxygen to the tissues is insufficient due to chronic impairment of blood flow in the arteries. - In most cases, the cause of chronic ischemia is atherosclerosis.

Answer 384

I - asymptomatic IIa - claudication > 200 m - mild claudication IIb - claudication < 200 m - moderate/severe claudication III - pain at rest IV - necrosis and ischemic ulcers

Answer 385

set of symptoms caused by stenosis or occlusion of the distal abdominal aorta and/or iliac arteries

Answer 386

- In >98% of patients, atherosclerosis is the cause of ischemia. Symptoms: - easier fatigue of the lower limbs, cold and pale feet. - no pulse in the groin on both femoral arteries - erectile dysfunction caused by obstruction of the internal iliac arteries impotence - clear symptoms of ischemia, i.e. intermittent claudication and retrograde changes, appear only after 3-5 years

Answer 387

** ulcer bleeding:** Grade: **(Ia)** - active bleeding that is throbbing **(Ib)** - oozing **IIa** - visible non-bleeding vessel **IIb** - clot at the bottom of the ulcer **IIc **- discolored ulcer base **III** - white bottom of the ulcer

Answer 388

adenomatous polyps

Answer 389

- diameter (the risk increases with large polyp sizes), - shape (sitting polyp is more predisposed to transformation), - histological structure - the risk of transformation into cancer is the highest in the case of villous adenoma - the lowest in the case of tubular adenoma

Answer 390

1. hamartomas (found in Peutz-Jeghers disease and juvenile polyposis 2. inflammatory polyps (pseudo, arise as a result of incomplete destruction of the mucous membrane), 3. hyperplastic polyps (small changes made of glandular tubules, without features of cellular atypia )

Answer 391

- otherwise cough symptom; pain when coughing is caused by an increase in intra-abdominal pressure and an increase in abdominal muscle tone. - May be positive in acute appendicitis

Answer 392

- is a symptom found in peritonitis, acute appendicitis, characterized by sharp pain that occurs when the pressure is suddenly released when the examiner's hand is removed from the abdominal integuments.

Answer 393

- characteristic of retro-caecal appendicitis. - The patient, lying on his back, raises the straightened lower limb, and the examiner presses with his hand in the area of the appendix. - The symptom is positive when the patient feels gradually increasing pain when lowering the lower limb.

Answer 394

(between the outer and middle 1/3 of the line connecting the navel with the right upper iliac spine), muscular defense and Blumberg's sign.

Answer 395

Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.

Answer 396

- acute pancreatitis, where methemalbumin formed from digested blood tracks around the abdomen from the inflamed pancreas - bleeding from blunt abdominal trauma - bleeding from aortic rupture - bleeding from ruptured ectopic pregnancy

Answer 397

- Disturbances of consciousness (memory disorders, periodic blackouts, apathy). - Hypoglycemia. - Relief of symptoms after administration of carbohydrates (occur during fasting).

Answer 398

- is a rare cancer of the pancreas that can occur in any age group, but most often affects adults. - In most cases it is a benign tumor (75%). Diagnosis: determination of the serum insulin to glucose ratio after fasting. Treatment: surgical enucleation of the tumor or partial pancreatectomy.

Answer 399

(acute pseudoobstructive obstruction of the large intestine) - this is a special form of paralytic ileus, involving a significant dilatation of the right half of the colon.

Answer 400

age - occurs in people over 70 years of age, medical history - past operations within the abdominal cavity, injuries - extensive bodily injury.

Answer 401

Symptoms - similar to mechanical obstruction: - colicky abdominal pain that runs in waves, - vomiting, - gas and stool retention - abdominal bloating, - in slim people, the symptom of "intestinal erection", - auscultation of single, metallic tones of peristalsis, - peritoneal signs may appear on physical examination.

Answer 402

A colorectal contrast scan or colonoscopy that does not show a mechanical obstruction is critical (differentiation from mechanical obstruction).

Answer 403

**Colorectal cancer** - about 85% are adenocarcinomas. Stage - Dukes classification : A - tumor limited to the intestinal wall B - the tumor crosses the intestinal wall C - the extent of the tumor is irrelevant because there are metastases in the lymph nodes: C1 - paracolic C2 - along the blood vessels D - distant metastases.

Answer 404

**Stomach cancer** - 95% of it is gastric adenocarcinoma Lauren I - intestinal type - more endemic, most likely related to environmental factors, better prognosis Lauren II - diffuse type - worse prognosis, genetic predisposition.

Answer 405

TNM classification.

Answer 406

**acute pseudoobstructive ileus** - colonic obstruction without obstruction - - manifested by a large dilatation of the right half of the colon without obstruction of the large intestine - most likely it is caused by disturbed autonymous innervation of the intestine as a result of e.g. injury, surgery, medications, metabolic diseases - most often affects people over 70 years of age - diagnostics (examinations do not show a mechanical obstacle in the large intestine): - colorectal examination of the large intestine - colonoscopy

Answer 407

- a special form of gastric cancer, causing diffuse thickening of its wall , which makes it stiff and resistant to stretching. - This form gives early metastases to the lymph nodes.

Answer 408

The most common malignant tumor of the stomach, occurring in up to 95% of cases

Answer 409

a cancer of the bile ducts located at the junction of the right and left hepatic ducts

Answer 410

extrahepatic ducts, taking the form of adenocarcinoma.

Answer 411

- pain in the epigastrium often appearing at night, radiating to the left hypochondrium or to the thoracic spine of a "burning" or "crushing" nature. - Changing the position of the body with a forward bend usually reduces the intensity of pain. - Mechanical jaundice and Courvoisier's sign (palpable through the integuments, enlarged, painless gallbladder) may be the first symptom of a tumor located in the head of the pancreas. - Jaundice is caused by compression or tumor invasion of the common bile duct. - The risk of pancreatic cancer increases with age, and more than 80% of cases are diagnosed after the age of 50, so in a 68-year-old patient with painless jaundice, always rule out pancreatic head cancer first.

Answer 412

- this is the old name of primary cholangitis (PBC) , i.e. a chronic autoimmune liver disease of unknown etiology, with cholestasis caused by the destruction of the small intrahepatic bile ducts. - The main symptoms are chronic fatigue, skin itching and pain in the right subcostal area. - Hepatomegaly, jaundice, signs of cirrhosis are present. - Other autoimmune diseases may coexist.

Answer 413

- chronic, cholestatic liver disease leading to damage to the intrahepatic and extrahepatic bile ducts. - In 15-45% of patients, the course is asymptomatic. - Main symptoms as in PBC. Ulcerative colitis or, less frequently, Crohn's disease coexist in 70% of patients.

Answer 414

- in 90% of cases caused by obstruction of the gallbladder duct by deposits of gallstones. - Usually preceded by an attack of biliary colic. - The pain is dull, not clearly localized, and may cover the entire epigastrium. - They are accompanied by nausea, vomiting, fever, chills and elevated inflammatory parameters. - There was tenderness on pressure and muscular defense in the right hypochondrium, positive Chełmoński's sign .

Answer 415

- an acute inflammatory process of the intra- and/or extrahepatic bile ducts caused by infection as a result of obstruction or obstruction of the outflow of bile. - Typical clinical symptoms include the Charcot triad - severe pain in the form of biliary colic in the right hypochondrium or in the middle epigastrium, fever with chills and jaundice.

Answer 416

- peptic ulcer perforation , - acute retrocecal appendicitis in the upper abdominal cavity, - acute pancreatitis , - myocardial infarction, - basal pneumonia.

Answer 417

- the inferior epigastric vessels visible in ultrasound lie lateral to the hernial sac - This hernia is less common than the oblique inguinal hernia, - has a short canal, - and never descends into the scrotum.

Answer 418

Tx- primary tumor cannot be assessed T0- no features of the primary tumor Tiscan in situ - does not infiltrate the lamina propria, high-grade dysplasia T1- tumor invades the lamina propria, muscularis or submucosa T2- the tumor invades the muscle layer T3- the tumor infiltrates the subserous layer T4- Tumor perforates the serosa (visceral peritoneum) or invades adjacent structures

Answer 419

Nx- local lymph nodes cannot be assessed N0- there are no metastases in regional lymph nodes N1- metastases in 1-2 regional lymph nodes N2- metastases in 3-6 regional lymph nodes N3- metastases in at least 7 regional lymph nodes

Answer 420

M0- no distant metastases are found M1- distant metastases are found

Answer 421

** recurrent hernias** traditional operations: Bassini Halsted Shouldice

Answer 422

mesh operations ( tension-free methods ): --> better results than traditional operations Liechtenstein Rutkow PHS (prolen hernia system)

Answer 423

Type I - there are symptoms of cerebral ischemia resulting from changes in the aortic arch, Type II - there are arterial hypertension, which is the result of changes in the aorta or renal arteries, Type III - there are changes above and below the diaphragm, Type IV - there are changes in the aortic wall or its branches.

Answer 424

Hypertonic dehydration is a lack of water in the body, and increased effective molality (hypertonia) of body fluids is also present. - insufficient water supply - loss of water through the lungs (hyperventilation - in addition, it can cause respiratory alkalosis) - loss of hypotonic fluid through the skin (sweating) - fluid loss through the digestive tract (diarrhoea, vomiting) - renal fluid loss (diabetes insipidus, excessive diuresis due to glucosuria).

Answer 425

- an enlarged, painless and palpable gallbladder. - It occurs in tumors located within the junction of the cystic duct with the common hepatic duct or within the common bile duct.

Answer 426

- **conservatively. ** - It is advisable to regulate the rhythm of bowel movements, increase the amount of fluids, a high-residue diet, - drugs that increase stool volume and soften the consistency: e.g. paraffin, mebeverine - antispasmodics:e.g. hyoscine, drotaverine

Answer 427

→ severe diarrhea leading to electrolyte disturbances such as hypochloridia, hypokalemia with cardiac arrhythmias and asthenia, non-respiratory acidosis is typical.

Answer 428

→ it is a tumor originating from the alpha cells of the pancreas and secreting glucagon. Symptoms are related to the secreted hormone and include diabetes, weight loss, mucositis, diarrhea, anemia, creeping erythema necrotic.

Answer 429

→ it is a tumor originating from the alpha cells of the pancreas and secreting glucagon. Symptoms are related to the secreted hormone and include diabetes, weight loss, mucositis, diarrhea, anemia, creeping erythema necrotic.

Answer 430

→ it is a tumor originating from the β cells of the islets of the pancreas. It secretes insulin, and for this reason, in the course of this cancer, we can expect hypoglycemic episodes in the patient and related disorders of consciousness and behavior.

Answer 431

→ a tumor that secretes gastrin, which stimulates the production of gastric juice. Symptoms cause Zollinger-Ellison syndrome.

Answer 432

- is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers. - Symptoms include abdominal pain and diarrhea. - The syndrome is caused by a gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin. - Too much gastrin in the blood (hypergastrinemia) results in the overproduction of gastric acid by parietal cells in the stomach. - Gastrinomas most commonly arise in the duodenum, pancreas or stomach

Answer 433

degree I - covers only the epidermis (erythema) stage II a - involves the epidermis and part of the dermis (bladder) stage II b - covers the epidermis and dermis (superficial necrosis) stage III - the entire thickness of the skin is necrotic (deep necrosis) stage IV - necrosis or charring of deeper tissues.

Answer 434

- 2nd degree burns >25% of the body surface in adults and >20% of the body surface in children - 3rd degree burns >10% of body surface regardless of age - 3rd degree burns of hands, face, neck, feet, hands, perineum, circular - inhalation, electrical and chemical burns - burns complicated by other severe injuries or comorbidities

Answer 435

Head - 9% Each of the upper limbs - 9% Each of the lower limbs - 18% Front torso - 18% Back of the body - 18% crotch - 1%

Answer 436

**Parkland's Rule **is the most commonly used rule for calculating fluid transfusions. First 24h: Ringer's lactate solution - **4ml * kg body weight * % burnt body surface,** i.e. in our case: 4ml * 100kg * 19 = 7600 ml in 24 hours NOTE: The planned daily volume of fluids is given in the following time intervals: In the first 8 hours, we administer half of the calculated volume of fluids.

Answer 437

- an inflammation of the skin around the nail, which can occur suddenly, when it is usually due to the bacterium Staphylococcus aureus, or gradually when it is commonly caused by the fungus Candida albicans

Answer 438

I a - active arterial bleeding (active bleeding). I b - active oozing bleeding. IIa - visible non-bleeding vessel (recent bleeding). II b - clot at the bottom of the ulcer. II c - discolored ulcer base. III - white bottom of the ulcer (long-term bleeding).

Answer 439

- bleeding during gastroduodenoscopy . - It is the basic diagnostic test when bleeding into the upper gastrointestinal tract (above the Treitz ligament) is suspected.

Answer 440

1. superficial (application of the drug to the surface of the mucous membranes, used in dentistry and endoscopic procedures), 2. infiltration (injecting lidocaine into the surgical field during small procedures on integuments), 3. peripheral nerves ( nerve plexus blocks ), 4. epidural (administration of the drug into the epidural space), 5. subarachnoid (administration of the drug into the subarachnoid space), 6. segmental intravenous anesthesia (administration of the drug into a vein distal to the applied tourniquet, useful in fractures of the upper limb and hand operations).

Answer 441

Blood type A

Answer 442

BMI < 18.5 kg/m2.

Answer 443

- Hypoalbuminemia - Edema (due to hypoalbuminemia) - water and electrolyte disturbances. You can also come across a definition saying that kwashiorkor is malnutrition caused by a significant deficiency of protein in a diet with a high supply of carbohydrates.

Answer 444

Visceral pain Organic pain Somatic pain Neuralgic pain

Answer 445

it is conducted by sympathetic and parasympathetic fibers of the autonomic nerves it is difficult to locate it exactly more often it is referred pain than felt at the source of pain the pain is deep and diffuse may be permanent or colic it is characteristic that the patient cannot find a position in which the pain would be less severe

Answer 446

Organic pain is caused by an organic disease (such as obstruction, Crohn's disease, etc.)

Answer 447

results from irritation of the pain endings of the spinal nerves that innervate the parietal peritoneum it is precisely located, it radiates in certain directions it is accompanied by muscular defense and increased eyelid tension

Answer 448

pain occurs in the area of innervation of a given nerve its example is, for example, trigeminal neuralgia is often violent

Answer 449

pain occurs in the area of innervation of a given nerve its example is, for example, trigeminal neuralgia is often violent

Answer 450

discomfort is felt at the site of the amputated part of the body it is unrelated to the action of pain stimuli the pain may be dull , burning or cramping

Answer 451

discomfort is felt at the site of the amputated part of the body it is unrelated to the action of pain stimuli the pain may be dull , burning or cramping

Answer 452

- the angle formed between the cardia and the esophagus.

Answer 453

- protrusion of the cardia and the upper part of the stomach through the esophageal hiatus into the posterior mediastinum. Hiss angle is abolished -

Answer 454

- protrusion of the cardia and the upper part of the stomach through the esophageal hiatus into the posterior mediastinum. Hiss angle is abolished -

Answer 455

- protrusion of the cardia and the upper part of the stomach through the esophageal hiatus into the posterior mediastinum. Hiss angle is abolished -

Answer 456

- protrusion of the fundus of the stomach and the greater curvature through the esophageal hiatus into the posterior mediastinum. - The groove is positioned correctly -

Answer 457

- displacement to the mediastinal cardia, upper stomach, fundus and greater curvature

Answer 458

Diaphragmatic hernias** (not affecting the angle of His):** Morgani's hernia Bochdalek's (posterior) hernia

Answer 459

- also known as the esophagogastric angle, is the acute angle created between the cardia at the entrance to the stomach, and the esophagus. - It helps to prevent acid reflux of stomach acid into the esophagus. - It is commonly undeveloped in infants, making acid reflux more common

Answer 460

groin, thigh, navel, peristomal, lumbar.

Answer 461

Internal hernias consist in the displacement of the viscera into the recesses of the peritoneum or into the chest. Most often they occur in the form of the intestine entering the recesses of the duodenum or cecum. diaphragmatic hernia, paracaecal hernia, periduodenal recess, net bag.**

Answer 462

Lumbar hernia - arises in the course of weakness of the muscles of the lumbar triangle (Petit's triangle). The hernial sac invaginates through the posterior abdominal wall - a bulge is visible above the iliac crest, especially during coughing.

Answer 463

Bassini, Halsted, Shouldice

Answer 464

Liechtenstein, Rutka, PHS (prolen hernia system).

Answer 465

the removal of pancreatic tumors

Answer 466

pancreatic head duodenum gallbladder PŻW pylorus

Answer 467

pancreatic head duodenum gallbladder PŻW pylorus

Answer 468

pancreatic head duodenum gallbladder PŻW pylorus

Answer 469

pancreatic head duodenum gallbladder PŻW pylorus

Answer 470

pancreatic head duodenum gallbladder PŻW pylorus

Answer 471

pancreatic head duodenum gallbladder PŻW pylorus

Answer 472

The Whipple operation in the Traverso modification includes the removal of: pancreatic head duodenum gallbladder PŻW

Answer 473